Pelvic Congestion Syndrome: Symptoms and Treatment

Chronic pain is never a pleasant experience, but the causes of chronic pain are many and varied. If you are one of the 33% of women that experience chronic pelvic pain, it could be due to Pelvic Congestion Syndrome (PCS).

PCS is often connected to varicose veins located in the ovaries or pelvic region. It is often overlooked during checkups because when a woman lies flat, it relieves the pressure on the bulging veins and they do not appear to bulge as much. There are several risk factors that increase the likelihood of PCS, but there are also treatment options available.

Risks, Causes, and Factors

• Multiple pregnancies and increases in hormonal activity
• Hormonal dysfunction
• Polycystic Ovaries
• Women under 45 in childbearing years
• Previous pregnancies

Symptoms

• Dull, aching pain in the lower abdomen or back. Pain may increase after intercourse, during menstruation, toward the end of the day (especially while standing), or during pregnancy.
• Irritable bladder issues.
• Abnormal menstruation cycles.
• Varicose veins in the pelvic region, buttocks, or thighs.

Diagnosis

• MRI – A non-invasive method to detect venous abnormalities. There is a specific method for detection by MRI that differs from standard MRI procedures.
• Pelvic Ultrasound – Unlike typical ultrasounds, the patient needs to stand for this detection method to be effective. It is more commonly used to rule out other pelvic pain causes.
• Transvaginal Ultrasound – Like the pelvic ultrasound, this test needs to be conducted while standing. It is also used to rule out other causes.
• Pelvic Venography – This method is the most accurate for detection and involves injecting a contract dye into the pelvic veins. This dye shows up well on subsequent x-rays and allows medical staff to find the hidden varicose veins.

Treatment

• Embolization – Embolization is a minimally invasive procedure that uses radiologic imaging to locate and repair damaged veins. It is an outpatient procedure that involves inserting a spaghetti strand sized catheter into the femoral or jugular vein in the groin. Using x-ray imaging for guidance, the catheter is moved to the affected vein. Upon reaching its destination, a radiologist inserts tiny metal coils and a sclerosing agent, which causes the vein to close itself. Once the vein is closed, blood will flow through other, healthy veins and the affected vein will shrink.
• Hormonal – Birth control pills can decrease hormonal levels and adjust menstrual cycles, which may alleviate the pain.
• Surgery – A hysterectomy may be performed, depending on the severity of issues. This involves removing the ovaries, and tying off or removing the affected veins.

Over 95% of cases where embolization is used are successful in alleviating symptoms, but they may return or require further treatments. Consult a vein specialist if you think you may be experiencing symptoms of Pelvic Congestions Syndrome so that a proper evaluation can be performed.

Why Pelvic Veins Become Congested

The ovarian veins run from the pelvis up to the kidney vein on the left and the main abdominal vein on the right. Like leg veins, they contain one-way valves. During pregnancy, these veins carry much more blood than usual and can widen considerably. If the valves do not recover after delivery, blood flows backward down the ovarian veins and fills a network of veins around the uterus and ovaries. The pooled blood stretches the veins further, and the stretched veins ache.

Less often, the problem is a blockage rather than a leak. A major vein that drains the pelvis or the left kidney can be pressed between an artery and the spine, forcing blood to find detours through the pelvic veins. These compression patterns are known as nutcracker syndrome and May-Thurner syndrome. Identifying them matters, because they change which veins should be treated and in what order.

Comparing Pelvic Congestion Syndrome Treatment Options

The treatments described above work in different ways. Some ease symptoms, while others address the veins themselves. This comparison is meant to help you have an informed conversation with your care team.

How We Evaluate Pelvic Congestion Before Treatment

Good results depend on treating the right veins. At Premier Vein & Vascular Center, every patient follows a clear pathway before any procedure is planned.

1. Detailed history. We review your pain pattern, pregnancies, menstrual and gynecologic history, previous scans and treatments, and bladder or bowel symptoms.
2. Examination. We look for varicose veins in the vulva, buttocks, thighs and legs, and check for leg swelling.
3. Non-invasive imaging. Ultrasound of the leg and groin veins, and pelvic imaging such as MRI, show enlarged pelvic veins, the pathways they use and any compression of the major veins.
4. Review of other causes. We confirm that other common causes of pelvic pain have been evaluated, and coordinate with your gynecologist when needed.
5. A clear treatment plan. We explain what the imaging shows, whether embolization is likely to help, and what to expect, so you can make an informed decision.

What Happens During Pelvic Vein Embolization

Embolization is performed by an interventional radiologist in a procedure suite equipped with live X-ray imaging. Most procedures take about an hour, although it varies with the number of veins treated.

• You lie on your back, and medication is given through an IV to help you relax. You stay awake but comfortable.
• The skin over a vein in the neck or groin is numbed, and a thin catheter is introduced through a small needle puncture. No surgical incision is needed.
• Contrast dye is injected through the catheter to map the ovarian and pelvic veins on X-ray, confirming which ones are leaking. This venography step is the most precise way to see the problem.
• The faulty veins are closed using tiny coils, a sclerosing agent, or both. As noted above, once the veins are closed, blood drains through other healthy veins.
• The catheter is removed and light pressure is applied to the puncture site. There are no stitches.

Most patients rest for a few hours afterward and go home the same day with someone to drive them.

Recovery After Treatment: What to Expect

Recovery is usually straightforward, but it is common to feel some pelvic cramping or aching for a few days as the treated veins close. This is a normal inflammatory response and is usually managed with anti-inflammatory medicine if your doctor approves it.

• First few days: rest, gentle walking and plenty of fluids. Avoid heavy lifting and strenuous exercise.
• First week or two: most women return to desk work and normal daily routines within this time, depending on how they feel.
• Following weeks to months: pelvic pain often improves gradually as the veins shrink. Many women notice the heavy, dragging feeling easing first.
• Follow-up: we review your symptoms after the procedure, and leg or vulvar varicose veins that remain can be treated in a second step.

Like any procedure, embolization has possible risks, including bruising at the puncture site, temporary pain, reaction to contrast dye and, rarely, movement of a coil or injury to a vein. We discuss these with you individually before treatment.

Treating Leg and Vulvar Varicose Veins Linked to PCS

Pelvic vein reflux often feeds varicose veins in the vulva, buttocks and legs. Once the pelvic source has been closed, these surface veins frequently become less prominent, and any that remain can be treated with sclerotherapy, ultrasound-guided foam sclerotherapy or other office procedures. Treating the source first and the branches afterward lowers the chance of the leg veins returning.

If your main concern is leg veins, a venous ultrasound will show whether they are coming from the usual leg vein pathways or from the pelvis, which changes the plan.

Living With Pelvic Congestion: Everyday Steps That Help

While you are being evaluated, or if you choose not to have a procedure, these steps can ease symptoms:

• Lie down with your hips and legs raised for 15 to 20 minutes when the ache builds
• Break up long periods of standing or sitting with short walks
• Wear supportive compression shorts or stockings if leg or vulvar veins are present
• Stay active with walking, swimming or cycling to support circulation
• Avoid constipation and heavy straining, which raise pressure in the pelvic veins
• Talk with your gynecologist about hormonal options if symptoms follow your cycle

Questions to Ask Before Choosing a Treatment

Pelvic congestion syndrome is a quality-of-life condition, so the right choice depends on how much the symptoms affect you and what matters most in your life right now. These questions help shape that conversation with your care team:

• How confident are we that my pelvic veins are the main cause of my pain, rather than one of several causes?
• Which veins are involved, and is there any compression of the larger veins that drain my pelvis?
• What results can I reasonably expect for my symptoms, and over what time frame?
• Will I need treatment for leg or vulvar veins afterward, and when?
• How does treatment fit with my plans for future pregnancies?
• What happens if I choose to wait and manage symptoms for now?
• Who do I contact after the procedure if I have questions or concerns?

There is no pressure to decide at the first visit. Some women prefer to try conservative measures first and return if symptoms persist. Others have lived with pain for years and want to move ahead once the imaging is clear. Our role is to make sure you understand the findings and the trade-offs, and to coordinate with your gynecologist and primary care doctor so that the plan makes sense as a whole. Bringing a partner or family member to the discussion can help, especially when weighing timing around work or family plans.

Pelvic Congestion Syndrome Treatment in Houston

If you have been living with pelvic pain that worsens through the day, especially after pregnancy, and other causes have been ruled out, a vascular evaluation can show whether your pelvic veins are involved. Dr. Syed Raza is a fellowship-trained interventional radiologist, board certified in diagnostic and interventional radiology by the American Board of Radiology and a Fellow of the Royal College of Radiologists (UK), with more than 15 years of experience in image-guided vein treatment. Women from across Houston and Katy are seen at our Houston vein and vascular center, where same-week appointments are usually available and most insurance plans, including Medicare, are accepted. You can learn more on our pelvic congestion syndrome page.

Frequently Asked Questions

Is pelvic vein embolization painful?

Most women feel only mild discomfort during the procedure because the skin is numbed and relaxing medication is given. Cramping or aching in the pelvis for a few days afterward is common and usually settles with anti-inflammatory medicine if your doctor approves it.

How long does pelvic vein embolization take?

The procedure usually takes about an hour, depending on how many veins need to be treated. Most patients rest for a few hours and go home the same day.

Can I get pregnant after pelvic vein embolization?

Embolization treats the veins and leaves the uterus and ovaries in place. If you are planning a pregnancy, discuss the timing and any considerations with your specialist and gynecologist before treatment.

Will my leg varicose veins go away after pelvic vein treatment?

Leg and vulvar veins fed by the pelvic veins often become less prominent after the source is closed, but many still need direct treatment such as sclerotherapy. Treating the pelvic source first usually makes leg vein treatment more lasting.

Does insurance cover pelvic congestion syndrome treatment?

Most insurance plans, including Medicare, cover evaluation and medically necessary treatment when symptoms and imaging support the diagnosis. Some plans require prior authorization, and our team can help check your coverage.

Can pelvic congestion syndrome come back after treatment?

Symptoms can return in some women, for example if other veins enlarge over time or a new pregnancy occurs. Follow-up visits allow us to assess any returning symptoms and treat additional veins if needed.

Trusted Health Resources

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