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Cochin Hospital · AP-HP · Université Paris Cité
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Cochin AP-HP

Pelvic Congestion Centre — Paris, Cochin AP-HP

Interventional Radiology · Cochin Hospital AP-HP · Paris

️ ri.cch@aphp.fr +33 1 58 41 46 12
IR Home›Pelvic Congestion Centre — Paris, Cochin AP-HP
🏥 Gynaecology · Vascular

Pelvic Congestion Centre — Cochin AP-HP, Paris

Ovarian vein embolization · Chronic pelvic pain · 80–85% improvement · No surgery · Paris

Pelvic congestion syndrome

Pelvic congestion syndrome (PCS) is a frequently under-diagnosed cause of chronic pelvic pain in women, caused by incompetent ovarian or uterine veins leading to pelvic varicosities — similar to varicose veins, but inside the pelvis. It is estimated to affect up to 30% of women with chronic pelvic pain.

Ovarian vein embolization is the reference treatment for PCS. At Cochin AP-HP, embolization is performed via the right femoral vein (or brachial vein), with selective catheterisation of both ovarian veins, under local anaesthesia. For low pelvic varicosities (vulvar, perineal), a complementary transvaginal ultrasound-guided approach may be added. 80–85% of patients experience significant pain reduction. No patient fees.

Who should be treated?

  • Chronic pelvic pain (>6 months) worsening with prolonged standing or after intercourse
  • Pelvic varicosities confirmed on MRI or Doppler ultrasound
  • Vulvar or lower-limb varicosities of pelvic origin
  • May-Thurner syndrome (left iliac vein compression)
  • Failure of medical therapy (progestogens, hormonal contraception)

Access routes

🩺 Right femoral vein (main approach)

Preferred route at Cochin for ovarian vein embolization. Provides access to both ovarian veins via the IVC and left renal vein. Local anaesthesia at the groin puncture site.

💪 Brachial vein (alternative)

Used when femoral access is not feasible or for anatomical reasons. Puncture of the right brachial vein at the elbow under local anaesthesia.

🔍 Transvaginal approach

For low pelvic varicosities (vulvar, perineal) not adequately reached via the systemic venous route. Sclerosing agent injection under ultrasound guidance.

🩻 Pelvic MRI & Doppler pre-procedure

MRI pelvis with venous sequences to map varicosities and plan embolization. Doppler ultrasound to assess ovarian vein diameter and reflux.

FAQs

Most patients notice improvement within 2–4 weeks. Maximum benefit is seen at 3 months. 80–85% report significant pain reduction.
Yes. If lower-limb or vulvar varicosities are of pelvic origin, they typically regress after ovarian vein embolization as the driving reflux is eliminated.
Yes. At Cochin AP-HP (French public hospital), ovarian vein embolization is covered by national health insurance with no patient fees.

Frequently asked questions

It is chronic pelvic pain caused by dilated, refluxing pelvic or ovarian veins. Pain is typically worse after prolonged standing, at the end of the day, before menstruation, or after intercourse.
With pelvic Doppler ultrasound and MR or CT venography to document venous reflux before considering embolization.
Significant pain improvement is achieved in 75-85% of appropriately selected patients, without affecting fertility.

Related pages

Why this page is trustworthy

Written by the Interventional Radiology team at Cochin Hospital AP-HP, Université Paris Cité. Medically reviewed by an interventional radiologist of the department. Last updated: August 2026.

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