Uterine varicose veins

Uterine varices (also known as pelvic varices, a component of pelvic congestion syndrome – PCS) are pathological dilations and insufficiency of the veins of the uterine plexus and ovarian veins. These conditions lead to venous blood stasis, valve insufficiency, and chronic congestion of the pelvic organs. The disorder primarily affects women of reproductive age, particularly multiparous women. It most commonly manifests as chronic dull pelvic pain, which worsens when standing or at the end of the day. Uterine varices are a significant but insufficiently recognized factor in chronic pelvic pain.

Varicose veins of the uterus – causes

The pathogenesis of uterine varices is associated with the insufficiency of ovarian and uterine veins and with venous hypertension within the lesser pelvis.

The most important etiological factors:

Ovarian vein valve insufficiency – leads to blood backflow (venous reflux).
Pregnancy and multiparity – an enlarged uterus compresses the iliac veins, and the high level of progesterone causes relaxation of the vessel wall.
Hormonal factors – estrogens promote vein dilation and reduce vascular wall tension.
Congenital weakness of connective tissue – predisposes to venous insufficiency (often coexists with lower limb varices).
Left renal vein compression syndrome (so-called nutcracker syndrome) – increased pressure in the left ovarian vein.
Prolonged standing or sitting position – hinders venous outflow.

The disease mechanism involves sustained increased pressure in the pelvic veins, leading to their dilation, tortuosity, and the formation of venous plexuses around the uterus and adnexa. Imaging studies show veins with a diameter >5–6 mm and the presence of reflux in the ovarian veins.

Varicose veins of the uterus – symptoms

The clinical picture is often nonspecific, which is why the disease is sometimes mistaken for endometriosis, pelvic inflammatory disease, or psychosomatic disorders.

Typical symptoms include:

Chronic lower abdominal pain (lasting >6 months), dull, and pressing
Increased pain:
- when standing
- at the end of the day
- before menstruation
- during or after intercourse (dyspareunia)
Feeling of heaviness in the pelvis
Painful menstruation
Swelling and varicose veins of the vulva or perineum
Coexisting varicose veins of the lower limbs

It is characteristic that the symptoms decrease when lying down – improved venous outflow reduces congestion.

Diagnostics include:

Transvaginal ultrasound with flow assessment (Doppler)
Pelvic magnetic resonance imaging (MRI)
Phlebography (the gold standard for diagnostics)
Computed tomography (CT) in selected cases

In clinical practice, the correlation of symptoms with the radiological image is crucial.

Uterine varices – are they dangerous?

Uterine varices rarely pose a direct threat to life, but they can significantly reduce the quality of functioning.

Possible consequences:

Chronic pelvic pain syndrome
Sexual dysfunction
Worsening of symptoms in subsequent pregnancies
Coexistence with vulvar and perineal varices
Rarely – pelvic vein thrombosis

No definitive link between uterine varices and infertility has been shown, but the chronic state of congestion may affect the comfort of intercourse and the psychological well-being of the patient.

It is worth emphasizing that the condition is chronic and usually does not resolve spontaneously without treatment, although symptoms may periodically decrease.

Varicose veins of the uterus – treatment

Therapeutic management depends on the severity of symptoms and imaging test results.

1. Conservative Treatment

Pharmacotherapy (e.g., diosmin, hesperidin)
Anti-inflammatory and pain relief medications
Hormonal therapy (in selected cases)
Lifestyle modification:
- avoiding prolonged standing
- regular physical activity
- weight reduction

The effectiveness of pharmacological treatment can be limited in advanced stages.

2. Procedural Treatment

Ovarian vein embolization – currently the treatment of choice.

This involves intravascular closure of incompetent veins using embolization coils or vascular glue. The procedure is performed under angiography control and is characterized by high effectiveness (symptom improvement in 70–90% of patients).

Other methods:

Sclerotherapy
Surgical treatment (rarely, in severe cases)

The embolization procedure is minimally invasive, does not require large incisions, and allows for a quick return to activity.