Get the Facts About Pelvic Congestion Syndrome

Pelvic congestion syndrome is a common but often misunderstood condition that affects women in their childbearing years. It is associated with varicose veins in the pelvic region, including around the ovaries, uterus, and vulva, and causes chronic pelvic pain. Fortunately, treatments similar to those that treat varicose veins in the legs can ease the symptoms. If you have been diagnosed with pelvic congestion syndrome in Houston, here are the facts you need to know.

What Causes Pelvic Congestion Syndrome?

Pelvic congestion syndrome is caused by varicose veins in the pelvis that appear for the same reasons they develop in other parts of the body. The valves in the veins in the pelvic region may weaken, which allows blood that is supposed to travel back to the heart to instead pool in the veins. The excess blood causes the veins to swell, in this case pressing against structures in the pelvis. This kind of venous insufficiency is fairly common in women between the ages of 20 and 50, but not every woman with varicose veins in the pelvis will experience symptoms. What causes the vein valves to weaken is not known, but hormone fluctuations, multiple pregnancies, and polycystic ovary syndrome may all play roles.

What Are the Symptoms?

Chronic, dull, aching pain in the lower back and abdomen is the most common symptom of pelvic congestion syndrome. The pain typically intensifies during menstruation, after long periods of standing, and after intercourse. It may also get worse during pregnancy. Some women also experience abnormal bleeding or vaginal discharge, irritable bladder, and varicose veins around the buttocks and thighs. Pelvic congestion syndrome can be challenging to diagnose. After other conditions have been ruled out, imaging tests can help doctors pinpoint varicose veins in the pelvis.

What Treatments Are Available?

A vein specialist can treat pelvic congestion syndrome using treatments that resolve varicose veins in other parts of the body. After treatment, most women experience a dramatic improvement in their symptoms. Other treatments, including pain medications and birth control pills, can also help control symptoms.

Pelvic Congestion Syndrome Explained: Why the Veins Matter

Most people think of varicose veins as a leg problem, but the same process can happen deep in the pelvis. The ovaries drain through a pair of long veins, the ovarian veins, which run up the back of the abdomen. On the left side, the ovarian vein empties into the left kidney vein; on the right, it drains directly into the large vein called the inferior vena cava.

These veins have valves that should keep blood moving upward. When the valves fail, blood flows backward down the ovarian vein and fills a network of veins around the uterus, ovaries and vulva. Pregnancy makes this more likely because blood volume rises sharply and the veins can stretch to many times their normal size, and they do not always return to normal afterward. Over time, the pelvic veins stay swollen, and the stretched vein walls and the pressure they create on surrounding tissue produce pain.

Patients are often relieved to hear that their pain has a physical, visible cause. Many women with PCS have been told for years that their tests are normal, because standard scans done lying flat can miss veins that only fill when a person is upright.

Compression Syndromes That Can Cause Pelvic Venous Congestion

Not all pelvic venous congestion comes from faulty valves. Sometimes a vein is squeezed by an artery or another structure, and blood backs up into the pelvis. The two compression patterns we look for most are:

Nutcracker syndrome

The left kidney vein crosses between two large arteries, the aorta and the superior mesenteric artery. If it is pinched there, blood from the left kidney and left ovarian vein has difficulty draining and is diverted down into the pelvis. Some patients with this pattern also notice flank pain or blood in the urine.

May-Thurner syndrome

Here the right iliac artery crosses over and compresses the left iliac vein, which drains the left leg and pelvis. This can cause left leg swelling, pelvic congestion, and in some cases a deep vein thrombosis in the left leg.

Identifying a compression problem matters because the treatment plan can differ. Closing the ovarian veins alone may not be enough if a blockage further up is driving the congestion.

Pelvic Congestion Syndrome vs. Other Causes of Pelvic Pain

Chronic pelvic pain has many possible causes, and several can exist together. That is why PCS is usually diagnosed in partnership with a gynecologist after other conditions have been considered. Some features help tell them apart.

If fibroids are part of the picture, they are also treatable without surgery through uterine fibroid embolization, another interventional radiology procedure.

Signs That Point Toward Pelvic Congestion Syndrome

Beyond pelvic pain, there are a few clues that make us think about the veins specifically:

• Pain that is mild in the morning and steadily worse by evening, or after a long shift on your feet
• Pain that eases noticeably when you lie down or raise your hips
• An aching or throbbing feeling that lasts for hours after intercourse
• Visible varicose veins on the vulva, buttocks, back of the thigh or inner thigh
• Leg varicose veins that keep coming back after treatment
• Symptoms that began or worsened after one or more pregnancies

Recurrent leg varicose veins deserve special mention. When pelvic veins leak, they can feed varicose veins in the legs through small connections in the groin and upper thigh. Treating only the leg veins in that situation often leads to recurrence, so finding the pelvic source is important.

How We Evaluate Pelvic Congestion at Premier Vein

Because PCS can look like many other conditions, the evaluation is careful and stepwise. At Premier Vein & Vascular Center, it usually involves:

1. Detailed history. We ask about the pattern of your pain, how it relates to standing, periods and intercourse, past pregnancies, prior imaging and treatments, and any leg or vulvar varicose veins.
2. Review of gynecologic findings. We coordinate with your gynecologist so that conditions such as endometriosis, fibroids and infection have been considered.
3. Duplex ultrasound. A pelvic venous ultrasound can show dilated veins around the uterus and ovaries and reversed flow in the ovarian veins. We often also scan the legs for reflux connected to the pelvis.
4. Cross-sectional imaging when needed. CT or MR venography maps the pelvic veins and checks for compression of the left kidney vein or the left iliac vein.
5. A clear plan. We explain what the imaging shows, whether embolization is likely to help, and whether a catheter venogram should be done to confirm the findings at the time of treatment.

Treatment Options for Pelvic Congestion Syndrome

Ovarian vein embolization

Embolization is the main minimally invasive treatment for PCS caused by leaking ovarian or internal iliac veins. It is performed by an interventional radiologist through a small puncture, usually in the neck or groin, under local anesthesia and light sedation. A thin catheter is guided into the abnormal veins using X-ray imaging. The veins are then closed with small metal coils, a sclerosing agent, or both, so blood can no longer flow backward into the pelvis. There is no incision, and patients usually go home the same day.

In the days afterward, some women feel pelvic aching or a low-grade fever as the veins close, which is usually managed with anti-inflammatory medication. Most return to desk work and light activity within a few days. Pain relief tends to develop gradually over the following weeks to months as the congested veins shrink. You can read more on our pelvic congestion syndrome treatment page.

Treating compression

When a vein compression such as May-Thurner syndrome is the main cause, treatment may involve opening the narrowed vein with a balloon and stent, decided case by case after imaging.

Treating leg and vulvar veins

Once the pelvic source is closed, any remaining leg or vulvar varicose veins can be treated with sclerotherapy or other office-based procedures, with a much lower chance of them returning.

Medical management

Pain medication and hormonal treatment can reduce symptoms for some women, particularly while they decide on next steps. These options control symptoms but do not change the vein problem itself.

What Recovery From Pelvic Vein Embolization Looks Like

Knowing the usual course of recovery helps patients plan time off and recognize what is normal. Every case is different, but the general pattern looks like this.

The day of the procedure

Embolization usually takes one to two hours, depending on how many veins need to be closed. Afterward you rest in a recovery area for a short period while the puncture site is checked. You will need someone to drive you home because of the sedation. A small bandage covers the entry point, and there are no stitches.

The first week

Pelvic aching, cramping or a feeling of fullness is common for several days as the treated veins close and the body responds to the coils or sclerosant. A low-grade temperature can occur. We usually suggest regular anti-inflammatory medication if it is safe for you, plenty of fluids and gentle walking. Most women return to desk work within a few days and avoid heavy lifting and strenuous exercise for about a week.

The following weeks and months

Improvement is gradual rather than immediate. The congested veins shrink over time, and many women notice the evening ache becoming less frequent and less intense over the first few months. We arrange follow-up to review your symptoms and to check any leg or vulvar varicose veins that may still need treatment. If symptoms persist, further imaging can show whether other pelvic veins or a compression problem are contributing.

Coils used for embolization are designed to stay in place permanently and do not usually cause problems with later imaging or daily life. Tell any future doctor that you have had pelvic vein embolization so they understand what they see on an X-ray.

Living With Pelvic Congestion: Everyday Measures

While you are being evaluated or awaiting treatment, a few simple measures can make days more comfortable:

• Lie down with your hips slightly raised for 15 to 20 minutes when the ache builds
• Break up long periods of standing with short walks or sitting breaks
• Try compression shorts or pelvic support garments, which some women find helpful
• Keep a symptom diary noting time of day, standing, periods and intercourse, and bring it to your appointment
• Stay active with low-impact exercise such as walking, swimming or cycling

Pelvic Congestion Syndrome Care in Houston

If you have pelvic pain that is worse by evening and after standing, or varicose veins on the vulva, buttocks or thighs, it is worth asking whether your pelvic veins have been properly evaluated. Dr. Syed Raza is a fellowship-trained interventional radiologist and former Chief of Interventional Radiology at UTMB Galveston and Memorial Hermann Memorial City, and pelvic vein embolization is part of the image-guided care our team provides. Patients come to our Houston vein specialist practice from across Greater Houston and Katy, and same-week appointments are usually available. Call (832) 321-5355 to schedule a consultation.

Frequently Asked Questions

Can pelvic congestion syndrome be seen on a regular ultrasound?

Sometimes, but it is easy to miss. Pelvic veins fill more when you are upright, and standard scans are often done lying flat. A dedicated pelvic venous ultrasound, or CT or MR venography, is more reliable for showing enlarged and refluxing pelvic veins.

Is ovarian vein embolization painful?

The procedure is done under local anesthesia with light sedation, so most women feel only pressure. Afterward, pelvic aching for several days is common and is usually controlled with anti-inflammatory medication.

Does pelvic congestion syndrome affect fertility?

Pelvic congestion syndrome is not generally considered a cause of infertility. Women planning a future pregnancy should discuss timing and treatment options with their specialist and gynecologist before embolization.

Can men get pelvic venous congestion?

Men can develop a related problem called a varicocele, which is an enlargement of the veins around the testicle. The term pelvic congestion syndrome is usually used for women.

Does pelvic congestion syndrome go away after menopause?

Symptoms often lessen after menopause as hormone levels fall and the pelvic organs become less congested, but enlarged veins can persist. Women with ongoing pain or leg varicose veins fed by pelvic veins may still benefit from evaluation.

How is pelvic congestion syndrome different from endometriosis?

Endometriosis is caused by tissue similar to the uterine lining growing outside the uterus, while pelvic congestion syndrome is caused by enlarged, leaking veins. The pain patterns overlap, and some women have both, so evaluation often involves both a gynecologist and a vein specialist.

How long does it take to feel better after ovarian vein embolization?

Most women go home the same day and return to light activity within a few days. Pain relief usually builds gradually over several weeks to a few months as the treated veins shrink.

Trusted Health Resources

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