Some women (and doctors) may not realize that pelvic pain can be related to vein health.
For many women with pelvic pain, relief is hard to find.
How long the pain lasts, however, may give doctors a clue to its cause.
For premenopausal women whose pelvic pain lasts fewer than six months, the cause is often determined to be a ruptured ovarian cyst.
If the pain lasts longer than six months, it is classified as a chronic condition and is often harder to diagnose.
Diagnosing chronic pelvic pain
“There are many causes for pelvic pain, and some of them are related to the gynecologic organs,” said Dr. Stephen F. Daugherty, a vascular disease specialist and surgeon at the Vanderbilt Vascular Surgery Clarksville.
“A vein-related condition may be responsible for chronic pelvic pain in up to 30% of patients.”
Commonly, women with chronic pelvic pain are told they have endometriosis, a condition in which the cells lining the uterus escape through the fallopian tubes or bloodstream and implant in pelvic tissue.
This may not, however, always be the true source of the pain, Daugherty said.
“Everyone who has pain wants an answer as to why,” he said, adding that endometriosis is often blamed for pelvic pain when another cause cannot be easily determined.
“We can do ultrasounds and perform biopsies, which sometimes support the diagnosis of endometriosis. But in reality, a vein-related condition may be responsible for chronic pelvic pain in up to 30% of patients,” Daugherty said.
How vein compression can cause pelvic pain
The most common cause of vein-related (also called venous) pelvic pain results from compression of a vein that limits blood flow out of the pelvic region.
“Women who experience this type of pain over a period of months need to come in for an evaluation.”
While some women with this condition — known as pelvic venous disorder — may also have leg pain or swelling, others only experience an unexplained deep pelvic pain that can worsen with intercourse or exercise.
“When there is increased blood flow into the pelvis, such as during sex or exercise, the veins below the compressed veins stretch and cause pain. Women who experience this type of pain over a period of months need to come in for an evaluation,” Daugherty said.
Diagnosing vein-related pelvic pain
Diagnosis of pelvic venous disorder requires a high-quality venous ultrasound of the pelvic veins.
“It takes a high-quality ultrasound and skilled technologists.”
These specialized ultrasound devices are only available at a small number of specialty pelvic pain centers across the country. They can pinpoint enlarged or narrowing veins and determine blood flow direction.
“It takes a high-quality ultrasound and skilled technologists to look at the veins across the abdominal wall and inside the vagina,” Daugherty said.
Treatment for pelvic venous disorder
Once a patient is diagnosed with pelvic venous disorder, treatment may involve inserting a stent into the vein to open the compressed vein and increase blood flow.
“The majority of patients have suffered for many years with no answer. After treatment of the pelvic venous disorder, their lives are radically changed.”
Some patients experience pain from enlarged varicose veins in the pelvis, which can be treated with embolization techniques to seal shut the varicose veins.
These procedures are performed in the office setting with light sedation and most patients go home about two hours after the procedure.
For many women, these outpatient procedures can be life-altering, Daugherty said.
“The majority of patients have suffered for many years with no answer. After treatment of the pelvic venous disorder, their lives are radically changed,” Daugherty said.
Spreading the word about vein-related chronic pelvic pain
While vascular specialists such as Daugherty are developing a better understanding of pelvic venous disorder, many gynecologists are still unaware of the condition.
“Helping women uncover the true cause of their chronic pelvic pain and receive successful treatment is what I’m most passionate about in medicine.”
“We are slowly educating more gynecologists across the country about this condition,” he said.
As part of that effort, in 2015 Daugherty published the world’s first-ever study demonstrating the use of stents to treat patients with pelvic pain caused by pelvic vein compression in the Journal of Vascular Surgery: Venous and Lymphatic Disorders.
“Helping women uncover the true cause of their chronic pelvic pain and receive successful treatment is what I’m most passionate about in medicine,” Daugherty said.