Pelvic Congestion Embolization
Pelvic congestion syndrome is chronic pelvic pain caused by varicose veins around the ovary and pelvis, where failed valves let blood pool instead of draining. It is frequently missed for years and mislabelled as unexplained pelvic pain. Embolization closes the refluxing veins through a pinhole puncture, and the congestion — and the pain that comes with it — settles.
Dr. Mohamed El Ghobashy · Consultant Interventional Radiologist
What it treats
- •A dull, dragging pelvic ache lasting more than six months, worse on standing
- •Pain that intensifies through the day and eases when lying down
- •Pain during or after intercourse
- •Visible varicose veins on the vulva, buttock or upper thigh
- •Pelvic pain that has persisted despite gynaecological assessment and laparoscopy
Who is a candidate?
- Women with chronic pelvic pain and dilated pelvic veins on ultrasound, CT or MR venography
- Women in whom gynaecological causes have been assessed and addressed
- Women whose symptoms follow the typical pattern of worsening on standing
- Women who prefer a day-case procedure to surgical options
How the procedure works
- 1
Diagnosis
Doppler ultrasound plus CT or MR venography demonstrate dilated ovarian and pelvic veins with reflux. Making the diagnosis confidently is the most important step, because the condition is so often missed.
- 2
Access
Under local anaesthetic and sedation, a fine catheter is passed into a vein at the neck or groin — no incision in the abdomen or pelvis.
- 3
Venography and embolization
Contrast maps which veins are refluxing. Coils, and often a sclerosant foam, are then placed to close the ovarian and internal iliac branches that are feeding the congestion.
- 4
Completion
The catheter is withdrawn and the puncture is covered with a small dressing.
Recovery
Most women go home the same day or after one night. Cramping for a few days is common and is managed with simple analgesia. Pain relief is usually gradual over several weeks as the congested veins shrink, rather than immediate, and a review is arranged to assess the response.
Discuss this procedure
Private consultations and procedures are at Andalusia Hospitals, Maadi. Kasr Al-Ainy is Dr. El Ghobashy's academic post at Cairo University and does not take private cases.
Frequently asked questions
Why did nobody find this before?
Pelvic congestion does not show on a standard pelvic ultrasound performed lying down, because the veins decompress in that position. It needs dedicated venous imaging and a clinician who is specifically looking for it — which is why many women carry the diagnosis of 'unexplained' pelvic pain for years.
Does closing these veins affect my ovaries or hormones?
The ovarian artery supplying the ovary is not touched — only refluxing veins are closed, and the ovary drains through other normal channels. Hormonal function and menstruation are not expected to change.
Will the pain come back?
Treated veins stay closed. In a minority of women other pelvic veins become symptomatic later and can be treated in the same way. Follow-up is arranged so this is picked up rather than left.
Other procedures
This page is general information, not medical advice for an individual. Whether a procedure suits you depends on your imaging, your history and an in-person assessment.