The association of ovarian and pelvic varices with chronic pelvic pain was recognized in the 1950s and has been termed pelvic congestion syndrome. The diagnosis is suggested when pelvic pain is most severe in the upright position, during or after intercourse, or in the postpartum period. Superficial varicosities of the thigh, buttocks, perineum, vulva or vagina may also be present.

CT and MR are helpful in delineating pelvic anatomy, and T2W MR sequences in particular often demonstrate pelvic varicosities clearly. However, supine imaging can result in false negative results, since pelvic and ovarian varices may only be prominent while the patient is upright. Supine positioning and the requirement for a full bladder also limit the sensitivity of transabdominal US (a distended bladder may compress varicose veins).

Laparoscopy is performed with the patient supine and the abdomen distended with carbon dioxide, so it may underestimate or miss ovarian and pelvic varices as well. For these reasons, venography is the most reliable means of diagnosis, and it provides an opportunity for therapeutic intervention. At venography, the ovarian veins are typically prominent and lack competent valves. Contrast may reflux into the pelvis, as far as the internal iliac veins. Multiple channels often constitute the ovarian veins.

Ovarian vein ligation has been performed in this setting for symptomatic relief. More recently, transcatheter embolotherapy has been employed. Coils are used alone or in combination with sclerosing agents. Some authorities also advocate internal iliac vein embolization. A recent study found significant improvement in symptoms following the procedure, without disruption of the menstrual cycle.