The 'Love Vein' – and pelvic varicose veins in women

Did you know that one rather inconspicuous vein in your abdomen and pelvis could be responsible for a whole cascade of health problems—from painful periods to pelvic venous insufficiency, to venous insufficiency of the lower limbs?

That vein is the left ovarian vein named years ago by the Phlebology Clinic Team the 'LOVE vein'Its role in most women increases with maturity. this is the time when the ovaries begin to play a crucial role in a woman's life, and the onset of menstruation often reminds young women about the existence of the ovarian veins. the left ovarian vein plays a key role in the development of female-type pelvic venous insufficiency. This problem affects even 30-40% of women suffering from chronic lower abdominal pain, is responsible for the majority of venous insufficiency in women's lower limbs, and yet remains one of the most frequently overlooked diagnoses in gynecological and phlebological offices.

At Phlebology Clinic in Warsaw we meet patients every day whose long-standing suffering could have been ended much earlier, if only someone had thought of examining this one vein, which is key to women's lives

The left ovarian vein Left Ovarian Vein – Why did we name it the 'Love Vein'?

Left ovarian vein Left About thevarian VEin. The association is obvious: LOVE 😊 in medical nomenclature, the acronym used to describe it is LOV, which sounds almost identical to the English word for love. the Name 'LOVE vein' the name proposed by the Phlebology Clinic team several years ago was, of course, created for the needs of a more popularizing approach to phlebology, but how accurately it reflects the significance of this vessel in a woman's life!

Even Hypocrites himself (460–370 bc) wrote about the “wandering uterus” and blood stasis as a cause of women's suffering. today, we know that he was often referring to the very symptoms of pelvic venous insufficiency. Our the contemporary 'LOVE vein' plays a key role in the development of pelvic venous insufficiency, affecting intimate life, fertility, and the health of veins throughout a woman's body. it is a particularly important vessel during the so-called standard reproductive period (typically defined as 15-49 years).

The left ovarian vein – our 'LOVE vein' – begins to play a special role as early as puberty, precisely when a young woman enters adult emotional and sexual life. it's no coincidence that this is when the first warning signs that may indicate its insufficiency often appear. young women complain of painful, long (over 7 days), and heavy periods, which are often trivialized by parents and doctors and lumped into one category under the heading of "normal adolescent complaints." meanwhile, this may be the first sign that our 'love vein' needs attention, care, and, above all, verification with a doppler ultrasound!

As shown by many years of observation by the Phlebology Clinic team, a properly functioning left ovarian vein is the foundation of female intimate health. its efficiency directly translates into the quality of sexual life. women with a properly functioning LOV rarely experience pain during intercourse, usually do not feel discomfort after sex, and their intimate life is not limited by ailments resulting from pelvic venous congestion. That is precisely why we call it the 'love vein'—because when it works properly, it allows you to fully enjoy intimacy with your partner.

What is more, our 'love vein' has a direct impact on fertility. Proper venous blood drainage from the ovary provides optimal conditions for egg maturation, regular menstrual cycles, and increases the chances of conception. An insufficient LOV can be a silent enemy of the dream of motherhood—advanced pelvic venous insufficiency often disrupts cycles, lengthens menstruation beyond 7 days, and in extreme cases can make conception difficult or increase the risk of miscarriage.

The romantic association with love has one more dimension – just like in a relationship, problems with the 'love vein' often remain unspoken, hidden out of shame or embarrassment. Varicose veins in intimate areas, pain during intercourse (venous dyspareunia), a feeling of heaviness in the lower abdomen—these are topics that women are reluctant to discuss even with a doctor. yet, just like in love, an honest conversation and a quick reaction to problems can save what is most precious—health and quality of life.

How does it work the left ovarian vein and why is it so important?

Anatomy and function of the left ovarian vein

Left ovarian vein (LOV) it's the vessel responsible for draining venous blood from the left ovary and the area of the left parametrium. under normal conditions, this vein has a diameter of about 2-5 mm and transports blood upwards toward the left renal vein, from where it then flows into the inferior vena cava and the right side of the heart. however, this seemingly simple task becomes incredibly complicated when we consider the particular anatomy of this vessel.

Left ovarian vein (LOV) it is longer than the right one, and its course is sometimes more complicated. it has to cover a greater distance, has worse drainage conditions, which generates higher hydrostatic pressure inside it. additionally, in contrast to right ovarian vein, ROV , which drains directly into the inferior vena cava, the left ovarian vein empties into the left renal vein at an angle close to 90 degrees. the vein into which the LOV drains, i.e., the left renal vein, is a vessel that is very often narrowed or developmentally abnormal. these anatomical complexities mean that the left ovarian vein is the one that most often becomes an insufficient venous vessel in women. it is the main cause of the development of Pelvic Venous Insufficiency, PVI of the female type, causing a set of symptoms that includes, among others, Pelvic Congestion Syndrome, PCS miednicy (ang. Pelvic Congestion Syndrome, PCS).

Consequences of left ovarian vein insufficiency

When the left ovarian vein stops functioning properly and becomes insufficient, blood begins to back up excessively and collect in in the parametrial venous plexuses and other veins of the small pelvis organs. this retrograde flow generates a large congestive effect, leading to the depletion of the reservoir functions of the venous plexuses of the left ovary and parametrium. subsequently, there is congestion of the reproductive organ and overload of the internal iliac vein network and the right ovarian vein.

You can read more about the mechanisms of ovarian vein insufficiency and their radiological classification in a scientific article by the Phlebology Clinic team: Hemodynamic and Radiological Classification of Ovarian Veins System Insufficiency; Szary C, Wilczko J, Zawadzki M, Grzela T; J Clin Med. 2021 Feb 8;10(4):646; doi: 10.3390/jcm10040646.

In women after pregnancies, the left ovarian vein can widen up to 10-15 mm. an insufficient left ovarian vein becomes the cause of a whole cascade of health problems, affecting not only the pelvic organs but also the veins of the lower limbs.

Why is the left ovarian vein sometimes insufficient even before pregnancy?

Pre-pregnancy Pelvic Venous Insufficiency – when the problem starts early

Pregnancy and childbirth – the period of highest risk for pelvic venous insufficiency

Pregnancy is the most critical period for a woman's venous system. The scale of changes occurring in the future mother's body is truly dramatic and directly affects the state of the veins, especially the left ovarian vein. Estrogen levels during pregnancy can increase by as much as 50–100 times compared to the pre-pregnancy state. These huge hormonal fluctuations have a direct effect on the walls of the venous vessels, making them more susceptible to stretching.

The second important factor is the increase in circulating blood volume (by about 30–50%). In short, this means that significantly more blood than usual must flow through the veins. The enlarging uterus exerts increasing pressure on the iliac veins, renal veins, and finally the inferior vena cava, further complicating blood drainage from the pelvis. In addition, there is the effect of progesterone—a hormone that relaxes not only the uterine muscles but also the walls of the venous vessels, weakening their tension and making them more susceptible to excessive stretching.

Kombinacja tych kilku czynników sprawia, że niewydolność żylna miednicy wtórna do przebytych ciąż i porodów jest najczęstszą postacią tego schorzenia.

What are parametrial varicose veins and how do venous leaks into the legs form?

The mechanism of parametrial varicose vein formation

veins is (ang. periuterine varices) to pathologically dilated, tortuous, and elongated veins of the venous plexuses that surround the uterus in the area known as the parametrium. They arise as a direct consequence of ovarian vein insufficiency—more often on the left side. When the main outflow tract for blood from the pelvis is blocked or insufficient, the body tries to find alternative routes to drain the excess blood. As a result, an elaborate network of collateral circulation develops, and the parametrial venous plexuses dilate, forming the varicose veins characteristic of this disease.

These dilated vessels form specific reservoirs of venous blood, which not only cause pain but also disrupt the proper functioning of the reproductive organs. Excessive and long-term congestion of the ovaries can lead to menstrual cycle disorders, prolonged menstrual bleeding (lasting over 7 days), and in advanced cases, this mechanism may prevent conception or increase the risk of miscarriage.

The formation of venous leaks/shunts from the pelvis to the lower limbs

One of the most clinically significant aspects of left ovarian vein insufficiency is the formation of the so-called venous leaks (from the pelvis) to the lower limbs. Dilated pelvic veins communicate with the veins of the groin, buttocks, thighs, and lower legs through numerous direct vascular connections (pelvic floor perforatorsand indirect (overload effect). when the pressure in the pelvic veins is elevated, blood begins to flow through these alternative routes to the leg veins, overloading the venous system of the lower limbs and subsequently leading to its dilation.

These pathological vascular connections, called venous leaks, are the main cause of the development of lower limb venous insufficiency in women. In young women with anatomically conditioned pelvic venous insufficiency the first symptoms of venous insufficiency in the legs – most often in the form of unsightly spider veins and varicose veins – appea already before the age of 20 (before the 1st pregnancy) and are decidedly more often severe on the left side.

Varicose veins of the intimate area – the most embarrassing symptom of 'Love Vein' Insufficiency

Characteristics of vulvar and perineal varicose veins

Varicose veins of the intimate area is one of the most bothersome and, at the same time, most embarrassing manifestations of left ovarian vein insufficiency. these visible, dilated veins in the vulva and perineum are not only unsightly but, above all, cause a number of unpleasant ailments. women describe a feeling of heaviness, fullness, and sometimes even throbbing pain in the intimate areas, which intensifies during prolonged standing, during menstruation, and after sexual intercourse (the phenomenon known as venous dyspareunia).

Varicose veins in intimate areas arise as a result of excessive venous congestion in the area of the lesser pelvis and the pelvic floor. When the left ovarian vein is insufficient, blood can eventually collect not only in the parametrial venous plexuses, but also in the veins of the vulva, the paravaginal veins, the vaginal wall, and the perineal venous plexuses. In advanced cases, the varicose veins can be so extensive that they deform the contours of the reproductive organs, which constitutes not only an aesthetic but, above all, a functional problem.

Varicose veins in intimate areas and their impact on intimate life and psyche

The presence of varicose veins in intimate areas significantly affects the quality of women's sexual life. Venous dyspareunia—pain during sexual intercourse resulting from venous congestion—intensifies particularly in women after 2–3 births. Additionally, many patients also experience the so-called vulvodynia, which is spontaneous burning in the area of the vulva and the vestibule of the vagina, which may also result from venous congestion. These symptoms, combined with the aesthetic aspect of the problem, often lead to the avoidance of intimate contact, a reduction in self-esteem, and ultimately to the development of relationship problems with the partner.

When to treat left ovarian vein insufficiency – why is timing so important?

Early procedural intervention is the key to success

The answer to the question "when to start treatment for left ovarian vein insufficiency" is unambiguous: as early as possible. Many years of experience of specialists from the Phlebology Clinic show that early diagnosis and treatment of pelvic venous insufficiency can prevent the development of serious "congestive" complications and significantly improve the quality of life of young women. Unfortunately, in clinical practice, an average diagnostic delay of even 10–15 years from the onset of the first clinical symptoms is observed.

Early treatment of left ovarian vein insufficiency has several key benefits. First, it stops the development of pelvic venous insufficiency and prevents the formation of extensive parametrial varicose veins. Second, it protects against the development of lower limb venous insufficiency secondary to PVI, which is very difficult to manage without causal treatment. Third, and particularly important for young women, early intervention increases the chance of improving ovarian function and may have a positive impact on future fertility.

Special risk groups requiring urgent observation and faster treatment

Particular attention should be paid to young women aged 16-25 who experience painful and heavy menstruation, are suspected of having endometriosis, and additionally present with heavy legs, clinically unclear back pain, and spider veins and varicose veins on the legs.
In most of them, anatomically conditioned pelvic venous insufficiency should be ruled out. In these patients, venous embolisation is often the first procedure that should be performed.

The second group requiring a change in lifestyle and earlier intervention are women who actively engage in strength sports. Post-exertional venous insufficiency develops very rapidly and is extremely difficult to treat in an advanced stage due to the overall dilation of the venous network. The earlier it is diagnosed and treated, the greater the chances of preserving the proper function of the venous system.

The third group consists of women planning a pregnancy who have diagnosed pelvic venous insufficiency. Advanced venous insufficiency can not only make conception difficult by disrupting menstrual cycles but also increase the risk of miscarriage. Treatment before planned pregnancy can significantly improve the prognosis in this regard.

Modern treatment of ovarian vein insufficiency – venous embolisation as the gold standard

What does embolization of the left ovarian vein involve?

Venous embolisation is a minimally invasive method for treating pelvic venous insufficiency, which has become the gold standard in the therapy for this condition. The procedure involves the controlled closure of the lumen of the insufficient left ovarian vein using special embolization materials. In the Phlebology Clinic in Warsaw, the most frequently used are modern embolisation coils wykonane z metali szlachetnych oraz spienione sklerozanty, tj. substancje chemiczne powodujące włókniejące zamknięcie naczynia żylnego.

The procedure is performed in an operating room equipped with modern radiological equipment (the vascular lab of the Phlebology Clinic). Access to the venous system is obtained by puncturing a vein in the arm or leg under ultrasound guidance—without the need for surgical incisions. Subsequently, the parametrial venous plexuses are contracted under X-ray imaging control, and embolization materials are introduced through a thin catheter directly into the insufficient ovarian vein. Embolization coils induce vessel contraction and a fibrosis reaction, which leads to the permanent occlusion (closure) of the insufficient vein.

The course of the venous embolization procedure and the unique comfort of this treatment

Left Ovarian Vein Embolization at the Phlebology Clinic is characterized by exceptional comfort for the patient. The procedure is performed in shallow sedation under the supervision of an anesthesiology team, without the need for general anesthesia. The patient remains conscious but relaxed and feels no pain. The entire procedure usually lasts 20–40 minutes, and the stay at the Clinic is limited to 3–4 hours.

The key element of success is the use of a proprietary technique for the complete closure of the insufficient part of the venous system. Our approach is different from the "sandwich" technique which is used quite commonly, but which in long-term assessment is not very effective.  

Why is LOV embolization so minimally painful?

Left Ovarian Vein Embolization is considered one of the least painful procedures performed in our Clinic. The ovarian vein itself does not have pain receptors in its wall, which means that manipulation within it usually does not cause pain. Secondly, the use of modern, soft, new-generation embolization coils minimizes the risk of irritating surrounding structures. The sclerosants used at the Phlebology Clinic are well tolerated by patients both during the embolization procedure itself and afterward. Most women only describe a feeling of a "menstrual cramp" in the lower abdomen during the administration of the sclerosant. This feeling, however, quickly subsides

In the post-procedural period, pain is minimal. Any potential discomfort in the lower abdominal area, which may occur in some patients within 3–7 days of the procedure, venous embolisation, skutecznie kontrolowany jest przy użyciu standardowych leków przeciwbólowych. Powrót do codziennych aktywności następuje już następnego dnia po zabiegu, a do aktywności sportowej zazwyczaj po 10-14 dniach od wykonania embolizacji żylnej.

The key element of success is the use of a proprietary technique for the complete closure of the insufficient part of the venous system. Our approach is different from the "sandwich" technique used quite commonly (especially in the USA). The "sandwich" technique, in long-term assessment, is not very effective, often leading to recanalization and recurrence of pelvic venous insufficiency.  

The effectiveness of venous embolization procedures and their long-term results

Left Ovarian Vein Embolization is characterized by very high effectiveness. The correct performance of this procedure along with the subsequent performance of sclerotherapy of varicose veins in the intimate area gives a reduction of symptoms of Pelvic Congestion Syndrome in about 90% of patients (data collected from a group of over 1000 treated patients at the Phlebology Clinic in Warsaw). It should be noted that women in whom an overlap of endometriosis and Pelvic Venous Insufficiency, PVI. Our studies have shown that in women with pelvic venous insufficiency treated using the full protocol venous embolisation a normalization of menstrual cycles, a shortening of the duration of menstruation, and a reduction in lower abdominal pain are observed. The most spectacular, however, is the improvement of symptoms in the lower limbs with a significant reduction in the risk of recurrence of venous disease.

Conclusion: do not ignore the symptoms insufficiency of the left ovarian vein

Insufficiency of the left ovarian vein is a condition that can develop insidiously over the years, giving seemingly unrelated symptoms. From painful menstruation in adolescence, through fertility problems, varicose veins in intimate areas, up to advanced venous insufficiency of the lower limbs—all these problems may have a common source in one insufficient vein.

Modern phlebology offers effective and minimally invasive methods for treating this condition. Left Ovarian Vein Embolization performed in experienced centers, such as the Phlebology Clinic in Warsaw, is a safe, comfortable procedure that brings long-lasting results. The key to success is an early, correct diagnosis and the exclusion or confirmation of endometriosis. Comprehensive diagnostics of the venous system, including expert Doppler ultrasound examination of the veins of the abdomen, pelvis, and lower limb veins, will allow for the establishment of a proper diagnosis and the planning of optimal treatment.

Remember :)! The condition of your venous system affects your entire life, and insufficiency of the left ovarian vein ('LOV vein') is a problem that can be effectively solved using minimally invasive techniques.