Among the common causes of chronic pelvic pain is a condition called pelvic congestion syndrome. This problem occurs when blood accumulates in the veins that run through the pelvis, resulting in chronic pain that affects the pelvic area. If you’re wondering if you could be suffering from pelvic congestion syndrome near Houston, then there are some additional indicators of which you should be aware. Common symptoms of pelvic congestion syndrome include:
Quick Answer: You could have pelvic congestion syndrome (PCS) if you have a dull, aching or heavy pelvic pain that has lasted six months or more, gets worse as the day goes on or after standing, and flares during or after intercourse, especially if you have had children or have varicose veins in the vulva, buttocks or upper thighs. PCS is caused by enlarged, refluxing veins around the ovaries and uterus. It is diagnosed with imaging such as pelvic ultrasound, MRI or CT venography and is often treated with a minimally invasive procedure called ovarian vein embolization.
- Backache
- Pelvic pain or heaviness with intercourse
- Varicose veins in the vaginal area or in the thighs or buttocks
- Tender lower abdominal area
- Frequent urination
- Abnormal or painful menstruation
- Feeling of swelling in the vagina or vulva
Pelvic congestion syndrome results from the formation of varicose veins around the ovaries, a problem which causes valves in the veins to fail. When these valves no longer function properly, this allows blood to back up and accumulate in the veins, resulting in painful symptoms. If you think that you may be suffering from pelvic congestion syndrome, talk to a vein specialist about your diagnosis and treatment options.
Meet your vein specialist
Dr. Syed Raza, MD
Vascular & Interventional Radiology · Founder, Premier Vein & Vascular Center
Fellowship-trained interventional radiologist, board certified in diagnostic and interventional radiology with a Certificate of Added Qualification (CAQ) in interventional radiology, and a Fellow of the Royal College of Radiologists (UK). Member of SIR and RSNA. Former Chief of Interventional Radiology at UTMB Galveston and Memorial Hermann Memorial City, with 15+ years treating varicose veins, venous reflux and peripheral arterial disease.
What Is Pelvic Congestion Syndrome?
Pelvic congestion syndrome is a cause of chronic pelvic pain in women that comes from the veins rather than from the uterus, ovaries or bowel themselves. The ovarian veins and the internal iliac veins drain blood out of the pelvis. When the valves in these veins weaken, or the veins become stretched, blood flows backward and pools. The pelvic veins swell, much like varicose veins in the legs, and that congestion produces a deep, dragging discomfort.
Doctors sometimes use the broader term pelvic venous disorders, because the same vein problem can show up in different ways: pelvic pain, varicose veins in the vulva or thighs, or leg varicose veins that keep coming back after treatment. PCS is most common in women of childbearing age, particularly after one or more pregnancies, and it often goes undiagnosed for years because standard gynecologic tests may look normal.
Why pregnancy matters
During pregnancy, the volume of blood flowing through the pelvic veins rises sharply, hormones relax the vein walls, and the growing uterus presses on the veins. The ovarian veins can stretch to several times their normal size. In many women they return to normal afterward, but in some the valves never close properly again. Each additional pregnancy adds to that strain, which is why PCS is seen much more often in women who have had more than one child.
How Pelvic Congestion Pain Feels
The pattern of the pain is often the strongest clue. Patients usually describe it as:
- A dull ache, heaviness or dragging feeling low in the pelvis, sometimes more on one side
- Pain that is mild in the morning and builds after hours of standing, walking or sitting upright
- Relief when lying down, especially with the hips raised
- Deep pain during intercourse, and an aching that can last for hours afterward
- Pain that worsens around the menstrual period or late in pregnancy
- Discomfort after long car rides, exercise or lifting
Many women also notice visible veins in places they did not expect: on the vulva, the inner or back of the thighs, or the buttocks. These veins are a sign that pressure from the pelvis is escaping downward. Some are told they have ordinary leg varicose veins, have them treated, and find they return within a year or two because the pelvic source was never addressed.
Pelvic Congestion Syndrome vs Other Causes of Pelvic Pain
Chronic pelvic pain has many possible causes, and PCS is often a diagnosis made after other conditions have been considered. Some women have more than one problem at the same time. The comparison below shows how PCS typically differs from conditions it is commonly confused with.
| Feature | Pelvic congestion syndrome | Endometriosis | Uterine fibroids |
|---|---|---|---|
| Underlying cause | Enlarged, refluxing pelvic veins | Tissue like the uterine lining growing outside the uterus | Benign muscle growths in the uterus |
| Typical pain | Dull, heavy ache that worsens with standing and eases lying down | Cramping or sharp pain, often severe around periods | Pressure, bloating, cramping |
| Bleeding pattern | Usually normal or mildly heavier periods | Painful periods, sometimes irregular spotting | Often heavy or prolonged periods |
| Other clues | Vulvar, buttock or thigh varicose veins; pain after intercourse | Pain with bowel movements, fertility concerns | Enlarged abdomen, frequent urination |
| Key tests | Pelvic duplex ultrasound, MRI or CT venography, venogram | Pelvic exam, ultrasound or MRI, laparoscopy | Pelvic ultrasound or MRI |
Because the symptoms overlap, we work closely with gynecologists and primary care doctors. If an evaluation points toward fibroids instead, our team also offers fibroid treatment with uterine fibroid embolization.
Who Is Most Likely to Develop Pelvic Congestion?
- Women between roughly their 20s and late 40s, before menopause
- Women who have had two or more pregnancies
- Those with varicose veins in the legs, especially veins that recur after treatment
- Women with a family history of vein disease
- Those with conditions that compress pelvic veins, such as narrowing of the left renal vein (nutcracker syndrome) or of the left iliac vein (May-Thurner syndrome)
- Women with a tilted (retroverted) uterus or polycystic ovaries, which have been associated with pelvic vein congestion
Symptoms often improve after menopause as estrogen levels fall, which is part of why hormones are thought to play a role in keeping the veins dilated.
When Pelvic Pain Needs Urgent Attention
Pelvic congestion pain is chronic and builds gradually. Sudden or severe symptoms are a different situation and should never be assumed to be PCS.
Call 911 or seek emergency care if you have:
- Sudden, severe pelvic or abdominal pain, especially on one side
- Pelvic pain with a positive pregnancy test or a missed period
- Heavy vaginal bleeding that soaks a pad every hour or causes dizziness or fainting
- Pelvic pain with fever, chills or vomiting
- Sudden swelling and pain in one leg, or new shortness of breath or chest pain
How We Evaluate Suspected Pelvic Congestion Syndrome
At Premier Vein & Vascular Center, PCS is evaluated as an interventional radiology problem: we are looking at the veins themselves and how blood is flowing through them.
- Focused history. We ask how long the pain has been present, what makes it worse or better, how it relates to your periods and intercourse, your pregnancies, and any vein treatments you have already had. We also review the gynecologic workup you have completed.
- Examination. We look for varicose veins on the vulva, buttocks, inner and back of the thighs, and legs, which can point to pelvic vein reflux as the source.
- Imaging of the pelvic veins. Depending on your situation, this may include a pelvic and transvaginal duplex ultrasound to measure vein size and reflux, and cross-sectional imaging such as MRI or CT venography to map the ovarian and iliac veins and look for compression. Ultrasound of the legs shows whether pelvic veins are feeding leg varicose veins.
- Confirmation at the time of treatment. A catheter venogram, done through a small needle puncture, remains the most direct way to see reflux in the ovarian and internal iliac veins and is usually performed together with embolization.
- A clear plan. We explain what the imaging shows, whether your symptoms fit the findings, and what treatment we recommend, if any.
Pelvic Congestion Syndrome Treatment Options
Ovarian and pelvic vein embolization
Embolization is the most widely used treatment for PCS and is performed by interventional radiologists. Through a tiny puncture in a vein in the neck or groin, a thin catheter is guided under X-ray to the enlarged ovarian vein, and sometimes to branches of the internal iliac veins. The faulty veins are then closed from the inside using small metal coils, a sclerosing agent, or both. Blood reroutes through healthy veins, and the pressure in the pelvic veins falls.
The procedure is done as an outpatient, typically with local anesthesia and light sedation, and usually takes about one to two hours. There is no surgical incision. Most women go home the same day and return to normal activity within a few days. Some pelvic aching or cramping for several days afterward is common and is managed with anti-inflammatory medicine. Symptom relief tends to build gradually over the following weeks and months as the congested veins shrink.
Medication and conservative options
Hormonal medications that suppress ovarian function and certain pain medicines can reduce symptoms in some women, but they tend to work only while they are taken and can cause side effects. Simple measures such as lying down with the hips raised, avoiding prolonged standing and wearing supportive compression shorts can ease discomfort while you decide on treatment.
Treating leg and vulvar varicose veins
Once the pelvic source is closed, remaining varicose veins in the vulva, buttocks or legs can be treated with ultrasound-guided foam sclerotherapy or other office procedures. Treating the pelvic source first lowers the chance that these veins return. More detail is on our pelvic congestion syndrome treatment page.
Questions to Ask Before Treatment
We encourage patients to come to their consultation with questions. Some of the most useful ones are:
- Do my imaging findings clearly match my symptoms?
- Which veins would be treated, and on which side?
- Is there any compression of the iliac or renal veins that needs to be addressed differently?
- Are there other causes of my pain that should be ruled out first?
- What should I expect in the first week after embolization?
- Would embolization affect a future pregnancy, and how much radiation is involved?
An honest conversation about these points helps set realistic expectations. Embolization relieves symptoms for many women with PCS, but pelvic pain can have more than one cause, and part of our job is to tell you when the veins are unlikely to be the main problem.
Easing symptoms while you decide on treatment
Many women want time to think, finish family planning or complete other tests before choosing a procedure. In the meantime, a few practical steps can make pelvic congestion more manageable. Lying down for 15 to 20 minutes with the hips raised on a pillow, especially after a long day on your feet, lets the pelvic veins drain and often eases the ache.
Supportive compression shorts or pelvic support garments help some women, particularly those with vulvar or upper thigh varicose veins. Breaking up long periods of standing, staying active with walking or swimming, and avoiding constipation, which raises pressure in the abdomen, are also worthwhile. Keeping a simple pain diary that notes your cycle, activity and any pain with intercourse gives your doctor a much clearer picture at the consultation. None of these steps treats the faulty veins, but they can reduce flares while you weigh your options.
When to See a Pelvic Congestion Specialist in Houston
If you have had pelvic pain for six months or longer, your gynecologic tests have not found a clear cause, and the pain worsens when you stand and improves when you lie down, a vein evaluation is a reasonable next step. The same is true if you have varicose veins on the vulva, buttocks or thighs, or leg veins that keep returning after treatment. At our vein clinic in Houston, Dr. Syed Raza, a fellowship-trained interventional radiologist and former Chief of Interventional Radiology at UTMB Galveston and Memorial Hermann Memorial City, evaluates and treats pelvic venous disorders. Patients from across Houston and Katy are seen, and same-week appointments are usually available.
Talk With a Specialist at Premier Vein
Have questions about your symptoms or treatment options? Dr. Syed Raza and the team at Premier Vein & Vascular Center can evaluate your concerns and explain your options clearly. Same-week appointments are usually available, and most insurance plans are accepted.
Frequently Asked Questions
How is pelvic congestion syndrome diagnosed?
Diagnosis starts with a careful history and examination, followed by imaging of the pelvic veins. A pelvic or transvaginal duplex ultrasound, MRI or CT venography can show enlarged, refluxing veins, and a catheter venogram confirms the findings, usually at the time of treatment.
Can pelvic congestion syndrome go away on its own?
Symptoms often ease after menopause as hormone levels fall, but before that the condition rarely resolves without treatment. Many women live with the pain for years, so it is worth getting evaluated if it is affecting your daily life.
Is ovarian vein embolization painful?
The procedure is done with local anesthesia and light sedation, so most women feel only pressure. Pelvic aching or cramping for several days afterward is common and is usually controlled with over-the-counter anti-inflammatory medicine.
Can pelvic congestion cause leg varicose veins?
Yes. Reflux in the pelvic veins can travel down through veins in the vulva, buttocks and inner thighs and feed varicose veins in the legs. This is a common reason leg varicose veins come back after treatment.
Can you get pregnant after pelvic vein embolization?
Embolization does not involve the uterus or ovaries themselves, and many women have had pregnancies afterward. Because the procedure uses X-ray guidance, it is important to discuss family planning and radiation exposure with your doctor beforehand.
What kind of doctor treats pelvic congestion syndrome?
Pelvic congestion syndrome is usually diagnosed and treated by an interventional radiologist or vein specialist, often working with a gynecologist who helps rule out other causes of pelvic pain.
Trusted Health Resources
- Varicose Veins and Spider Veins, MedlinePlus (NIH)
- Chronic Venous Insufficiency, Society for Vascular Surgery