Pelvic Congestion Syndrome (PCS) is a condition where veins in the pelvis—especially around the ovaries and uterus—become stretched and congested with blood, much like varicose veins in the legs. This pooling of blood can put pressure on surrounding nerves and tissues, leading to ongoing pelvic discomfort.
Typically affects women aged 20–45, particularly those who have had multiple pregnancies, since pregnancy increases pelvic blood flow and stretches veins.
Every additional pregnancy can raise the risk.
Higher estrogen levels during reproductive years make veins more prone to enlarging. PCS usually goes away after menopause.
Most women describe a dull ache or heaviness in the lower abdomen or pelvis. Other symptoms may include:
Pain that worsens during the day, especially after standing or sitting for long periods, and eases with lying down.
Pain during or after intercourse (dyspareunia) and before or during menstruation.
Near constant low-back or hip pain, leg discomfort, and varicose veins in the vulva, thighs, or buttocks.
Possible urinary or bowel issues, bloating, fatigue, mood swings, and abnormal vaginal bleeding or discharge.
PCS is often overlooked because its symptoms overlap with conditions like endometriosis, IBS, or interstitial cystitis. Diagnosis usually follows:
Clinical evaluation
Detailed history: pain patterns, symptom timing, triggers.
Pelvic exam: may reveal tenderness in ovaries or uterus.
Imaging tests
Doppler ultrasound (often transabdominal or transvaginal): first-line to detect enlarged veins and reverse blood flow.
CT or MRI venography: detailed images of pelvic veins and possible compression from nearby structures (e.g., fibroids, nutcracker or May–Thurner syndromes).
Pelvic venography (X-ray with dye via catheter): the gold standard for confirming PCS.
Rule out other issues
Laparoscopy, blood and urine tests help exclude other causes.
Choosing care depends on symptom severity. A step-by-step treatment approach is typical:
NSAIDs help relieve pain and reduce inflammation .
Hormonal medications, including medroxyprogesterone, GnRH agonists, and progestins, can reduce pelvic blood flow, easing congestion.
Some clinicians use combined oral contraceptives or phlebotonics, though evidence is limited.
Ovarian/internal iliac vein embolization: An interventional radiologist inserts coils or sclerosant to block problematic veins under sedation; about 70–80% of patients experience significant symptom relief.
Foam sclerotherapy: Similar to embolization, but uses liquid foam to collapse veins.
Laparoscopic vein ligation: Veins are tied off during minimally invasive surgery .
Oophorectomy or hysterectomy: Reserved for rare, severe cases when other treatments haven’t worked .
Pelvic floor physical therapy to reduce muscle tension and manage associated bladder/bowel symptoms.
Counseling or pain management support, such as CBT, for chronic pain, stress, or sexual dysfunction.
With embolization, about 75–80% of women report lasting relief; only around 5% experience recurrence .
Early, less invasive methods are tried first; invasive procedures are reserved for persistent, severe cases .
PCS isn’t life-threatening, but can cause chronic pain and negatively affect mood, sex life, and daily functioning .