A targeted embolization treatment that closes off faulty, refluxing pelvic veins — relieving chronic pelvic pain without affecting fertility or hormonal function.
Pelvic congestion syndrome occurs when the valves inside the ovarian veins — and sometimes the internal iliac veins — fail to work properly, allowing blood to flow backward and pool within dilated, varicose-like veins around the uterus, ovaries, and broader pelvis. This chronic pooling and venous pressure is understood to be a significant cause of dull, aching pelvic pain that typically worsens through the day, with prolonged standing or sitting, and around the menstrual cycle, and often eases when lying down.
Ovarian vein embolization treats this at its source. A catheter is advanced from a vein in the neck or groin into the affected ovarian vein (and, where relevant, other refluxing pelvic veins), and under X-ray guidance, coils and/or a liquid or foam sclerosant are deployed to permanently close off the faulty vessel. With the abnormal backward flow blocked, pressure in the congested pelvic veins falls, and blood is redirected through the body's normal draining pathways — relieving the chronic pooling that drives the pain.
Lasting six months or more, typically worse by the end of the day or after standing.
Dilated, refluxing pelvic or ovarian veins confirmed on Doppler ultrasound or venography.
Pain-relief medication or hormonal treatment tried without adequate relief.
Doppler ultrasound or venography confirms the pattern of refluxing veins.
A needle puncture is made in the neck or groin vein under local anaesthesia.
Coils and/or a sclerosant permanently close the refluxing veins.
Observed for a few hours to overnight before going home.
Ovarian vein embolization is most useful for women with the specific combination of factors below, generally reviewed jointly by gynaecology and interventional radiology:
**Chronic pelvic pain lasting six months or more, **typically dull or aching, worse by the end of the day or after standing, and not fully explained by other gynaecological, urinary, or gastrointestinal causes after appropriate work-up.
**Imaging evidence of dilated, refluxing pelvic or ovarian veins, **usually on transvaginal ultrasound with Doppler, CT, or MR venography, confirming the venous pattern responsible for the symptoms.
**Associated visible pelvic, vulval, or upper thigh varicose veins **in some patients, reflecting the same underlying venous insufficiency extending beyond the pelvis.
**Pain that has not responded adequately to conservative measures, **such as pain-relief medication or hormonal treatment, where a structural venous cause is suspected.
Ovarian vein embolization isn't the right choice for every woman with pelvic pain — pain fully explained by another gynaecological condition such as endometriosis or fibroids, the absence of significant venous reflux on imaging, or an active pelvic infection generally shift the diagnostic and treatment approach elsewhere instead, decided on a case-by-case basis after appropriate evaluation.
**Planning: **imaging beforehand (transvaginal ultrasound with Doppler, and/or CT or MR venography) confirms the presence and pattern of refluxing pelvic veins and helps plan the safest catheter route.
**Access: **under local anaesthesia with light sedation, a needle puncture is made in the internal jugular vein in the neck or the femoral vein in the groin.
**Venography: **contrast dye and X-ray imaging are used to map the ovarian and pelvic veins and confirm the presence and severity of reflux.
**Embolization: **a catheter is guided into the affected ovarian vein (and other refluxing veins where relevant), and coils and/or a sclerosant are deployed along its length to permanently close it off.
**Completion: **once adequate closure is confirmed on imaging, the catheter is removed and the access site is treated appropriately.
**Recovery: **most patients are observed for a few hours to overnight, with mild pelvic or lower back discomfort managed with simple pain relief, before going home the same day or the following morning.
Ovarian vein embolization is generally well tolerated. The most common effects are transient — mild pelvic or lower back discomfort, and sometimes minor bruising, for a few days after the procedure. Site-related risks, such as bruising or bleeding at the neck or groin puncture, are uncommon and usually minor. As with any embolization procedure, there is a small risk of coil migration or non-target embolization, minimised through careful technique and imaging confirmation during the procedure. Because the ovaries themselves are not treated or removed, ovarian vein embolization does not affect fertility or hormonal function.
Most women notice a gradual reduction in pelvic pain over the weeks following the procedure, with continued improvement often reported over the following months as venous pressure normalises. Clinical follow-up tracks pain scores and overall symptom improvement, and follow-up imaging is used selectively where symptoms persist or recur, to confirm the treated veins remain closed or to identify any additional refluxing vessels that may need treatment.
Getting ovarian vein embolization right depends on accurately identifying every refluxing vein contributing to the syndrome — since incomplete treatment of all affected vessels is a recognised reason for persistent symptoms — as well as safe catheter navigation and confirming durable closure with coils or sclerosant. Because chronic pelvic pain has many possible causes and pelvic congestion syndrome is still under-recognised, decisions about diagnosis and treatment are best made jointly by interventional radiology and gynaecology, working from the same clinical picture and imaging.
Ovarian vein embolization is used to treat pelvic congestion syndrome — chronic pelvic pain caused by dilated, poorly-draining pelvic veins — by closing off the faulty veins responsible for the pooling and pressure.
Pelvic congestion syndrome typically causes dull, aching pelvic pain that worsens through the day, with standing, or around the menstrual cycle, and often eases when lying down. Because these symptoms can overlap with other gynaecological conditions, imaging such as Doppler ultrasound or MR venography is used to confirm the diagnosis.
No. The procedure closes off the affected veins only — it does not remove or treat the ovaries themselves, so it does not affect fertility or hormonal function.
The treated veins are permanently closed, and most women experience durable symptom relief. In some cases, additional refluxing veins may be identified later and require further treatment.
The procedure is done under local anaesthesia and light sedation through a single neck or groin puncture, so there's no surgical incision. Most patients are observed for a few hours to overnight and return to normal activities within a few days, though full symptom relief builds gradually over the following weeks to months.
No. Patient selection is important. Imaging evidence of venous reflux, symptom pattern, and exclusion of other causes of pelvic pain are considered before treatment.
Book a consultation with Dr. Giragani to discuss whether ovarian vein embolization is right for you.