Chronic Pelvic Pain Screen at The Venus Clinic

This screen is performed in collaboration with our partner clinic – The Harley Street Vascular Clinic. Chronic pelvic pain, heavy periods and painful intercourse in women of reproductive age are often due to problems with the circulation in the veins in the pelvis causing pelvic congestion. The screen includes:

Pelvic duplex ultrasound scan for pelvic disease and occlusion plethysmography for pelvic vein obstruction
Comprehensive female hormone profile and pelvic congestion syndrome risk scoring
Consultation with a senior consultant vascular surgeon

Chronic pelvic pain can be from pelvic congestion or a variety of gynaecological causes. In some 30% of women of reproductive age, this can be from varicose veins causing poor circulation in the pelvis, which usually develop after childbirth. Of course, other gynaecological conditions like fibroids and endometriosis can also co-exist with pelvic congestion.

The chronic pelvic pain screen at The Venus Clinic helps to screen for the underlying cause and directs you towards treatments from a vascular surgeon or a gynaecologist.

Who is this screen for?

If you are a woman between 21 and 50 years of age and suffer from chronic pelvic pain, heavy periods, painful intercourse or back pain and leg swelling and heaviness, especially around the time of your menses – then this screen is for you. If you have had a Mirena coil insertion or hormone treatment that made pelvic pain worse, had IVF for your pregnancy and then developed symptoms after childbirth or had varicose veins around the vagina or vulva or the groin during or after your pregnancy, then you have a high likelihood of having pelvic congestion syndrome.

This screening is done in stages over 3 days. Yes, we understand that this is frustrating in terms of time commitments for some of you, but each stage has tests that require you to prepare differently, hence need to be spaced out. In addition, pelvic duplex scans and 24-hour urine collection are ideally done when you are NOT having a period.

What tests does this screen contain?

Nurse assessment

For medical and obstetric history, pelvic congestion risk scoring, medication and vaccination history.

24 Urine test

For protein loss and blood cells – kidney function can be affected in some women with pelvic congestion.

Blood tests

Full blood count – low haemoglobin levels affect the ability of the circulation to carry oxygen; high white cell counts can signify infection
Glycated haemoglobin or HbA1C – a measure of average blood sugar control over 3 months
Kidney function – kidney function can especially be affected in pelvic congestion
Liver function
Thyroid function – poor thyroid function can affect energy levels and mental concentration, menses, and body weight
Lipid (cholesterol) profile – to assess circulation health.
Autoimmune antibody screen – to look for the risk of auto-immune vascular diseases, more prevalent in young women
Comprehensive female hormone profile

Pelvic duplex ultrasound scan

For abnormal blood flow in the pelvis and pelvic organ disease.

Occlusion plethysmography

A non-invasive simple screening test for pelvic problems causing restrictions to venous blood returning to the heart.

Consultation with a senior specialist vascular surgeon

To discuss results and develop a follow-up plan for approaches to your symptoms.

An MRI or CT scan of the pelvis (usually needs radiological contrast dye) is not a routine part of our pelvic screen due to exposure to pelvic radiation (in CT scans) in a woman of childbearing age, and the very small, yet real, risks of contrast allergy or toxicity. However, if the screening shows the presence of pelvic congestion or other pelvic organ disease, then we may recommend a CT or MRI scan. This is not a part of this screening package.

How do I prepare for this screen and how long does it take?

If you have booked this screen, you should have received instructions on what to expect via email or phone. If not, please call or WhatsApp the clinic at least 1 day before the screen at +65 86669639 during working hours to confirm the instructions.
Ideally, you should not be having a period on days 1 or 2 of the screening.
The screen is conducted over 3 days. Plan about 2-3 hours in the clinic on the first day, about 2 hours on the second day and 1 hour on the third day.
You will need to come in the morning on Day 1 having eaten a light breakfast. You may have any medication you normally have as prescribed. You will go home with a 24 hour urine collection bottle.
The day before day 2, you will need to collect a 24-hour urine sample – so please set a reminder. Hand in the bottle with a collected 24-hour urine sample on the morning of Day 2.
On Day 2 you should have fasted for at least 6 hours (no food), although you can have clear drinks (water, non-aerated drinks, black coffee or tea) for the pelvic ultrasound scan. You may have any medication you normally have as prescribed with sips of water.
On Day 3 (which can be scheduled to your convenience but would be at least 3-5 days after Day 2 to allow for all test results to come back in), you will see the specialist vascular surgeon for a consultation and discussion. Please eat and drink as normal on Day 3.

What can I expect on the screening days?

On Day 1 of the screen, you will first be registered for the screening.
You will then have your blood tests and nurse assessment. You will also be handed a bottle for a 24-hour urine collection.
You will now have your occlusion plethysmography test, after which you may go home. Please remember to take your 24-hour urine bottle and schedule your pelvic duplex scan for Day 2.
Start your 24-hour urine collection the day before Day 2, so you can hand in the sample bottle on the morning of your duplex scan.
On Day 2, you will have your pelvic duplex scan in two stages – first with a full bladder (we will help you fill it with a drink of a large glass of water if needed) and the second with an empty bladder. The second stage is usually done as an internal transvaginal scan. However, if you are not sexually active, or do not wish to have an internal scan, then it can also be done as an external scan (though a little less information is obtained). You may then go home.
On Day 3 you will have your specialist consultation with the senior vascular surgeon to discuss your results and recommendations. We shall endeavour to schedule this as per your convenience.

What if my screening detects a problem?

We will give you a detailed report and recommendations in writing to take away.
If screening results suggest you need further investigations or treatment, you will also be given a note for you to show your family doctor to make a formal referral to us. Further treatments or tests may not be covered by insurance if there is not a formal referral. We will, however, automatically enter you into our aneurysm follow-up programme.
Your screening results and reports are NOT shared by us with your doctor or any third party including your insurers or employers. Sharing your report results with other doctors, insurers or employers is for you to do as you deem fit but is recommended.

How often is a chronic pelvic pain screen needed?

A screen for pelvic congestion is needed as a one-off screen only.
However, regular screening with your gynaecologists or family doctors for women like breast screening, cervical smears and bone mineral density must continue at the appropriate intervals, even if our screening is negative for pelvic congestion.

you are covered

We are on the panel with most insurers in Singapore and with many international insurers; We also offer convenient options for self-paying patients.