Varicose veins in the legs can be a nuisance and even embarrassing, but when they occur in the pelvis, varicose veins can cause constant discomfort and pain. It’s a condition called ovarian vein reflux, and it’s been under-diagnosed and rarely treated, until now."Most of these women have gone on for years trying to figure out why they have this pain, and nobody’s been able to tell them what it is," said Dr. Anne Roberts, chief of vascular and interventional radiology at the University of California San Diego Medical Center.
Nearly 15 percent, or one in seven women, suffer from some sort of chronic pelvic pain, according to the International Pelvic Pain Society. Most of the women who experience ovarian vein reflux are in their 30’s and 40’s.
It is often lumped into the broad category of pelvic congestion syndrome. In the case of ovarian vein reflux, pain occurs when blood backs up and pools in the pelvic veins. This causes symptoms of pain and heaviness in the pelvis that develops after intercourse or after standing for long periods of time. The pain often becomes worse just before a woman’s menstrual period.
Women with ovarian vein reflux commonly have had more than one pregnancy by the time symptoms occur. During pregnancy there is an enormous amount of blood flowing through the pelvis, and various hormones can make the veins grow larger, while the valves inside the vessels stay the same size. Because blood is flowing against gravity, the valves help to keep it moving in the right direction. With all the pressure exerted on the pelvic veins, the valves can become incompetent and no longer close completely. As a result, blood flowing away from the pelvis falls backward and starts to pool in the ovarian veins. Dr. Roberts says this scenario is why more than 90 percent of ovarian vein reflux cases are women who have had previous pregnancies.
A visual sign that suggests pelvic pain may be due to ovarian vein reflux is having varicose veins in unusual places, such as the upper and inner part of the thigh as well as the vaginal area, and sometimes even the buttocks.
Dr. Roberts said some women will go through procedures like vein stripping or laser ablation to remove varicose veins in the legs but will have recurrent troubles because the problem wasn’t treated at the source—in the pelvis.
The veins around the ovaries are difficult to see and feel, so Dr Roberts says a physical exam is not a very useful tool for diagnosing ovarian vein reflux. And while a CT scan or an MRI can sometimes spot the problem, usually the patient is lying down so ovarian vein reflux is hard to diagnose.
When a woman comes into Dr. Robert’s office complaining of pelvic pain, she will first have the patient describe her symptoms and pregnancy history. If it suggests ovarian vein reflux, Dr. Roberts will perform a venography on the patient, which allows her to visualize exactly what is happening inside the pelvic veins.
The procedure takes about two hours, if a surgeon spots reflux and treats it. Venography involves injecting a dye into the renal vein to look for blood flow that may be going the wrong way. If it’s discovered that blood is falling back into the pelvis, the surgeon will perform an embolization where she places small steel coils in the damaged vein to block off blood flow. Blood will then reroute to collateral vessels in its journey back to the heart.
"Some women will feel a soreness or throbbing kind of sensation because the blood flow is redistributing," said Dr. Roberts, "and most of the women go home after the procedure."
She says many women will feel relief from their pelvic pain within a few weeks, while some may take up to two months to feel better.
It is difficult to predict who will develop ovarian vein reflux, and it’s not a preventable condition. But if a woman believes she has symptoms, Dr. Roberts says she should see her doctor right away to prevent damage to other veins in the pelvis.
