Diagnosis and Tests

Why diagnosis takes time

Pelvic pain has many causes, and they can overlap. Gynaecological conditions such as endometriosis and adenomyosis, bowel and bladder conditions, pelvic floor muscle problems and nerve pain can all feel similar to pelvic congestion. Widened pelvic veins are also common in women with no symptoms at all. So doctors look for two things: veins that are widened and refluxing, and symptoms that fit.

The usual steps

1. History and examination. The pattern of pain matters: a dull, dragging ache that builds through the day and eases lying down is typical of venous pain.
2. Ultrasound. A transvaginal and abdominal duplex ultrasound is usually the first scan. It shows vein size and the direction of blood flow, and checks the uterus and ovaries.
3. CT or MR venography. Cross-sectional scans map the pelvic and abdominal veins and can show compression such as nutcracker or May-Thurner anatomy.
4. Catheter venography. An X-ray of the veins using contrast dye, usually done at the start of a planned embolisation, as it confirms and treats in one sitting.

Rule out other causes

Many women with pelvic pain also need a gynaecology assessment. Some will have more than one cause. Ask your doctor which conditions have been checked and which have not.