May-Thurner Syndrome Causing Chronic Pelvic Pain in an Active Young Woman

Patient Story:
Kaila S., a 30-year-old active professional, came in with long-term pelvic pain, lower back pain and pain during intercourse (dyspareunia). Her symptoms had gradually worsened, limiting her physical activity and daily life. At first, doctors thought the problem was gynecologic, but further testing showed something different – she had pelvic congestion syndrome caused by a blocked pelvic vein due to May-Thurner syndrome, a condition where one vein in the pelvis gets compressed by an overlying artery.

Diagnosis:
Imaging tests, including venography and intravascular ultrasound (IVUS), confirmed that her left iliac vein was severely narrowed, about an 80% area reduction, which restricted normal blood flow out of the pelvis. The blockage had forced blood to reroute through large “collateral” veins, a classic sign of pelvic venous congestion.

Treatment:
Kaila underwent angioplasty and stent placement, a minimally invasive procedure to open the narrowed vein and restore normal blood flow. The procedure was guided by IVUS to measure exactly how much the vein improved.

Results and Flow Improvement:
Before the procedure, her vein’s narrowed area caused a 97% drop in blood flow through the main pelvic vein. After treatment, the open vein allowed over 57 times more blood flow than before. That massive improvement explained why her pain and pressure improved so quickly.

On follow-up imaging, the enlarged collateral veins had disappeared, and normal central venous flow was fully restored.

Patient Outcome:
Kaila reported remarkable results:

• Her lower back pain resolved completely.
• Painful intercourse improved dramatically.
• She returned to running and dancing, free of pelvic pain.

“Since the procedure, my lower back pain has completely resolved, and the painful intercourse has significantly improved. Thanks to Dr. Magnant, I’m back to running – I can already do a 5K and I’m working toward a 10K. I’m also dancing again, and my pelvic pain is no longer an issue.” – Kaila S.

Why This Case Matters:
Chronic pelvic pain in women is often labeled as a gynecologic issue, but many cases are actually due to venous outflow obstruction – a circulatory condition that is both identifiable and treatable.

This case demonstrates 3 key lessons:

• Severe iliac vein compression can cause major pelvic vein enlargement and pain.
• IVUS accurately shows the true severity of blockage and guides effective treatment.
• Venous stenting restores blood flow, relieves pressure and rapidly eliminates symptoms.

Key Takeaway:
Even small changes in vein diameter can have a huge impact on blood flow. For patients – or their physicians – recognizing potential May-Thurner syndrome early can make the difference between chronic pain and complete recovery.