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Treatment of Pelvic Varices: Therapeutic Options and Results

Interventional Radiology · Cochin Hospital AP-HP · Paris

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📖 Patient information · Pelvic veins

Pelvic varices: treatment options

Ovarian vein embolization, sclerotherapy, medical treatment: a complete guide to the options for pelvic congestion syndrome (PCS)

Quick answer

Four options exist to treat pelvic varices: catheter embolization (the reference treatment, minimally invasive), sclerotherapy, ligation surgery (rare) and medical treatment. Percutaneous embolization is preferred for its low invasiveness and good results.

TreatmentPrincipleAdvantagesLimits
Embolization (coils)Occlusion of the ovarian veins by catheterMinimally invasive, outpatient, effectiveMay require retreatment
SclerotherapyInjection of a sclerosing agentSimple if accessiblePartial efficacy
Surgery (ligation)Surgical division of the veinsDefinitiveInvasive, rare
Medical treatmentProgestogens, venoactive drugsNon-invasiveSymptomatic, temporary
Results of embolization for PCS
In published series, embolization of the ovarian (and/or uterine) veins improves chronic pelvic pain in 70 to 85% of cases. Symptom reduction is progressive over 3 to 6 months. The technique is outpatient (discharge the same day) with a return to activity in 2-5 days.
1
Consultation and work-up

Pelvic MRI or Doppler ultrasound. Discussion of the indication at a multidisciplinary team meeting if needed. Pain questionnaire (VAS) at D0 for follow-up.

2
Phlebography and embolization (same session)

Venous access via the jugular or femoral vein under local anaesthesia. Phlebography of the ovarian veins to confirm the reflux. Embolization with coils and/or sclerosing agent. Duration: 45-90 min.

3
Monitoring and discharge

Monitoring for 2-4 hours in the recovery room. Discharge the same day. Low back or pelvic pain possible for 24-48 hours, treated with painkillers.

4
Follow-up at 3 and 6 months

Clinical assessment of pain (VAS). Follow-up Doppler ultrasound if necessary. 70-85% significant pain reduction at 6 months.

Frequently asked questions

What are the treatment options for pelvic varices?
Four main options exist: catheter embolization (the reference treatment, minimally invasive), sclerotherapy (injection of a sclerosing agent), ligation surgery (rare, invasive), and medical treatment (progestogens, venoactive drugs), which remains symptomatic and temporary.
Is embolization of pelvic varices painful?
The procedure itself is performed under local anaesthesia, without significant pain. Moderate low back or pelvic pain may occur in the 24 to 48 hours after the procedure, treated with simple painkillers. It disappears within 2 to 5 days.
How long before the results of embolization can be seen?
Pain improvement is progressive over 3 to 6 months. Partial results may be noticed from the first week. The complete assessment is made at 6 months, with a significant pain reduction rate of 70 to 85% at that point.
Does pelvic embolization also treat varicose veins of the legs?
Often yes, because varicose veins of the lower limbs of pelvic origin (thighs, buttocks, labia majora) largely disappear after embolization of the ovarian veins, of which they are the direct consequence.
How does an embolization of pelvic varices actually take place?
In a single session: venous access via the jugular or femoral vein under local anaesthesia, phlebography of the ovarian veins to confirm the reflux, then embolization with coils and/or sclerosing agent. The procedure lasts 45 to 90 minutes, followed by 2 to 4 hours of monitoring before discharge the same day.
Is embolization more effective than sclerotherapy alone?
Coil embolization combined with a sclerosing agent is considered the reference treatment because it durably occludes the incompetent vein, with a higher success rate and a lower risk of recurrence than sclerotherapy used alone.
Can medical treatment be enough without embolization?
Medical treatment (progestogens, venoactive drugs) can partially relieve symptoms but does not treat the cause: the valve incompetence of the ovarian veins persists. It can be offered first-line or as a complement, but embolization remains the only treatment that durably eliminates the venous reflux.
Does embolization have to be repeated if the symptoms come back?
A new procedure may be necessary in case of recurrent reflux in a vein that was not completely occluded or reflux in another pelvic vein. Follow-up at 3 and 6 months (Doppler ultrasound, clinical assessment of pain) makes it possible to detect this situation and adapt management.
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Pelvic varices embolization

Everything about the technique and follow-up of pelvic varices embolization at Cochin.

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Related pages

Scientific references

Unveiling an under-recognized strain: New guidelines for pelvic congestion syndrome

Barat M, Soyer P, Dohan A. Diagn Interv Imaging 2025;106(10):335-336.

Endovascular management of pelvic congestion syndrome: an expert consensus statement from the French Society of Cardiovascular Imaging (SFICV), Interventional Radiology Federation (FRI), College of French Radiology Teachers (CERF), and French Society of Women's Imaging (SIFEM)

Le Pennec V, Douane F, Brun JL, Frandon J, et al. Diagn Interv Imaging 2025;106:356-366.

🇫🇷 French version: varices-pelviennes-traitement.html

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: July 2026.

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