Common Questions About Pelvic Congestion Syndrome

Pelvic congestion syndrome is a painful and distressing condition that occurs in women of childbearing years. If you are diagnosed with pelvic congestion syndrome in Houston, a vein specialist can offer treatments that provide relief. Here are the answers to some common questions patients have about pelvic congestion syndrome.

What Exactly Is Pelvic Congestion Syndrome?

Pelvic congestion syndrome occurs when varicose veins appear in the pelvis, causing discomfort. It is most common in women between the ages of 20 and 45 and may occur in up to 15% of women of childbearing age. Diagnosis is made using an ultrasound or venogram, during which dye is injected into the veins of the pelvis under x-ray guidance. Sometimes the distended veins can be noted on a laparoscopy, where an incision is made through the abdomen to insert a small camera that allows doctors to see inside of the pelvis. The cause of pelvic congestion syndrome, which is sometimes referred to as ovarian vein reflux, is unknown, but estrogen may play a role.

What Are the Symptoms?

Chronic pelvic pain is the most common symptom of pelvic congestion syndrome. The pain is usually described as a dull aching or heaviness; it can be constant or it may come and go. Many women have worsened symptoms with their menstrual cycle. Backaches, a swollen vulva, and pain during intercourse are also possible. Many women with pelvic congestion syndrome experience a vaginal discharge and abnormal or painful menstrual bleeding. Women with pelvic congestion syndrome may have other varicose veins as well. For some women, the symptoms of pelvic congestion syndrome are so severe that they interfere with their everyday lives and cause significant distress.

How Is Pelvic Congestion Syndrome Treated?

Over-the-counter pain medication can help to control the discomfort caused by pelvic congestion syndrome, but for long-term treatment, see a vein specialist. Treatments to prevent blood flow into the affected veins, so that it doesn’t pool there, can help. Minimally invasive procedures can be performed under x-ray guidance to block the blood flow to the veins in the pelvis can be performed. Your specialist will determine which treatment is right for you based on a number of different factors, including the severity of your symptoms.

Pelvic Congestion Syndrome Explained: How Pelvic Veins Fail

The pelvis is drained by a network of veins around the uterus, ovaries and bladder. These veins empty into the ovarian veins, which run up toward the kidneys, and into the internal iliac veins deeper in the pelvis. Like leg veins, the ovarian veins have one-way valves meant to keep blood flowing up toward the heart.

When those valves fail, or are absent, blood flows backward down the ovarian vein and pools in the veins around the uterus and ovaries. The veins widen and become varicose, in the same way leg veins do. Pressure builds when you are upright, and the swollen veins stretch the surrounding tissues and irritate nearby nerves. That is the source of the deep, dragging ache that women with pelvic congestion describe.

Pregnancy is a major contributor. During pregnancy the ovarian veins carry far more blood than usual and are compressed by the growing uterus, and the hormones of pregnancy relax the vein walls. After several pregnancies, some veins never return to their normal size. That is why pelvic congestion syndrome is seen most often in women who have had more than one child.

Compression syndromes that can contribute

In some women, a vein is squeezed between arteries rather than simply leaking. In nutcracker syndrome, the left renal vein is compressed between the aorta and another artery, which can push blood down the left ovarian vein. In May-Thurner syndrome, the left iliac vein is compressed by the right iliac artery. These are less common but important, because the treatment plan is different when a compression is the main problem. Careful imaging is how we tell the difference.

Who Gets Pelvic Congestion Syndrome?

Pelvic congestion syndrome is a condition of women before menopause, because estrogen plays a role in widening the veins. Symptoms often ease after menopause. The women we most often see share some of these features:

• Two or more previous pregnancies
• Varicose veins of the legs, especially unusual ones on the back of the thigh or inner thigh
• Visible veins on the vulva or buttocks, sometimes first noticed during pregnancy
• A family history of varicose veins
• Months or years of pelvic pain with normal results from standard gynecologic testing

Many women tell us they were told the pain was “nothing” or that they had to live with it. A normal pelvic exam and a normal standard ultrasound do not rule out pelvic congestion, because the veins can look normal when you are lying down and the scan is not looking specifically for reflux.

How Pelvic Congestion Pain Differs From Other Causes of Pelvic Pain

Chronic pelvic pain has many possible causes, and more than one can be present at the same time. These features can help a doctor narrow things down, but testing is still needed.

If fibroids turn out to be the main cause of your symptoms, Dr. Raza also treats them without surgery. You can learn more on our fibroid treatment page.

Pelvic Congestion Syndrome and Leg Varicose Veins

Pelvic vein reflux does not always stay in the pelvis. The refluxing veins can connect to veins of the vulva, perineum, buttocks and the back or inner thigh. Blood then flows downward into the legs and feeds varicose veins in unusual places.

This matters for anyone being treated for varicose veins. If leg veins keep coming back after treatment, or appear in a pattern that does not match the usual saphenous vein reflux, a pelvic source may be the reason. Treating the pelvic reflux first can make the leg treatment more successful and longer lasting.

How Pelvic Congestion Syndrome Is Diagnosed

Diagnosis is a step-by-step process. Each test adds information, and not every woman needs every test.

Pelvic venous duplex ultrasound

A transabdominal or transvaginal duplex ultrasound performed specifically to look at pelvic veins can measure vein size and show reflux. Doing the scan with the patient tilted upright, or while she bears down, makes reflux easier to see. This is different from a routine gynecologic ultrasound, which looks mainly at the uterus and ovaries.

CT or MR venography

Cross-sectional imaging shows enlarged pelvic veins and can reveal compression of the left renal vein or iliac veins. It also helps rule out other causes of pain.

Catheter venography

Venography is the definitive test and is usually performed in the same session as treatment. A thin catheter is placed into a vein through a small puncture in the neck or groin, and contrast dye shows the direction of flow in the ovarian and internal iliac veins under X-ray.

Ovarian Vein Embolization: What the Procedure Involves

Embolization closes the faulty veins from the inside so that blood reroutes through healthy veins. It is the same principle used to treat leg varicose veins, applied to the pelvis.

1. Preparation. You arrive fasting for a few hours. A pregnancy test is done, and some medications may need adjusting.
2. Access. After numbing the skin and giving light sedation, the interventional radiologist places a small tube in a vein in the neck or groin.
3. Venogram. Contrast dye maps the ovarian and pelvic veins and confirms which are refluxing.
4. Closure. Small metal coils, sometimes combined with a sclerosant foam, are placed into the refluxing veins to seal them. Both ovarian veins and some internal iliac branches may be treated.
5. Recovery. The catheter is removed, pressure is applied, and you rest for a short time before going home the same day.

Most women return to desk work and light activity within a few days. Cramping pelvic ache, similar to period pain, is common for several days and is managed with anti-inflammatory medication. Symptom improvement is usually gradual over the following weeks to months as the congested veins shrink. Any remaining vulvar or leg varicose veins can then be treated with ultrasound-guided foam sclerotherapy or other techniques.

Other treatment options

Hormonal medications that suppress the ovaries can reduce symptoms in some women but are not always well tolerated over the long term. Surgical ligation of the ovarian veins or hysterectomy are older approaches that are now used far less often because embolization is less invasive and avoids abdominal surgery.

Easing Pelvic Congestion Symptoms Day to Day

While you are being evaluated, or if you are not ready for a procedure, some simple measures can take the edge off pelvic venous pain. They work by lowering pressure in the pelvic veins or reducing the time you spend upright without moving.

• Lie down with your hips raised on a pillow for 15 to 20 minutes when the ache builds, especially in the late afternoon
• Break up long periods of standing with short walks, and sit when you can at work
• Use anti-inflammatory pain relievers around your period if your doctor says they are safe for you
• Try compression shorts or pelvic support garments, which some women find helpful for vulvar and upper-thigh veins
• Treat constipation and avoid heavy straining, which raises abdominal pressure
• Keep a simple symptom diary noting pain level, time of day, activity and your cycle to share at your visit

These steps do not close the leaking veins, so they rarely give complete relief, but they can make daily life more manageable. A symptom diary is also genuinely useful to us, because a clear pattern of pain that worsens with standing and improves lying down strongly supports a venous cause.

How We Evaluate Pelvic Pain at Premier Vein

1. Focused history. We ask about the type and timing of your pain, how it changes with standing and lying down, pregnancies, periods, intercourse, bladder and bowel symptoms, and any previous gynecologic workup.
2. Examination. We look for varicose veins of the legs, thighs, buttocks and vulva and review prior imaging reports.
3. Targeted imaging. A pelvic and leg venous duplex ultrasound is performed in our in-office vascular lab, with CT or MR venography arranged when compression syndromes or other causes need to be ruled out.
4. A clear plan. We explain whether the findings fit pelvic congestion syndrome, whether embolization is likely to help, and how it fits with care from your gynecologist or primary doctor.

When to See a Pelvic Vein Specialist in Houston

If you have had pelvic pain for six months or more that is worse after standing and better lying down, especially with vulvar, buttock or unusual thigh veins, it is reasonable to ask for a pelvic vein evaluation. Our vein clinic in Houston, led by fellowship-trained interventional radiologist Dr. Syed Raza, evaluates and treats pelvic congestion syndrome with minimally invasive techniques. Learn more on our pelvic congestion syndrome page. Same-week appointments are usually available, and most insurance plans, including Medicare, are accepted.

Frequently Asked Questions

Can pelvic congestion syndrome affect fertility?

Pelvic congestion syndrome itself is not considered a cause of infertility. The pain can, however, affect quality of life and intimacy. If you are planning a pregnancy, discuss timing of any embolization with your doctor beforehand.

Is ovarian vein embolization painful?

The procedure is done with local anesthetic and light sedation, so most women feel only pressure. Cramping similar to period pain is common for a few days afterward and is usually controlled with anti-inflammatory medication.

Can pelvic congestion syndrome come back after treatment?

Many women have lasting relief after embolization, but new reflux can develop over time, particularly after another pregnancy. If symptoms return, repeat imaging can show whether additional veins need treatment.

Why did my regular pelvic ultrasound not show pelvic congestion?

Routine pelvic ultrasounds are done lying down and focus on the uterus and ovaries. Pelvic veins often look normal when you are lying flat, so a dedicated venous duplex study, CT or MR venography or a venogram is usually needed.

Does pelvic congestion syndrome go away after menopause?

Symptoms often improve after menopause as estrogen levels fall and the veins become less engorged. However, enlarged veins may persist and can continue to feed varicose veins in the legs.

What kind of doctor treats pelvic congestion syndrome?

Pelvic congestion syndrome is usually treated by an interventional radiologist or vascular specialist who performs ovarian vein embolization. Gynecologists often help rule out other causes of pelvic pain and may refer patients for venous evaluation.

Trusted Health Resources

1. Varicose Veins and Spider Veins, MedlinePlus (NIH)
2. Chronic Venous Insufficiency, Society for Vascular Surgery