Simultaneous embolisation of uterine arteries and ovarian veins as a management for chronic pelvic pain due to pelvic venous disorders and adenomyosis

Chronic pelvic pain (CPP) of gynaecological origin encompasses a heterogeneous group of disorders, among which pelvic venous disorders (PeVD) and adenomyosis are recognised contributors. Concomitant PeVD and adenomyosis may potentiate symptom burden and complicate management strategies. A 45-year-old parous woman was referred with a protracted history of CPP manifesting as lower abdominal, lumbar and hip pain, exacerbated by prolonged orthostasis and coital activity. Menstrual symptoms comprised dysmenorrhoea and menorrhagia complicated by iron-deficiency anaemia. Prior conservative measures were ineffective and the patient declined definitive surgical intervention. Transvaginal ultrasonography demonstrated features consistent with both adenomyosis and pelvic venous congestion. After multidisciplinary discussion, the patient underwent endovascular treatment consisting of concurrent embolisation of the bilateral uterine arteries and ovarian veins, performed by an interventional radiologist. At six-month follow-up the patient reported complete resolution of abdominal, back and hip pain and of menstrual pain and menorrhagia; postcoital ache persisted but was markedly attenuated. Magnetic resonance imaging demonstrated a reduction in the radiological extent of adenomyosis and no evidence of pelvic venous reflux. To our knowledge, this is the first reported case of simultaneous embolisation of the uterine arteries and ovarian veins for CPP attributable to coexisting PeVD and adenomyosis. While these preliminary results are encouraging, the efficacy and safety of this combined endovascular approach warrant evaluation in appropriately designed prospective studies.