at 2 years
guidelines (co-authored)
outpatient
❓ What is pelvic congestion syndrome?
Pelvic congestion syndrome (PCS) : also known as pelvic venous insufficiency or pelvic varicose veins : is caused by dilated, incompetent ovarian or pelvic veins. Pooling of blood in the pelvis causes chronic pelvic pain that is often misdiagnosed for years.
PCS affects an estimated 30–40% of women with chronic pelvic pain. It is most common in women who have had one or more pregnancies. Standard gynaecological examination is often normal, making diagnosis difficult.
⚠️ Common signs of PCS: dull or heavy pelvic pain worse at end of day or after prolonged standing · pain during or after intercourse (dyspareunia) · pain worsening during menstruation · vulvar or inner thigh varicose veins · abnormal uterine bleeding
🩸 How is embolization performed?
Ovarian vein embolization uses the natural venous pathway to reach and occlude the incompetent veins without surgery. A catheter is introduced through a small skin puncture (jugular or femoral vein). Coils, biological glue or sclerosing agents are deposited in the dilated ovarian veins, permanently blocking abnormal blood flow.
Consultation : Pelvic MRI or Doppler ultrasound to confirm diagnosis and map affected veins
Phlebography : Dynamic mapping of the incompetent veins under X-ray guidance
Selective embolization : Coils or sclerosing agents deposited in the target veins
Same-day discharge : Return home the same day, light pain for 24–48h
Follow-up : Progressive improvement over 4–8 weeks
In published series, pelvic vein embolisation achieves significant pain improvement in around 80 to 90% of patients, with pain intensity typically falling from about 7/10 to 2/10 and a marked improvement in quality of life. Effectiveness depends on the pain mechanism, medical and surgical history, and how long symptoms have been present before treatment.
⚡ At a glance — key figures
Pelvic congestion syndrome is caused by dilated ovarian or pelvic veins in which blood pools because of reflux. It is an often-overlooked cause of chronic pelvic pain in women. Embolization occludes the refluxing veins through a catheter, under local anaesthesia, as a day case.
| Criterion | Data |
|---|---|
| Effect on pain | Significant improvement in 75–85% of cases |
| Diagnosis | Pelvic Doppler ultrasound, MR or CT venography — reflux must be documented before treatment |
| Anaesthesia / stay | Local anaesthesia — day case, back to activity in 24–48 hours |
| Scar | None — percutaneous venous puncture |
| Fertility | Preserved — ovarian function and future pregnancy are not compromised |
| Cost | Covered by French national health insurance at Cochin AP-HP — no out-of-pocket fees |
Chronic pelvic pain has many possible causes (endometriosis, adhesions, gynaecological or digestive conditions); documenting venous reflux on imaging before treatment is what makes embolization appropriate. Data validated by the team of Prof. Anthony Dohan, Department of Interventional Radiology, Cochin Hospital AP-HP, Université Paris Cité.
📋 Required before consultation
- Pelvic MRI (preferred) or transvaginal Doppler ultrasound
- Complete gynaecological assessment to exclude other causes of pelvic pain
- Description of symptoms and their evolution
You can also fill in our PCS symptom questionnaire → before your appointment.
❓ Frequently asked questions
My gynaecological examination was normal : can I still have PCS?
Yes. This is one of the hallmarks of PCS. Internal pelvic varicose veins are not visible on standard examination. Only specific imaging (pelvic MRI or Doppler in standing position) can identify them.
Does embolization affect fertility?
Ovarian vein embolization does not suppress ovarian function or affect fertility. Pregnancies have been reported after the procedure. This question is discussed individually at the consultation.
How long before pain improves?
Improvement is usually progressive over 4–8 weeks following embolization. Some patients notice improvement from the first menstrual cycle after the procedure.
📄 Patient Information Sheet
✅ Covered by French Assurance Maladie · Zero extra fees · EU EHIC accepted · English spoken
✓ 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.