Performed at The Venus Clinic in Singapore by vascular specialist Dr Sriram Narayanan, pelvic vein embolisation is a minimally invasive, image-guided treatment for pelvic venous disorder (PeVD).
If you have been living with chronic pelvic heaviness, unexplained varicose veins around your thighs, or deep discomfort that worsens after standing, you may be dealing with pelvic venous insufficiency. Often described as “varicose veins in the pelvis,” this vascular condition may be treated in Singapore with a procedure called pelvic vein embolisation.
an Introduction
Pelvic vein embolisation is a minimally invasive, image-guided procedure that addresses pelvic venous disorder (PeVD), also widely known as pelvic congestion syndrome. If you experience chronic pelvic heaviness, discomfort that flares during prolonged standing, or pain during and after intercourse, these symptoms can significantly affect daily life.
This procedure targets the underlying vascular cause of symptoms rather than masking them with medication alone.
They drain venous blood away from the uterus, ovaries, and surrounding pelvic structures back toward the heart. Inside these veins, small one-way valves prevent blood from flowing backwards. When these valves become incompetent (meaning they no longer close properly), blood begins to flow in the wrong direction. This is called retrograde flow, or reflux.
Blood accumulates in the ovarian veins and their pelvic tributaries, causing them to dilate and become engorged. This creates sustained venous hypertension (raised blood pressure within the pelvic veins). Over time, this increased pressure leads to the chronic aching, heaviness, and fullness that characterise PeVD.
A vascular surgeon navigates a catheter (a thin, flexible tube) into the incompetent veins and deploys embolic agents, such as metallic coils or sclerosant solutions, to close them. Once sealed, these veins can no longer carry refluxing blood. The body then naturally redirects venous drainage through healthy, competent pathways.
Not everyone with pelvic pain will require embolisation. Candidacy depends on a careful evaluation of your symptoms, their duration, and a confirmed vascular cause.
Symptom patterns that suggest a pelvic venous origin include:
If three or more of these patterns sound familiar, a specialist vascular assessment can confirm whether pelvic venous disorder is the underlying cause.
Many gynaecological and urological conditions share overlapping symptoms with PeVD. Endometriosis, uterine fibroids, ovarian cysts, interstitial cystitis, and musculoskeletal pelvic floor dysfunction can all produce chronic pelvic discomfort. Before embolisation is considered, these conditions must be assessed and either excluded or identified as co-existing factors.
Dr Sriram Narayanan, MBBS, MS (Surgery), FRCS (Glasgow), FRCS (Gen Surg), Dip Lap Surgery (France) — a Senior Consultant Vascular and Endovascular Surgeon practising at Gleneagles Hospital and Mount Elizabeth Novena Hospital — leads The Venus Clinic team with a comprehensive approach that addresses both the medical and psychosocial dimensions of pelvic venous disorder. His evaluation protocol integrates pelvic floor assessments alongside vascular imaging to ensure the full clinical picture is understood before any procedural decision is made. Dr Narayanan brings over two decades of vascular and endovascular surgical experience across the United Kingdom and Singapore to every patient assessment.
Definitive candidacy requires specialist imaging. Specialist imaging is required to confirm the presence and pattern of pelvic venous reflux before proceeding. Duplex ultrasound is commonly used as an initial screening tool, while cross-sectional venous imaging (CT or MR venography) and diagnostic venography provide more definitive anatomical detail, with catheter-directed venography considered the gold standard for diagnosis and often performed immediately prior to treatment.
A specialist vascular assessment can deliver diagnostic clarity on whether pelvic venous insufficiency is the confirmed cause. No GP referral is required, and every enquiry is reviewed by our team directly, not a call centre. Contact us today and speak with a vascular specialist within 48 hours.
Your specialist will review your imaging findings, confirm the treatment plan, and discuss any medications that may need adjusting. You will typically be asked to fast for several hours beforehand. Bring a list of your current medications and any relevant imaging from prior assessments.
A note on expectations. Understanding that this procedure targets a specific vascular problem can help contextualise years of unexplained symptoms. A confirmed diagnosis provides a clinical explanation and a pathway forward.
Why thorough imaging matters. Many women spend years being told that their chronic pelvic pain is “just hormonal,” “stress-related,” or a normal part of their reproductive life. This means PeVD may be undiagnosed or misattributed to gynaecological conditions alone. A dedicated vascular assessment is essential to differentiate pelvic venous insufficiency from other conditions with similar symptom profiles.
The procedure is performed in a catheterisation laboratory (also called an interventional suite) equipped with fluoroscopic imaging. Here is what happens at each stage.
The specialist gains access through a tiny puncture, usually in the neck (internal jugular vein) or groin (femoral vein). Using the neck approach allows for a smoother, more direct path to the pelvic veins, often resulting in a faster procedure.
Using real-time X-ray guidance (fluoroscopy), a thin catheter is advanced through the venous system toward the target pelvic veins, including the ovarian veins and any dilated internal iliac tributaries contributing to reflux.
Once the catheter is positioned within the target vessel, contrast dye is injected to create a real-time map of the incompetent veins, their branches, and the direction of blood flow. This step confirms which vessels require treatment and identifies any collateral pathways.
The specialist deploys embolic materials to seal the dysfunctional veins. This may involve:
The choice of agent depends on vessel diameter, anatomy, and clinical judgement.
After embolisation, additional venography confirms that reflux has been eliminated and that blood flow is appropriately redirected. The catheter is then removed, and gentle pressure is applied to the access site.
The entire procedure is conducted under continuous imaging guidance, allowing precise targeting and minimising the risk of non-target embolisation.
Pelvic vein embolisation is typically performed under conscious sedation or local anaesthesia rather than general anaesthesia. You will be awake but relaxed throughout.
What you may feel. Some patients notice a sensation of warmth or mild pressure when contrast dye is injected. Brief cramping in the pelvis may occur as embolic agents are deployed, particularly if sclerosant is used. These sensations are expected and generally short-lived.
What to communicate. If you experience sharp pain, sudden chest discomfort, or difficulty breathing at any point, inform the procedural team immediately. Your vital signs are monitored continuously, and the sedation level can be adjusted to maintain your comfort.
| Time After Procedure | What to Expect | Activity Guidance |
| Day 0 (Procedure Day) | Observed in recovery for a few hours post-procedure. Mild tenderness or bruising at the access site (neck or groin). Most patients discharged the same day; occasional overnight stay depending on complexity. | Rest for the remainder of the day. Eat and drink normally after sedation wears off. A companion is advised for the journey home. Avoid driving on the day of the procedure. |
| Days 1–14 (Weeks 1–2) | Pelvic aching or heaviness is a normal response as embolised veins begin to scar closed. Post-Embolisation Syndrome (temporary flu-like feeling, mild fever, or nausea) may occur and is usually self-limiting. | Light daily activities can resume within a few days. Avoid heavy lifting, strenuous exercise, and prolonged standing. Report persistent fever, worsening pain, or any concerns to your care team promptly. |
| Weeks 2–6 | Sealed veins continue to close fully; blood flow redistributes through healthy vessels. Some patients notice early symptom relief; others experience gradual improvement over weeks. | Most patients can return to normal activity around one week post-procedure. More demanding activities should be resumed only on specialist advice. |
| Beyond 6 Weeks | Continued symptom improvement expected; studies show sustained clinical benefit at 1, 2, and 3 years. Follow-up imaging confirms vein occlusion and checks for residual reflux. | Full activity as cleared by your specialist. Attend your scheduled follow-up (typically around 6 weeks), which may include duplex ultrasound or other imaging to confirm vein occlusion and track symptom progress. |
While serious complications are uncommon, certain signs warrant immediate specialist contact:
These symptoms require prompt assessment to rule out events such as access-site infection, deep vein thrombosis, or coil migration. Contact your specialist team if something feels wrong.
For urgent concerns within 30 days of your procedure, contact The Venus Clinic on +65 8666 9639 or proceed to your nearest A&E if you experience severe pain, chest tightness, or difficulty breathing.’
Structured post-procedural follow-up, including imaging review, provides objective confirmation of vascular occlusion and supports a clearly defined recovery pathway.
| Treatment | Anaesthesia | Recovery | Addresses Root Cause? | Day Surgery? |
| Pelvic Vein Embolisation | Local anaesthetic with conscious sedation | Return to light activity within days; most resume normal activity ~1 week | Yes — occludes incompetent veins directly | Yes — same-day discharge in most cases |
| Hormonal Therapy | None | Ongoing medication; symptoms may return on stopping | No — manages hormonal drivers only; does not correct venous reflux | N/A — outpatient prescription |
| Open Surgical Ligation | General anaesthesia | At least 2 days hospitalisation; 2 days to several weeks recovery | Yes — physically ties off incompetent veins | No — requires hospital admission |
| Laparoscopic Vein Clipping | General anaesthesia | Shorter than open surgery but still requires hospitalisation and recovery period | Yes — clips incompetent veins; may miss tributary reflux pathways | No — requires hospital admission |
| Conservative Management (NSAIDs, physiotherapy, compression) | None | Ongoing; no procedure-related downtime | No — symptom management only; does not treat venous reflux | N/A — outpatient |
Understanding the alternatives helps you make an informed decision alongside your specialist.
Incompetent ovarian veins can be surgically tied off through an open abdominal incision. This approach involves general anaesthesia, a longer recovery period, and a different risk profile compared to catheter-based techniques.
A minimally invasive surgical option that clips the ovarian veins using keyhole instruments. While less invasive than open surgery, it still requires general anaesthesia and may not address all tributary reflux pathways as comprehensively as selective catheter-directed embolisation.
For mild symptoms, non-steroidal anti-inflammatory medications, pelvic floor physiotherapy, and lifestyle modifications such as compression garments or activity pacing may provide partial relief. These measures manage symptoms but do not treat the underlying venous reflux. Consult your healthcare professional before commencing any medication.
Patients often arrive at a vascular assessment after years of treatment for presumed endometriosis, fibroids, or irritable bowel syndrome. Embolisation addresses a distinct vascular cause when the confirmed cause is venous. When pelvic congestion coexists with gynaecological conditions, a combined management approach may be appropriate.
Hormonal medications used in PeVD management include progestins, which help counter the vasodilatory effects of oestrogen on pelvic vein walls, and gonadotropin-releasing hormone (GnRH) analogues, which suppress ovarian hormone production to reduce the hormonal drivers of venous dilatation. While these may provide symptom relief for some women, they target symptoms rather than the underlying venous anatomy. Speak with your healthcare professional regarding suitability for any hormonal medication.
Symptoms may return once medication is discontinued, and long-term hormonal suppression carries its own side-effect profile. Speak with your healthcare professional regarding suitability for any hormonal medication.
The total cost of pelvic vein embolisation depends on several factors and varies from patient to patient. A personalised clinical assessment is necessary for accurate pricing.
Pelvic vein embolisation is a specialised interventional procedure performed in a catheterisation laboratory. While an authoritative published benchmark for this specific procedure is not currently available from Singapore’s health authority bill information portal (TOSP code SI703O), the overall cost at private facilities — inclusive of specialist fees, facility charges, consumables, and follow-up — is best discussed directly with your care team at the time of your consultation, as it varies by case complexity and provider. Your specialist’s clinic will provide a transparent cost estimate prior to your procedure.
Pelvic vein embolisation is listed under the Table of Surgical Procedures (TOSP) as a claimable surgical procedure (TOSP code SI703O). Medisave can be used for day surgery procedures, with withdrawal limits based on the TOSP ranging from $240 to $5,290 depending on the complexity of the surgery. The applicable withdrawal amount for your procedure will depend on which TOSP table the procedure is classified under. Your care team can confirm the applicable TOSP table and estimated Medisave withdrawal amount during your pre-procedure assessment.
MediShield Life is designed to cover subsidised bills at Class B2/C wards in public hospitals and subsidised day surgery. If you are treated at a Class A/B1 ward or a private hospital, MediShield Life still applies but covers a smaller portion of the bill, and you will need to meet the balance through Medisave and/or cash. Subject to your annual deductible and co-insurance, MediShield Life can contribute to your surgical claim.
An Integrated Shield Plan provides optional additional coverage beyond MediShield Life, and typically covers medically necessary day surgery including operating theatre fees, specialist fees, anaesthetist fees, and standard inpatient medications and consumables. If you hold an IP covering private hospital day surgery, your out-of-pocket expenses may be substantially reduced. Coverage scope, deductibles, and co-insurance percentages differ between insurers and plan tiers — check with your insurer or ask the clinic team to assist with pre-authorisation before your procedure.
Your total bill will generally cover the procedure itself, embolic materials used, catheterisation laboratory charges, specialist and sedation fees, and the immediate post-procedural recovery period. Items that may be billed separately include pre-procedural imaging, specialist consultation fees, follow-up duplex ultrasound, and any additional procedures required if further reflux is identified. Confirm what is included in any quote provided to you.
Contact the clinic to discuss your case, obtain a fee estimate, and clarify Medisave, MediShield Life, and IP applicability before your procedure. The care team can assist with insurance pre-authorisation where required.
Published studies report mean clinical improvement scores of approximately 80% at 45 days post-procedure, with sustained improvement maintained at one, two, and three-year follow-up. Clinical success rates across published series range from 96.7% to 98%, with full remission of symptoms in over half of patients and partial remission in over 90%. For many women, the goal of pelvic vein embolisation is to reduce chronic pelvic pain and its impact on daily activities.
Individual outcomes depend on your specific anatomy, the severity and duration of your venous reflux, how completely the embolisation addresses all contributing vessels, and whether co-existing conditions also contribute to your symptoms. Some women may experience substantial relief; others may notice moderate improvement. A proportion may require additional treatment sessions or complementary therapies.
Discuss realistic expectations with your specialist. Dr Sriram Narayanan approaches outcome discussions with transparency, ensuring patients understand both the potential benefits and the limitations of the procedure within the context of their individual presentation.
Several biological and clinical variables can affect how much relief you experience and how quickly it arrives:
These factors underscore the importance of thorough pre-procedural assessment and realistic goal-setting with your treating specialist.
Every medical procedure carries potential risks. Transparency about these risks is essential for informed consent.
Bruising and mild discomfort at the puncture site are common and self-limiting. For jugular access — the most commonly used approach — specific risks include inadvertent carotid artery puncture and, rarely, pneumothorax; ultrasound guidance during puncture is used to minimise these. For femoral access, haematoma or localised infection may occasionally develop. A pseudoaneurysm at the access site is a rare possibility with any vascular puncture and would require additional management if it occurred.
There is a small risk that embolic material could migrate to an unintended location. Meticulous catheter positioning, real-time imaging guidance, and careful agent selection aim to minimise this risk.
Metallic coils are designed to remain anchored within the target vessel. Rarely, a coil may shift position — in reported cases, the pulmonary circulation is the most common site of migration. Most migrated coils are either retrieved endovascularly or remain asymptomatic without further consequences.
Catheter manipulation within delicate venous structures carries a low risk of vessel wall injury. This is managed through a gentle technique and continuous fluoroscopic guidance.
Thrombosis of the parametrial or uterine veins adjacent to the embolised vessels can occur following the procedure, reported in a meaningful proportion of patients. This is often subclinical — meaning it may not cause noticeable symptoms — but your specialist will monitor for signs of deep vein thrombosis, including calf pain or swelling, which warrants prompt assessment.
Some patients may experience mild allergic reactions to the iodinated contrast dye used during venography. Severe reactions are rare. If you have a known contrast allergy, inform your specialist before the procedure.
Fluoroscopy involves X-ray exposure. The procedural team uses established protocols to minimise radiation dose while maintaining image quality.
Symptoms may return if collateral reflux pathways develop over time or if not all incompetent tributaries were addressed during the initial treatment. Follow-up imaging helps identify recurrence early.
Co-existing conditions may mean that venous treatment alone does not fully resolve all pelvic symptoms.
Dr Sriram Narayanan manages these risks through meticulous technique, intravascular ultrasound guidance where indicated, and comprehensive procedural planning. His approach combines imaging with careful haemodynamic assessment throughout the treatment process.
Most patients report mild discomfort rather than significant pain. Conscious sedation and local anaesthesia are used to maintain comfort. Brief cramping or warmth during the procedure may occur.
Typically under 45 minutes for straightforward cases, though more complex presentations involving multiple tributaries may extend to approximately one hour.
Many patients go home the same day after a period of observation. Your specialist will advise based on your individual case.
The impact of ovarian vein embolisation on ovarian reserve and fertility has not been conclusively established. A small study reported that 66.7% of women became pregnant following the procedure, with the majority progressing to live births. However, a 2025 study found that a procedure-related decline in AMH levels in younger patients cannot be ruled out, and recommends that fertility expectations and ovarian reserve be discussed prior to treatment — particularly for women under 30. If fertility is a concern, ovarian-vein-sparing approaches and timing relative to family planning should be discussed with your specialist before proceeding.
Recurrence is possible if collateral reflux pathways develop or if not all incompetent tributaries are addressed. Structured follow-up imaging helps detect this early so that repeat embolisation can be planned if needed.
Many women return to desk-based work within three to five days and to more physically demanding roles within two to four weeks. Your specialist will advise based on your individual recovery.
The principle is similar. Both involve closing incompetent veins to redirect blood through healthy pathways. Pelvic vein embolisation requires catheter-based access and treats deeper, internal vessels.
If symptoms persist, your specialist will investigate whether residual reflux exists, whether additional tributaries require treatment, or whether a co-existing condition needs separate management.
In Singapore, you can typically seek a specialist consultation directly, though a referral from your GP or gynaecologist may streamline the process and ensure relevant medical records are available.
A systematic review of 2,038 patients found that transcatheter embolisation has a high technical success rate of 94% with low complication rates, the majority of which were minor. Serious complications are uncommon, and the procedure is widely regarded as safer than open surgical alternatives.
Studies report clinical improvement in the majority of patients, with all included studies in one systematic review showing a reduction in pain scores following the procedure.
Yes — pelvic vein embolisation is listed under the Table of Surgical Procedures (TOSP code SI703O) as a Medisave-claimable day surgery procedure. Medisave withdrawal limits for surgical procedures range from $240 to $5,290 depending on procedural complexity. The applicable amount for your case can be confirmed with your care team prior to the procedure.
Pelvic vein embolisation is performed by interventional radiologists — vascular specialists trained in catheter-based procedures guided by real-time imaging. Dr Sriram Narayanan is a senior interventional radiologist in Singapore with specific expertise in pelvic venous disorders, offering assessment, embolisation, and structured follow-up care.
Structured imaging follow-up, typically with duplex ultrasound at around six weeks, confirms that treated veins remain sealed and monitors for any new reflux pathways. Report any return of symptoms to your specialist promptly. Lifestyle considerations — regular movement, avoiding prolonged static postures, and pelvic floor health — may complement the procedural outcome over time.
Chronic pelvic pain traced to venous reflux is a diagnosable, treatable condition — and for most women, pelvic vein embolisation offers a day-surgery solution that addresses the root cause without open surgery or general anaesthesia. Based on current evidence, embolisation provides better long-term pain relief than medical therapy alone and can be performed as a day surgery procedure concurrently with diagnostic venography. If you have been living with unexplained pelvic pain, a specialist assessment is the right next step.
Key Takeaways
Dr Sriram Narayanan Consultant Interventional Radiologist | Subspecialty expertise in pelvic venous disorders | Structured imaging-guided care from diagnosis to follow-up
Senior Vascular and Endovascular Surgeon
The Venus Clinic is led by Dr Sriram Narayanan (Dr Ram), a Senior Vascular and Endovascular Surgeon with over two decades of clinical experience in vascular surgery in the United Kingdom and Singapore.
Dr Ram was among the first surgeons in Singapore to develop vein stenting, intravascular ultrasound (IVUS), and duplex ultrasound assessment protocols for Pelvic Congestion Syndrome. He has published extensively on vascular disease and has served as a faculty member and trainer at international vascular and vein conferences, including training programmes in the UK and Asia focused on pelvic duplex ultrasound for PCS.
If you would like to discuss your symptoms or enquire about a consultation, please contact us by phone, WhatsApp, or email. You may also complete the enquiry form on our Contact page. A GP referral is not required to make an initial enquiry.
VISIT US
Led by Dr Sriram Narayanan
Director , Senior Consultant Vascular & Endovascular Surgeon
