Uterine varices The Phlebology Clinic / Pelvic venous insufficiency in women / Uterine varices Introduction Description of the condition Risk factors Recognition and diagnosis Treatment methods Frequently asked questions Introduction Uterine varices represent a complex clinical problem associated with pathological venous vasodilatation in the pelvic region, with a particular focus on venous insufficiency in the ovarian-uterine system. The uterus is one of the better vascularised organs of the female body. Its venous system interacts with the entire venous system of the lower limbs, small pelvis and abdominal cavity. The venous system of the uterus, which includes the veins of the genital tract and parametrium venous plexuses are some of the largest reservoir vessels in a woman's body. This is an advantage (e.g. during pregnancy), but at the same time a disadvantage, as it can lead to the formation of large varicose veins, which significantly disrupt a woman's cycle, prolong menstruation, increase its abundance, painfulness and, just as importantly, overload the rest of the veins in a descending mechanism, or anastomotic parallel connections. The venous system of the uterus then undergoes dramatic changes, which are necessary to ensure the proper development of the foetus. The process of adaptation starts already in the first weeks of pregnancy and progresses until the end of pregnancy. The walls of the uterine veins become thinner and more stretchable during pregnancy so that adaptive stretching can take place. The diameter of the uterine vessels can widen several times during pregnancy. During pregnancy, the venous system undergoes dramatic changes - the vessels widen significantly, lengthen and become very tortuous. Uterine blood flow increases from about 50-60 ml/min. (before pregnancy) to as much as 500-750 ml/min. in the third trimester of pregnancy.During pregnancy, the intramural and parametrium venous plexuses and the ovarian-uterine connections are expanded. Hormone-dependent insufficiency of the left ovarian vein and later the right ovarian vein are the most common causes of uterine venous volume overload in the first two trimesters of pregnancy. Disorders of venous outflow from the uterus - resulting from dilatation and compression of the internal iliac veins - occur at a later stage of pregnancy (third trimester). Description of the condition Venous system of the uterus forms an extremely complex and potentially extensive network of blood vessels. Within the uterus itself, in its muscular wall (known as the myometrium), there are numerous and tiny intramuscular veinswhich are arranged in three layers. These small venous vessels collect blood from particular areas of the uterus and drain it into a larger vascular system known as the uterine venous plexus (uterine venous plexus). The uterine venous plexus forms a large vascular bed seamlessly connected to the parametrium venous plexuses (parauterine venous plexus). Physiologically, the uterine and paracervical venous vessels have a diameter of approximately 2-4 millimetres and are characterised by a high degree of elasticity, allowing them to adapt to changes in the uterus during the menstrual cycle or pregnancy. The utero-pre uterine venous plexus connects to the ovarian veins to form an extensive venous drainage system, known as the utero-ovarian venous plexus. Schematic representation of the venous system of the uterus and adnexa. Blood from the uterine corpus preferentially drains through organ veins called the uterine veins (Uterine veins), which are slightly larger vessels 3-5 millimetres in diameter. These veins run in the parametria and drain blood into the internal iliac veins. In addition, there are numerous collateral connections in the uterine region (the so-called "collateral connections"). venous anastomoses), which creates a kind of safety net. In the event of obstructions to venous outflow, the flow is redirected to alternative outflow routes. O weave vaginal venous you can read more on the page dedicated to vaginal varices. Risk factors Anatomical factors abnormalities of the pelvic and abdominal venous system pressure on the venous vessels by other anatomical structures congenital malformations of the reproductive system and urinary tract Genetic factors malformation of the venous valves or sparse distribution in the vessels family predisposition to venous disease (e.g. flaccidity of the vascular wall) connective tissue disorders (e.g. Ehlers-Danlos syndrome) Hormonal factors increased oestrogen concentrations (endogenous or exogenous) number of pregnancies and deliveries (the risk increases with each subsequent pregnancy) polycystic ovary syndrome Post-pregnancy left ovarian vein insufficiency (LOV) is the most common cause of uterine varices and varicocele. Mechanism of formation Under normal conditions, venous outflow from the reproductive organs takes place through the ovarian and uterine veins and then through the internal iliac vein system. This is most often disturbed in the course of hypoplasia or compression of the left renal vein or during pregnancy. Pregnancy is undoubtedly the pathophysiological factor most capable of disrupting venous outflow from the uterus and increasing retrograde (intramural) inflow through significantly dilated ovarian veins. It is pregnancy that is the period in a woman's life when varicose veins of the uterus, parametrium, vaginal, vaginal wall, perineum or vulva develop. Recognition and diagnosis Modern diagnosis of uterine varices is based on the same diagnostic assumptions as for pelvic venous insufficiency. In an ideal world, the diagnosis of pelvic varicose veins should come from a gynaecologist who routinely performs a transvaginal ultrasound (TV ultrasound). The gynaecologist should understand the mechanism of pelvic varicose veins and be familiar with the symptoms typical of chronic pelvic venous disease. A patient diagnosed initially should then be referred to a specialist (e.g. a phlebologist who deals with the diagnosis and treatment of pelvic venous insufficiency on a daily basis). This should be followed by an expert study Doppler ultrasound of the veins of the abdomen and small pelvis with evaluation of the veins of the lower limbs On lying down and standing up. This examination evaluates the anatomy of the venous system, all developmental variations, assesses the morphology of the venous vessels, the relationship of arterial to venous vessels, assesses the causes of insufficiency, excludes flow disorders, etc. It is the examination of choice to assess the entire venous system and not just a section of it, as is the case with transvaginal ultrasound. This is followed by a study MR venography (usually performed using 3-tesla diagnostic systems), which allows an accurate assessment of the uterine wall and the exclusion of other pathologies that may mimic uterine variceal-like symptoms. Treatment methods The treatment of patients with uterine varices should always be comprehensive and address the underlying cause. Uterine and parametrium varices are usually one of the symptoms of pelvic venous insufficiency. The presence of varicose veins can contribute to a variety of symptoms, the most common of which are chronic lower abdominal pain that is worse when standing, sitting or lifting, a feeling of heaviness in the lower abdomen, discomfort during intercourse or heavy and painful menstruation. The presence of uterine varices usually indicates an advanced form of pelvic venous insufficiency. For this reason, conservative treatment is usually not applicable. In cases of complex ovarian venous insufficiency and significant blood overload in the uterine veins, treatment should be surgical and lead to a reduction in backflow and redirection of blood to the viable part of the venous bed. The standard of care in the treatment of uterine varicose veins is endovascular reduction of retrograde blood flow in insufflated ovarian veins (usually using a procedure of venous embolisation) leading to uterine vein relief. In more advanced cases, simultaneous embolisation of the failing branches of the internal iliac vein system is performed, minimising the need for uterine vein closure. Any treatment of pelvic veins and uterine varicose veins should be preceded by a thorough ultrasound and MR venography diagnosis. A detailed imaging diagnosis allows optimal treatment planning, minimises the risk of complications, increases treatment efficacy and allows individualisation of therapy. Varicose veins after pregnancy - how to avoid them? Are varicose veins after pregnancy inevitable? 🤔 Absolutely NO! Discover proven ways to minimise the risk of them and how to take care of your legs during this special time. Everything a mum-to-be should know! 🤰 Mostlyquestions asked Can uterine varices affect fertility and pregnancy? Research by the team at the Department of Phlebology shows that ladies with uterine and parametrium varicose veins in the course of long-standing pelvic venous insufficiency (patients whose disease begins at the age of 14-16 years) have much more frequent problems with ovarian reserve and getting pregnant. We then speak of primary infertility. Uterine varicoceles themselves can make it difficult for the embryo to implant in the uterus or increase the risk of miscarriage. They require special monitoring during pregnancy, as they can enlarge under hormonal and pressure changes. It is therefore important for patients planning a pregnancy to inform their gynaecologist and to be checked regularly. What are the main symptoms of uterine varices? How can I tell if I have them? The most common symptoms of uterine varices and varicocele are chronic pain in the abdominal fossa, exacerbated during menstruation, after prolonged standing or sitting, after exercise and during intercourse (venous dyspareunia). Patients with uterine varices often report a feeling of heaviness in the lower abdomen, sacral pain, as well as heavy and painful periods. It is worth remembering, however, that varicose veins can be asymptomatic in some women. Since giving birth to my third child, I feel that my periods are much heavier than they used to be and the clots are bigger. Can uterine varices affect the nature of my monthly bleeding? This is a common correlation seen by Phlebology Clinic patients. Uterine congestion (uterine varices) can significantly affect menstruation. Dilated venous vessels in the uterine wall can lead to increased bleeding during menstruation. Characteristically, larger clots occur due to the slower flow of blood in the dilated vessels, giving it more time to clot. In addition, bleeding may be more irregular and last longer than usual. Our study shows that the incidence of pelvic venous insufficiency is greater than 60% in ladies from the 3rd reported pregnancy upwards. I am planning surgery to remove endometriosis foci and endometrial cysts from my left ovary. Can the uterine varices be addressed at the same time? How will this affect the success of the surgery? Many forms of endometriosis appear to be associated with long-standing pelvic venous insufficiency and varicose veins of the reproductive organs, so it is often worth considering treating the venous insufficiency first. In the Department of Phlebology, we have noticed after observing patients with treated pelvic venous insufficiency for more than 10 years that this approach reduces endometrial symptoms and slows the development of adenomyosis. The decision on the sequence and treatment must always be made individually, depending on the severity of both conditions and the experience of the team performing the procedure. I feel a deep, dull pain during intercourse which continues for several hours afterwards. Could this be related to uterine varices? Pain during intercourse, especially with deep penetration, is a very characteristic symptom of congestion of the reproductive organs, including uterine and vaginal varices. This is due to the fact that the congested wall of the reproductive organ is more sensitive to external stimuli and increases so-called sensitisation. This phenomenon leads to excessive sensations that turn into pain and discomfort. It is also due to the fact that during intercourse there is an increased flow of blood to the pelvic organs, which puts additional strain on the already overloaded veins. Related issues 01 / Pelvic venous insufficiency in women 02 / Vaginal varices 03 / Varicose veins of the vulva Modern vein treatment We offer treatment both on an outpatient basis and in day ward admissions. The stay is of short duration. The patient spends between 1 and 5 hours in the Clinic. Make an appointment
