{"paper_id":"677a7ead-bd1b-42f0-89ed-b10b9b8e073b","body_text":"52\nThis is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International  \n(CC BY-NC-SA 4.0). License (http://creativecommons.org/licenses/by-nc-sa/4.0/)\nCase report\nDOI: https://doi.org/10.5114/pm.2026.161499\nMenopause Rev 2026; 25(1): 52-55\nIntroduction\nAmong the recognised gynaecological aetiologies \nof chronic pelvic pain (CPP) are pelvic venous disorders \n(PeVD) and adenomyosis [1]. These entities may coex-\nist, producing overlapping symptomatology and recip-\nrocal exacerbation that complicates clinical assessment \nand management.\nCase report\nA 45-year-old multiparous woman (three prior vagi-\nnal deliveries) was referred for management of CPP. She \nreported persistent abdominal, lumbar and hip pain, ex-\nacerbated by prolonged standing and associated with \npostcoital discomfort. Menstrual symptoms comprised \nmarked dysmenorrhoea and menorrhagia, culminating \nin anaemia (haemoglobin – Hb, on admission 9.8 g/dl).  \nSimultaneous embolisation of uterine arteries and ovarian veins  \nas a management for chronic pelvic pain due to pelvic venous disorders  \nand adenomyosis\nFilip Szkodziak1, Sławomir Woźniak1, Piotr Robert Szkodziak1, Krzysztof Pyra2, Tomasz Paszkowski1, \nMichał Sojka3\n13rd Chair and Department of Gynaecology, Medical University of Lublin, Lublin, Poland\n2Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland\n3Department of Vascular Surgery, University Clinical Hospital No. 4, Medical University of Lublin, Lublin, Poland\nAbstract\nChronic pelvic pain (CPP) of gynaecological origin encompasses a heterogeneous group of disorders, among \nwhich pelvic venous disorders (PeVD) and adenomyosis are recognised contributors. Concomitant PeVD and \nadenomyosis may potentiate symptom burden and complicate management strategies. A 45-year-old parous \nwoman was referred with a protracted history of CPP manifesting as lower abdominal, lumbar and hip pain, \nexacerbated by prolonged orthostasis and coital activity. Menstrual symptoms comprised dysmenorrhoea and \nmenorrhagia complicated by iron-deficiency anaemia. Prior conservative measures were ineffective and the \npatient declined definitive surgical intervention. Transvaginal ultrasonography demonstrated features consist-\nent with both adenomyosis and pelvic venous congestion. After multidisciplinary discussion, the patient un-\nderwent endovascular treatment consisting of concurrent embolisation of the bilateral uterine arteries and \novarian veins, performed by an interventional radiologist. At six-month follow-up the patient reported complete \nresolution of abdominal, back and hip pain and of menstrual pain and menorrhagia; postcoital ache persisted \nbut was markedly attenuated. Magnetic resonance imaging demonstrated a reduction in the radiological extent \nof adenomyosis and no evidence of pelvic venous reflux. To our knowledge, this is the first reported case of \nsimultaneous embolisation of the uterine arteries and ovarian veins for CPP attributable to coexisting PeVD and \nadenomyosis. While these preliminary results are encouraging, the efficacy and safety of this combined endo-\nvascular approach warrant evaluation in appropriately designed prospective studies.\nKey words: chronic pelvic pain, embolisation, adenomyosis, pelvic venous disorders.\nTransvaginal ultrasonography demonstrated findings \nin keeping with PeVD: dilatation of the left ovarian \nvein to 7.7 mm (cut-off diameter – 6 mm) (Figure 1 A) \nwith reduced blood-flow velocity of 2.82 cm/s (cut-off  \nvelocity – 3.0 cm/s) (Figure 1 B). Concurrent sonographic \nfeatures of adenomyosis were evident, including myo-\nmetrial cysts (Figure 1 CI), hyperechogenic islands (Fig-\nure 1 CII), subendometrial lines and buds (Figure 1 CIII) \nand an irregular junctional zone (Figure 1 CIV) [2–5]. \nOver the 24 months preceding hospitalisation the \npatient received pharmacotherapy with dienogest and \nvenoactive agents, started lifestyle modifications, and \nunderwent pelvic-floor physiotherapy [6, 7]. Despite \nthese measures, symptoms persisted.\nAs conservative management proved ineffective \nand the patient declined surgical intervention, she was \ndeemed eligible for simultaneous embolisation of the \nuterine arteries and ovarian veins. Eligibility was de-\nCorresponding author: \nFilip Szkodziak, MD, PhD, Third Chair and Department of Gynaecology, Medical University of Lublin, \nLublin, Poland, e-mail: filip.szkodziak@gmail.com\nSubmitted: 10.07.2025\nAccepted: 14.12.2025\n\nMenopause Review/Przegląd Menopauzalny 25(1) 2026\n53\ntermined in accordance with the Lublin Protocol for \nUterine Artery Embolisation by a multidisciplinary team \nof gynaecologists, interventional radiologists, and an-\ngiologists following pelvic magnetic resonance imaging \n(MRI) [8].\nSimultaneous embolisation of the uterine arteries \nand ovarian veins was performed by an interventional \nradiologist under local anaesthesia via a right trans-\nfemoral approach, with catheterisation of the common \nfemoral artery and vein. Venous intervention com-\nmenced with angiography of the left and right ovarian \nveins, followed by imaging of the iliac venous system; \nincompetent veins were subsequently embolised using \na sclerosing agent in conjunction with a coil. Arterial as-\nsessment of the uterine vascular bed was then under -\ntaken and uterine artery embolisation for adenomyosis \nwas performed using 500 μm particulate embolic ma-\nterial (Figures 2 A–D). At completion of the procedure, \nvascular access was secured by manual compression \nand application of a pressure dressing. \nThe patient was discharged on postoperative day \n2 following an uncomplicated perioperative course. At \nsix-month review, previously reported symptoms – ab-\ndominal, lumbar and hip pain, dysmenorrhoea, and \nmenorrhagia – had resolved completely. Postcoital ache \npersisted but with markedly reduced intensity, the Vi-\nsual Analogue Scale score declining from 7 to 3. After \ntwo months of oral iron replacement therapy, Hb con-\ncentration rose to 12.3–9.8 g/dl at admission. Follow-up \nMRI (Figure 3 A) demonstrated features of adenomyo-\nsis of diminished severity compared with the previous \nexamination, characterised by lower signal-intensity \nmyometrial foci on T1-weighted sequences (Figure 3 B), \nand there was no evidence of PeVD. Written informed \nconsent was obtained from the patient for publication \nof this case report and accompanying images.\nConclusions\nThe case presented herein delineates a novel ther -\napeutic strategy for a patient with CPP. Chronic pelvic \npain of complex aetiology is an increasingly prevalent \ncondition in both pre- and post-menopausal women; \nits heterogeneous pathophysiology, frequent comorbidi-\nties and variable clinical presentation render timely diag-\nnosis and effective management particularly challenging.\nWhether tumour markers such as CA-125 or CA19-9 \nshould be measured routinely in patients presenting \nwith CPP remains unresolved. In the case reported here, \novarian imaging furnished no oncological concern, and \ntherefore tumour-marker assays were not performed. \nFurthermore, the embolisation was undertaken in ac-\ncordance with the Lublin Protocol for Uterine Artery \nEmbolisation, and a preprocedural endometrial biopsy \ndemonstrated normal histology. Nonetheless, when \nclinical or radiological features raise the possibility of \nFigure 1. A) Transvaginal ultrasonography (TVUS) examination \nrevealing signs of pelvic venous disorders (PeVD) – dilatation \n(7.7 mm) of the left ovarian vein (cut-off diameter – 6 mm). \nB) TVUS examination revealing signs of PeVD – low blood flow \n(2.82 cm/s) in the left ovarian vein (cut-off velocity – 3 cm/s). \nC) TVUS examination revealing signs of adenomyosis – myo-\nmetrial cysts (I), hyperechogenic islands (II), subendometrial \nlines and buds (III) and irregular junctional zone (IV)\nA\nC\nB\n\nMenopause Review/Przegląd Menopauzalny 25(1) 2026\n54\ngynaecological malignancy, assessment of CA-125 and \nCA19-9 prior to intervention would be a prudent pre-\ncaution [9–11].\nTo our knowledge, this report constitutes the first \ndescription of simultaneous embolisation of the uterine \narteries and ovarian veins as a management strategy \nfor CPP secondary to PeVD and adenomyosis. Although \nthe efficacy and safety of this combined endovascular \napproach require confirmation in appropriately pow-\nered, well-designed clinical trials, it appears to repre-\nsent a promising therapeutic option for patients with \nCPP of complex, multifactorial aetiology.\nFigure 2. A) Embolisation of the left uterine artery (I). In the background, spirals used to embolize the left ovarian vein are visible (II).  \nB) Control angiography after the left uterine artery embolisation. No blood flow into the uterine vascular bed was observed. \nC) Embolisation of the right uterine artery (I). In the background, spirals used to embolize the left ovarian vein are visible (II). \nD) Control angiography after the right uterine artery embolisation. No blood flow into the uterine vascular bed was observed\nA\nC\nB\nD\n\nMenopause Review/Przegląd Menopauzalny 25(1) 2026\n55\nFigure 3. A) Pelvic magnetic resonance imaging (MRI) conducted before simultaneous embolisation of uterine arteries and ovar-\nian veins revealing features of adenomyosis. B) Pelvic MRI conducted after simultaneous embolisation of uterine arteries and \novarian veins revealing features of less severe adenomyosis (lower signal intensity myometrial foci on T1-weighted imaging)\nA B\nDisclosures\n1. Institutional review board statement: Not applicable. \n2. Assistance with the article: None. \n3. Financial support and sponsorship: None. \n4. Conflicts of interest: None.\nReferences\n1. Marcelin C, Le Bras Y, Molina Andreo I, Jambon E, Grenier N. Diagnosis \nand management of pelvic venous disorders in females. Diagnostics  \n(Basel) 2022; 12: 2337. \n2. Szkodziak F , Wozniak S, Szkodziak P , Pyra K, Paszkowski T. Noninvasive \ndiagnostic imaging of pelvic venous disorders. Ultraschall Med 2024; \n45: 597-603. \n3. 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