Vaginal varices in post-menopausal woman: A rare entity

Abstract

Post-menopausal bleeding occurs in 4-11% of post-menopausal women with the most common cause being endometrial atrophy followed by malignancies of genital tract. Vaginal varices are a rare cause and are usually seen in pregnant women. They are less common than vulval varicosities which occur in 2-4%of pregnancies. Other causes of vaginal varices are portal hypertension, pelvic congestion syndrome and Klippel-Trenaunay syndrome. Here we report a post-menopausal woman with vaginal varices without any evidence of liver disease nor pelvic congestion syndrome. A 71-year-old multipara presented with complaints of post-menopausal bleeding for 2 years. She gave typical history of passage of gush of fresh blood followed by spontaneous resolution within minutes. She had these episodes at an interval of 2 to 3 weeks for which she underwent total abdominal hysterectomy. There was no evidence of malignancy in histopathology. However, 7 months following surgery the symptoms recurred. On examination she was not pale and a pelvic examination was unremarkable except a 3*3 cm bluish swelling seen in the anterior vaginal wall. Ultrasound with doppler revealed increased vascularity around vagina. CT angiography was performed which showed a vaginal varix draining into left internal iliac vein. The patient was planned for embolization by transfemoral catheterization and feeding vessel was selectively embolized. Post -embolization the varix resolved, patient was discharged and is currently asymptomatic. Vaginal varices should be kept as a differential in post-menopausal bleeding especially when the discharge consists of fresh blood. Early recognition and treatment can also avoid unwanted hysterectomies.