You may already know that varicose vein symptoms typically develop in the legs. However, veins in other parts of the body may sometimes become abnormally enlarged. When veins in the pelvis become enlarged, it is known as pelvic congestion syndrome. Also known as ovarian vein reflux or pelvic vein incompetence, this condition is especially common among women ages 20 to 45. Women who have pelvic congestion syndrome near Houston may experience chronic pain, including backaches, lower abdominal tenderness, painful and abnormal menstruation, and pain during intercourse. It’s not unusual for these patients to also have varicose veins in the thighs or lower legs.
Quick Answer: Pelvic congestion syndrome is chronic pelvic pain caused by enlarged, refluxing veins in the pelvis, most often the ovarian veins. Faulty valves let blood pool around the uterus and ovaries, producing a dull, heavy ache that is usually worse after standing, late in the day and after intercourse. It mainly affects women who have had children. Diagnosis needs imaging of the pelvic veins, and the main treatment is ovarian vein embolization, a minimally invasive outpatient procedure performed by an interventional radiologist.
Like varicose veins in the legs, varicose veins in the pelvic region occur when the valves within the blood vessels fail to function normally. This results in the accumulation of blood and the engorgement of the veins. After confirming the diagnosis of pelvic congestion syndrome, the venous disease specialist will recommend treatment options. These may include medications that alter hormone levels or a minimally invasive procedure known as embolization.
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 and Why Does It Happen?
The ovaries drain blood through two long veins, the left and right ovarian veins, that run up the back of the abdomen. The pelvis is also drained by the internal iliac veins on each side. Like leg veins, these vessels rely on one-way valves to keep blood moving toward the heart. When the valves are weak, missing or overstretched, blood flows backward and pools in a network of veins around the uterus, ovaries, bladder and vulva. The veins dilate, much like varicose veins in the legs, and the pressure and stretching of the vein walls produce pain.
Several things contribute to this process:
- Pregnancy. Blood volume rises sharply during pregnancy, and the ovarian veins can enlarge many times over. After delivery, they do not always return to normal size, and with each pregnancy the risk grows.
- Hormones. Estrogen relaxes vein walls, which is one reason the condition affects women of reproductive age and tends to ease after menopause.
- Anatomy. Some women are born with fewer or absent valves in the ovarian veins, particularly on the left side.
- Vein compression. Less commonly, a vein higher up is squeezed between other structures, such as the left renal vein between two arteries (nutcracker syndrome) or the left iliac vein beneath an artery (May-Thurner anatomy). The back pressure then diverts blood into the pelvic veins.
Pelvic Congestion Syndrome Symptoms: The Typical Pattern
Pain from pelvic congestion syndrome has a fairly recognizable character, and the pattern is often more useful for diagnosis than any single symptom. Women typically describe:
- A dull, dragging or heavy ache deep in the pelvis that has lasted six months or more
- Pain that is mild in the morning and builds through the day, especially after long periods of standing or sitting
- Relief when lying down or raising the hips
- Aching during or, very characteristically, for hours after intercourse
- Pain that worsens just before or during the menstrual period and in pregnancy
- Pain on one side or shifting between sides
- Urinary urgency or a feeling of pelvic fullness
- Visible varicose veins on the vulva, buttocks, inner or back of the thighs
Many women with this condition have seen several doctors before the cause is found. Standard pelvic ultrasounds are often done lying flat, which reduces vein filling, so the problem can be missed. Pain that is real but unexplained, and that behaves in the way described above, is a good reason to ask specifically about pelvic veins.
How Pelvic Vein Reflux Connects to Leg Varicose Veins
The pelvic veins and leg veins are connected through small escape points around the groin and perineum. When pelvic veins are refluxing, blood can leak down through these connections and feed varicose veins on the vulva, the back of the thigh or the inner thigh. These veins often look different from typical leg varicose veins because they do not follow the usual saphenous vein path.
This matters for treatment. If leg varicose veins keep coming back after procedures, or they appeared in an unusual distribution after pregnancy, a pelvic source may be the reason. Treating the pelvic reflux first, and then the leg veins, usually gives better and longer-lasting results.
Pelvic Congestion Syndrome vs. Other Causes of Pelvic Pain
Chronic pelvic pain has many possible causes, and several can overlap. Pelvic congestion syndrome is diagnosed after other common conditions have been considered, often in partnership with the patient’s gynecologist.
| Condition | Typical pain pattern | Helpful clues | Key test |
|---|---|---|---|
| Pelvic congestion syndrome | Dull, heavy ache, worse standing and late in the day, after intercourse | Relief lying down; vulvar or thigh varicose veins; prior pregnancies | Pelvic duplex ultrasound, CT or MR venography, venogram |
| Endometriosis | Cyclical pain around periods, pain during deep intercourse | Painful periods since early years; fertility problems | Specialized imaging; laparoscopy |
| Uterine fibroids | Pressure, heavy or prolonged periods, cramping | Enlarged uterus; anemia | Pelvic ultrasound or MRI |
| Irritable bowel syndrome | Cramping linked to bowel movements | Bloating, diarrhea or constipation | Clinical assessment; tests to exclude other bowel disease |
| Interstitial cystitis | Bladder pain, worse as the bladder fills | Frequency and urgency without infection | Urologic evaluation |
If fibroids are part of the picture, they can also be treated by an interventional radiologist; see our fibroid treatment information.
Who Is Most Likely to Develop Pelvic Congestion Syndrome?
The condition is seen mainly in women between their twenties and mid-forties, and most of the women we evaluate have had two or more pregnancies. Each pregnancy stretches the ovarian veins and adds to the strain on their valves, so symptoms often begin or become noticeable after a second or third child. It is uncommon after menopause, when lower estrogen levels allow the veins to relax less.
Other features that raise our suspicion include:
- A personal or family history of varicose veins, especially veins that appeared or worsened during pregnancy
- Varicose veins that returned after previous leg vein treatment
- A tilted (retroverted) uterus or polycystic-appearing ovaries noted on earlier scans, which are sometimes seen alongside dilated pelvic veins
- A job that involves standing for most of the day, which tends to make the end-of-day ache more pronounced
None of these features proves the diagnosis, and women without them can still have the condition. They simply help us decide how carefully to look at the pelvic veins when the pain pattern fits.
How We Evaluate Suspected Pelvic Congestion Syndrome
At Premier Vein & Vascular Center the goal of the first visit is to confirm whether pelvic veins are really the source of your pain before recommending any procedure.
- Detailed history. We go through when the pain started, how it changes during the day and the menstrual cycle, the effect of standing and intercourse, pregnancies, previous pelvic investigations and any leg vein treatment you have had.
- Examination. We look for varicose veins on the vulva, buttocks and thighs and examine the legs for reflux and swelling. Your gynecologist’s findings and imaging are reviewed alongside ours.
- Targeted imaging. A duplex ultrasound of the pelvic and abdominal veins, performed by our vascular lab team, measures vein size and reflux. When more detail is needed, CT or MR venography maps the veins and checks for compression of the left renal or iliac veins.
- A clear plan. We explain what the imaging shows, whether embolization is likely to help and what to expect. A catheter venogram, which is the most precise test, is usually performed at the start of the treatment itself so diagnosis and treatment happen in one session.
Treatment Options for Pelvic Congestion Syndrome
Conservative and medical treatment
Some women manage mild symptoms with anti-inflammatory pain relievers, rest with the hips elevated during flare-ups and avoiding long periods of standing. Hormonal medicines that suppress ovarian function can reduce symptoms in some patients, but side effects limit long-term use and symptoms often return when they are stopped.
Ovarian and pelvic vein embolization
Embolization is the main procedural treatment and is performed by an interventional radiologist. Through a small tube placed in a vein in the neck or groin under local anesthesia and light sedation, a catheter is guided into the refluxing ovarian vein and, where needed, branches of the internal iliac veins. A venogram confirms the reflux, and the faulty veins are then closed from the inside, usually with tiny metal coils combined with a foam sclerosant similar to the medicine used in foam sclerotherapy. Blood is rerouted through healthy veins.
The procedure typically takes one to two hours and is done on an outpatient basis. Most women go home the same day, may have some pelvic aching or back discomfort for a few days, and return to normal activities within a few days to a week. Improvement in pain is often gradual over the following weeks and months. Embolization does not remove the ovaries or uterus and is not intended to affect periods or hormone function.
Treating related leg and vulvar veins
Once the pelvic source is closed, remaining varicose veins in the vulva or legs can be treated with sclerotherapy or other office procedures if they persist.
When a vein compression is found
If imaging shows a compressed renal or iliac vein driving the reflux, the treatment plan may need to address that as well. We explain these less common situations individually.
Living With Pelvic Congestion: Practical Tips
While you are being evaluated or waiting for treatment, a few measures can ease symptoms. Take short breaks to sit or lie down during long days on your feet. Lying with a pillow under the hips for 15 to 20 minutes can relieve pressure. Regular walking and core and pelvic floor exercise help venous return. Compression shorts or pelvic support garments help some women, particularly those with vulvar varicose veins. Keeping a symptom diary across a full cycle is also very helpful for your specialist.
Seek emergency care if you have:
- Sudden, severe pelvic or abdominal pain, especially with fainting, dizziness or a possible pregnancy
- Pelvic pain with fever, chills or foul-smelling discharge
- Very heavy vaginal bleeding that soaks a pad every hour
- Sudden swelling and pain in one leg, chest pain or shortness of breath
- Bleeding from a vulvar or leg varicose vein that does not stop with firm pressure
When to See a Pelvic Vein Specialist in Houston
Consider a specialist evaluation if you have had pelvic pain for six months or more that fits the pattern above, if your gynecologic workup has not explained it, or if you have varicose veins on the vulva, buttocks or back of the thighs, particularly after pregnancy. Recurrent leg varicose veins after previous treatment are another reason to look at the pelvic veins.
Dr. Syed Raza is a fellowship-trained interventional radiologist with more than 15 years of experience in image-guided vein and vascular procedures, and he evaluates women from across Houston and Katy for this condition. If you are looking for a vein doctor in Houston who understands both pelvic and leg veins, you can read more on our pelvic congestion syndrome treatment page or request an appointment. Same-week appointments are usually available, and most insurance plans, including Medicare, are accepted.
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
Can pelvic congestion syndrome go away on its own?
Symptoms often ease after menopause as hormone levels fall, but the enlarged veins themselves do not usually return to normal during the reproductive years. Many women find that pain persists or gradually worsens, particularly after additional pregnancies.
Is pelvic congestion syndrome dangerous?
Pelvic congestion syndrome is not usually dangerous, but it can cause significant chronic pain that affects work, relationships and quality of life. It is also linked to recurrent varicose veins in the legs and vulva. Any sudden, severe pelvic pain needs urgent medical assessment because it may have another cause.
Will ovarian vein embolization affect my fertility or periods?
Embolization targets only the refluxing veins and does not remove or block the arteries supplying the ovaries or uterus, so it is not intended to affect hormone function or periods. Women planning a future pregnancy should discuss their plans with the specialist before treatment.
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 the patient’s gynecologist. The interventional radiologist performs the venogram and embolization through a small catheter.
Can a regular pelvic ultrasound miss pelvic congestion syndrome?
Yes. A routine pelvic ultrasound is usually done lying flat and focuses on the uterus and ovaries, which can make dilated veins look smaller or be overlooked. A dedicated venous duplex study or CT or MR venography is more reliable for assessing pelvic veins.
How long is recovery after pelvic vein embolization?
Most women go home the same day and return to light activities within a few days. Some pelvic or back aching for several days is common and is managed with simple pain relievers. Strenuous exercise is usually resumed after about a week.
Can pelvic congestion syndrome cause back pain?
Yes. Many women with pelvic congestion syndrome describe a dull ache in the lower back or sacral area along with the pelvic heaviness. Like the pelvic pain, it usually builds through the day and eases when lying down.
Trusted Health Resources
- Varicose Veins and Spider Veins, MedlinePlus (NIH)
- Chronic Venous Insufficiency, Society for Vascular Surgery