Treatment for Pelvic Congestion Syndrome

Treatment for pelvic congestion syndrome is completely successful in about 75% of patients. Patients who have had successful treatment at The Whiteley Clinic report dramatic changes.

These range from patients saying that they are free of pain for the first time in years, to those who have got rid of varicose veins of the vulva or vagina. One lady even told us that her treatment for pelvic congestion syndrome was like having a “facelift for her pelvis”.

Prof Mark Whiteley speaking on indications and methods of treatment for pelvic congestion syndrome – Maastricht, EVC 2018

However, although The Whiteley Clinic and other leading experts around the world have been working to perfect the investigation and treatment for pelvic congestion syndrome, it is still a very difficult diagnosis to make and the treatment still needs to be perfected.

Although 75% of patients have successful treatment, this does mean that 25% do not. Comparing these results with the top clinics and hospitals treating pelvic congestion syndrome throughout the world, few reliable studies ever get higher than a 75% success rate at the present time.

What this means is that more research is needed into the understanding of pelvic congestion syndrome. We have to be able to diagnose it quicker and better, preferably without patients having to undergo surgery such as laparoscopy before they get a diagnosis.

Diagnosis of pelvic congestion syndrome.

The diagnosis of pelvic congestion syndrome is made by patients complaining of one or more of a certain number of symptoms and one or more of a certain number of signs related to pelvic veins. A free screening tool is available for patients on: https://thewhiteleyclinic.co.uk/self-assessment/pelvic-congestion-screening/.

Investigations for pelvic congestion syndrome.

Pelvic congestion syndrome appears to be intimately related to having pelvic varicose veins. Therefore, to see if any symptoms or signs are due to pelvic congestion syndrome, tests are needed to see if there are varicose veins or “pelvic venous reflux” in the pelvic veins.

Many doctors are still using MRI or venogram to look for these veins. However, research from The Whiteley Clinic has suggested that the transvaginal venous duplex ultrasound scan appears to have many advantages over these other techniques. Of course, some patients cannot have this, especially male patients and so other techniques such as MRI are needed as a backup.

Treatment for pelvic congestion syndrome.

Currently, published guidelines suggest that the best treatment for pelvic congestion syndrome is to block the veins internally using embolisation coils, probably with catheter guided foam sclerotherapy at the same time as is used at The Whiteley Clinic. Some specialists also use glue instead of coils, and research is needed to see if this is as good.

There are some new techniques including plugs that are put in the vein. There are also treatments such as medication which seems to have a short-term benefit in some patients although is proven in the medium to long-term. Some patients even get put forward for a hysterectomy! This may be appropriate in a few patients but it is a major operation which might be avoided by far less invasive techniques such as embolisation.

Further developments in pelvic congestion syndrome.

Academic meetings such as the European Venous Course (EVC 2018) and the forthcoming College of Phlebology meeting in London (http://www.collegeofphlebology.com/meeting2018/) allow specialists in the field to meet and share ideas. This lecture today by Prof Mark Whiteley at the EVC stimulated considerable conversation between doctors in Europe and the USA, all trying to improve the treatment for pelvic congestion syndrome in their patients.

Currently obstetricians and gynaecologists generally still ignore pelvic congestion syndrome as a diagnosis. Research in this area tends to be in specialist vein centres where groups of specialists work in a team. Such a team usually includes venous surgeons (phlebologists), interventional radiologists and clinical vascular scientists (vascular technologists).

At The Whiteley Clinic, we use this team approach, supplemented by a research team. The researchers collect and analyse our data to improve our service continuously. We hope that forward-looking gynaecologists will join the team in the future, as the evidence for pelvic congestion syndrome continues to mount.