Pelvic congestion research is essential if we are going to improve our treatments for patients with pelvic pain and symptoms.
Approximately one in three women with chronic pelvic pain have pelvic congestion syndrome (PCS). Pelvic congestion syndrome is caused by varicose veins in the pelvis.
Unfortunately, most gynaecologists and general practitioners do not diagnose PCS. Hence, most women with pelvic pain are told that they have endometriosis or that there is nothing wrong with them!
At The Whiteley Clinic, we have been researching and treating pelvic congestion syndrome for the last 20 years.
We have developed the gold standard test for pelvic congestion syndrome. This is the transvaginal duplex ultrasound scan performed using the Holdstock protocol.
We have also developed treatment for pelvic congestion syndrome. This treatment is pelvic vein embolisation. Pelvic vein embolisation used to need a hospital stay. We have now shown it is safe to have pelvic vein embolisation under local anaesthetic at our clinic in London.
On 2 March 2019, Dr David Beckett, consultant interventional radiologist at The Whiteley Clinic, won second prize for his pelvic congestion research. The prize was awarded at the Pan Arab Interventional Radiology Society Conference 2019.
The title of his research presentation was:
Varicose veins in the pelvic cause pelvic congestion syndrome. However, the question is, what causes these varicose veins in the pelvis?
20 years of research from The Whiteley Clinic has shown that in almost every case, it is simple varicose veins. Just the same as in the legs, the valves fail in the pelvic veins causing varicose veins. This is called “Venous Reflux“.
However, many doctors around the world, think that it is due to compression of the veins. They blame arteries that cross the veins and compress them. They think that this compression causes back pressure on veins lower in the pelvis. Hence this back-pressure makes the veins dilate and become varicose.
What makes this so important is that the treatment depends on the cause.
If venous reflux in the pelvic varicose veins is the cause of pelvic congestion syndrome, this can be treated by coil embolisation. Embolisation permanently blocks refluxing veins with metal coils.
However, if the problem is compression of the veins, then the compressed veins need to be held open by metal stents. This can be more expensive and can cause problems in the long term. Hence, it is important to avoid stents in PCS if possible.
David Beckett and the team at The Whiteley Clinic looked at these pelvic veins. They found that it wasn’t compression that was making the veins appear narrowed. Instead, the veins appeared narrow due to a lack of blood in them.
They found that venous reflux was taking blood away from the veins and causing them to collapse. Indeed, the veins opened up to normal size again when coil embolisation treated the venous reflux.
This has major ramifications for the treatment of patients. It also shows that the pelvic vein embolisation approach from The Whiteley Clinic is the correct approach in the vast majority of patients with pelvic congestion syndrome.