Ovarian Vein Embolisation (Embolization): How It Works and Who It Helps

Ovarian vein embolization (spelt embolisation in the UK and Singapore) is a minimally invasive procedure to close widened, leaky veins in the pelvis. It is the treatment most often offered for pelvic congestion syndrome when symptoms are troublesome and scans show refluxing veins. Instead of open surgery, a specialist works from inside the veins through a thin tube. This guide explains who it may help, what happens before, during and after, and what the evidence really shows.

What is ovarian and pelvic vein embolisation?

In pelvic congestion syndrome, the one-way valves in the ovarian veins fail, so blood flows back down into the pelvis and pools in a tangle of widened veins. Embolisation blocks off the faulty veins. Blood then drains through other, healthy veins, and the congested veins in the pelvis gradually shrink.

When other pelvic veins are treated as well, such as branches of the internal iliac veins, it is often called pelvic vein embolisation. The procedure is usually carried out by an interventional radiologist or a vascular surgeon with training in vein procedures. For background on the condition itself, see pelvic congestion syndrome.

Who is it for?

Embolisation may be considered if you have:

• Long-term pelvic pain typical of pelvic congestion, such as a dragging ache that is worse on standing and after sex
• Scans showing widened pelvic veins with backward flow that fits your symptoms
• Other likely causes of pain looked for and treated, or ruled out
• Varicose veins of the vulva, buttocks or legs that come from the pelvic veins

It is not suitable for everyone. It is not done during pregnancy, and it may not help if the veins are squeezed higher up rather than leaking. Compare it with the other choices in our guide to pelvic congestion syndrome treatment.

What happens before the procedure?

• Assessment and scans. You will usually have a duplex ultrasound and sometimes a CT or MR scan to map the veins.
• Blood tests and a pregnancy test, because the procedure uses X-rays and contrast dye.
• Medicines. Tell the team about blood thinners, diabetes medicines and any allergies, especially to contrast dye or iodine.
• Eating and drinking. You may be asked not to eat for a few hours beforehand if sedation is planned.
• Getting home. Arrange for someone to take you home and, ideally, to stay with you for the first night.

What happens during the procedure?

You lie on an X-ray table. The procedure is usually done under local anaesthetic with light sedation, so you are awake but relaxed. A general anaesthetic is used in some centres.

1. Access. The skin is numbed and a small needle is placed into a vein, usually at the neck, groin or arm.
2. Venogram. A thin, flexible tube (catheter) is guided to the pelvic veins. Contrast dye is injected to show which veins are refluxing. This is the most detailed test of the pelvic veins.
3. Closing the veins. The specialist blocks the faulty veins using one or more of: - Coils — tiny metal springs that trigger a clot and seal the vein - Plugs — small mesh devices for larger veins - Foam sclerosant — a medicine that irritates the vein lining so it closes - Medical glue — a liquid that sets inside the vein
4. One or both sides. The left ovarian vein is most often treated. The right ovarian vein and internal iliac branches may be treated in the same session or at a later one.

The procedure usually takes about one to two hours. The tube is removed, and a small dressing is placed over the entry point. No stitches are needed.

What happens afterwards?

Most women go home the same day. Common experiences include:

• An ache in the pelvis, back or groin for a few days, sometimes with a low-grade temperature. This is the body reacting to the closed veins, and it is usually eased by simple painkillers.
• Mild bruising where the tube went in.

Advice on returning to activity varies between centres. Many women are back to light activity within a day or two and to normal routines within about a week, but some teams advise avoiding strenuous exercise for longer. Follow the instructions your own team gives you. Pain relief often comes gradually over weeks to a few months. A follow-up appointment, sometimes with an ultrasound, checks how you are doing. Read more about recovery after embolisation, and a Singapore vascular surgeon’s post-procedure care guide gives another practical overview.

Results: what does the evidence show?

The most widely quoted summary is a 2016 systematic review by Daniels and colleagues. It looked at 22 studies covering 1,308 women:

• About 75% reported substantial pain relief early after treatment, and relief often improved with time.
• Pain scores fell significantly in every study that measured them.
• Repeat procedures were not common.

The honest caveat is that the reviewers rated the quality of the evidence as low. Most studies were case series from single centres, without a control group, and only one small randomised trial was included. The European Society for Vascular Surgery’s 2022 guideline says embolisation may be considered for selected patients, which is a cautious recommendation. Larger trials, including one comparing embolisation with a sham procedure, are under way.

Will symptoms come back? In a minority of women, yes. Reported recurrence rates vary widely, from about 1 in 10 to as many as 4 in 10, depending on the study and how recurrence was defined. Some women need a second procedure, and a later pregnancy can bring symptoms back.

What are the risks?

Serious problems are uncommon, but no procedure is risk-free. Possible risks include:

• Post-embolisation pain, a pelvic ache and sometimes mild fever for a few days. This is common.
• Bruising or bleeding at the entry site.
• Coil migration, where a coil moves out of place. Reviews put this at under 2 to about 3 in 100. If it happens, the team will decide whether anything needs to be done about it.
• Thrombosis, a clot in a nearby pelvic vein or, rarely, a deep leg vein.
• Phlebitis, an inflamed, tender vein, more likely after foam.
• Reaction to contrast dye, from mild rash to, rarely, a serious allergic reaction.
• Radiation exposure from the X-rays. Teams keep the dose as low as possible.
• Not improving, or symptoms coming back.

See side effects and complications of pelvic vein embolisation for more detail.

Fertility and pregnancy

Studies so far have not shown that embolisation harms periods or fertility, and many women have had children afterwards. However, the data are limited, and researchers are still studying whether the procedure has any effect on markers of ovarian reserve. If you plan to become pregnant, talk to your specialist about timing before treatment. Our guide to pelvic congestion and fertility covers this in more depth.

How much does it cost in Singapore?

The Ministry of Health fee benchmark for ovarian vein embolisation (TOSP code SI703O, table 3B) is S$4,905 to S$8,175 for the surgeon’s fee, including GST, before hospital and other charges. The MediSave limit for a table 3B procedure is S$1,740. See our guide to what embolisation costs in Singapore for insurance and MediSave details.

When to see a doctor

See a doctor if you have long-term pelvic pain, pain during or after sex, or vulval or leg varicose veins that may come from the pelvis. After embolisation, contact your team if the pain is getting worse rather than better after a few days, or if the entry site becomes red, hot or swollen.

Get urgent medical help for severe or worsening pain, a high fever, heavy bleeding from the entry site, a painful swollen leg, chest pain or sudden breathlessness. In Singapore, call 995 in an emergency.

This article is general information, not personal medical advice. Please speak to a doctor about your own symptoms. How we create our content.