Why Women Choose MIPS for Their Pelvic Pain?

When you come to our office in the Denver area, you’re going to be treated differently. Many of our women have seen many other specialists and often have undergone multiple procedures or surgeries and continue to have horrible pelvic pain. When frustrated patients come to see us, we sit down, we listen to our patients, and through this process and reviewing their imaging are often able to identify the cause of their chronic pain and provide a cure. MIPS vascular specialists are world-renowned and women have come from all over the country and the world to benefit from MIPS level of expertise, experience, and care. We see many patients from Colorado and Nationwide.

In addition, our Medical Director, Dr. Brooke Spencer, trains other vascular specialists from all over the United States and internationally, through direct on-site training, speaking at national meetings, and by performing and publishing research.

What is Pelvic Venous Disease?

Pelvic venous disease (PVD) is a common cause of chronic pelvic pain but is frequently underdiagnosed. This may result in multiple physician consults, years of discomfort, pelvic floor physical therapy, and even unnecessary procedures and surgeries. Other terms frequently used when referring to the pelvic venous disease include pelvic congestion syndrome, Iliac vein compression syndrome, May-Thurner syndrome, gonadal or ovarian vein reflux, pelvic varices, and enlarged pelvic veins.

What Causes Chronic Pelvic Pain?

According to Yale Medicine, the causes of chronic pelvic pain vary but most patients are only evaluated for endometriosis, uterine fibroids, problems with the ovaries, and bowel and bladder problems. Vascular causes of chronic pelvic pain are often overlooked but may be the culprit in a large number of these patients. The more frequently discussed “pelvic congestion syndrome” is similar to varicose veins in the legs in that the valves in the ovarian veins that help return blood to the heart against gravity become weakened and don’t close properly. This allows blood to flow backward and pool in the vein causing pressure and bulging. In the pelvis, it can cause pain and affect the uterus, ovaries, and vulva. While not all women experience symptoms, up to 15 percent of women, generally between the ages of 20 and 50, have varicose veins in the pelvis.

More recently, it has been discovered that iliac vein compression or May Thurner may cause pain more often than ovarian vein problems. In these patients, the compression can be seen on CT scan or MRI but is often not commented on by the radiologist and varices are often absent and so the diagnosis is not made.

What are Common Symptoms Associated with Pelvic Pain?

Some common pelvic pain symptoms are:

• Low back pain
• Pelvic pain, vaginal pain, groin pain, leg pain, or back pain
• Dilated leg or pelvic varices (varicose veins)
• Painful intercourse or bleeding after intercourse
• Unexplained urinary urgency, frequency, or sensation of incomplete bladder emptying
• Heavy and/or painful periods
• Pain with ovulation
• Continued leg swelling and symptoms after superficial vein treatments
• A feeling of physical anxiety in the chest when one does not feel mentally anxious
• Migraine headaches

Conditions that Frequently Occur with and may be caused by Pelvic Venous Disease

• Postural orthostatic tachycardia syndrome (POTS)
• Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME)
• Ehlers-Danlos syndrome (EDS)
• Mast cell activation syndrome (MCAS)
• Irritable bowel syndrome (IBS)
• Interstitial cystitis (IC)
• Chronic migraine headaches
• Temporomandibular joint (TMJ) pain in the jaw

Pelvic Congestion Syndrome caused by ovarian vein reflux most often occurs in women who have had previous pregnancies.  However, iliac vein compression can occur in women with no history of pregnancy.

How is Pelvic Venous Disease Diagnosed?

Patients will first undergo a consultation with one of our providers to go over symptoms and perform a clinical exam. Patients may then undergo further testing with CT and/or MRI depending on each clinical situation. We will evaluate all possible causes of your pelvic pain so you can be treated with the right plan for you.

How is Pelvic Pain Treated?

Our vascular specialists treat chronic pelvic pain with a variety of minimally invasive outpatient procedures, depending on the cause of the symptoms. The goal of these procedures is to improve and reverse the abnormal vein pressure in the pelvis by closing veins where blood flows in the wrong direction and opening veins that are blocked causing a backup of pressure.  This redirects blood flow into the normal veins.

Treatment may include:

• Stent placement for Iliac Vein Compression or May Thurner syndrome. This is the most common treatment for pelvic venous disease. A metal (Nitinol) stent is placed into the left common iliac vein where it is compressed between the right iliac artery and spine to widen the vein size and encourage flow through this normal venous pathway.
• Embolization. This is used for gonadal/ovarian vein reflux or other venous malformations. Small coils or medication are placed into abnormal veins to block backward blood flow and decrease the pressure off varicose veins in the pelvis.
• Sclerotherapy. Injecting medication into abnormal veins to stop blood flow into veins that are no longer working properly.

Experience Matters for Pelvic Pain

Minimally Invasive Procedure Specialists have the most experience of any practice in Colorado in treating pelvic venous disease. We have placed over 4000 venous stents and our providers work closely with referring clinicians and pelvic floor physical therapists to achieve the best outcomes. The majority of our procedures are done at our outpatient interventional suite, decreasing the time between consult to treatment and decreasing cost.

We are also currently conducting a multicenter study with the Mayo Clinic evaluating the association of many symptoms and conditions with pelvic venous disease and conducting quality-of-life surveys before and after treatment.