Pelvic Congestion Syndrome (PCS)

Varicose veins are most common on the feet and legs, but they can also occur in the pelvis causing chronic pelvic pain in women. This condition is known as pelvic congestion syndrome (PCS) or ovarian vein reflux. 

What is Pelvic Venous Congestion syndrome?

PCS occurs when blood vessels in the pelvis become engorged from faulty vein valves in the lower abdomen. Veins have valves to guide blood flow towards the heart. Valves can become damaged and weaken overtime. When this happens, blood can start to flow backwards and “pool.”  

Engorged or congested varicose veins in the lower abdomen can cause chronic, unrelenting pain. It affects at least one in three women at some point during their lifetime. Without treatment, chronic PCS can last for six months or more. It is not associated with menstrual pain at all. PCS is most common among women who’ve been pregnant more than once.

Pelvic venous congestion syndrome is most commonly experienced for the first time during or following pregnancy. It is characterized as a heavy aching feeling that may get worse as pregnancy progresses. Typically, you feel the pain on the left side only. PCS pain is usually worse during the evenings. Additional symptoms are listed below.

  • Pain when you change posture
  • Pain during intercourse
  • Standing for extended periods
  • Severe menstrual pain
  • Pain during or after intercourse
  • Sudden urge to urinate
  • Lower back pain
  • Irritable bowel syndrome (diarrhea and constant abdominal pain accompanied with constipation)
  • Engorged and distorted veins around the vagina, vulva, inner thigh, buttocks, and lower legs
  • Enlarged blood vessels are a primary cause of the painful symptoms associated with pelvic venous congestion syndrome.Factors that contribute to enlarged veins are pregnancies and polycystic ovaries. 
  • Hormones can also be a cause for pelvic venous congestion syndrome. Estrogen, for example, can the veins to dilate, hence why PCS mainly affects women between ages 20 and 45. After menopause, however, estrogen levels decrease, and so does your risk of developing PCS.
  • Obesity leads to  structural changes and excess pressure on the pelvis. Extra weight exerts excess pressure on the lower abdominal veins, thus weakening their walls.

Studies have shown that women between ages 20 and 45 are most likely to be affected due to the presence of estrogen hormones. Additional risk factors for pelvic venous congestion syndrome are listed below.

  • Multiple pregnancies
  • Retroverted or tipped uterus
  • Polycystic ovaries
  • Fuller leg veins
  • Obesity

How is Pelvic Congestion Syndrome Diagnosed?

There are a few different methods that are used at Monterey Bay Vascular to diagnose pelvic congestion. Pelvic venous congestion syndrome can be difficult to diagnose because while many women experience pelvic pain, not all are congested blood vessels. Our state-of-art diagnostic testing allows for an accurate, timely diagnosis. A few examples include CT, MRI, pelvic venography, and ultrasound.

Congested veins in the pelvis and lower abdomen can be diagnosed with an ultrasound. This diagnostic test helps the vascular surgeon to visualize backward blood flow and identify enlarged veins.

Abdominal and pelvic CT and MRI scans help help the vascular surgeon visualize suspected backward blood flow even further. A CT or MRI of the pelvis or abdomen may be ordered in addition to an ultrasound to help the doctor get a clearer picture of your veins.

A pelvic venography is an X-ray imaging technique used to take images of veins in the pelvis. It’s the most definitive, minimally invasive screening technique when checking for pelvic venous congestion syndrome. During a pelvic venography, a catheter is inserted into a vein through your neck or groin. Then, it is guided into the veins in the ovary. An iodine-based dye is used to obtain detailed images of the pelvis.

After the images have been taken, the catheter is removed. The doctor will then apply slight pressure on the puncture area to stop bleeding. You will be discharged 1 to 4 hours later. A pelvic venography may also be used as a treatment method in conjunction with pelvic embolization.

When Should I Contact
My Doctor?

Pelvic venous congestion syndrome does not usually warrant a serious cause for medical concern. However, symptoms can be chronic, painful, and decrease your quality of life. Seeking treatment from your doctor during the early stages of the condition could also help to prevent any complications in the future.


To get the most out of the consultation, the following tips may be helpful to remember during your visit.   

  • Know the purpose of the visit and what you want to get from it.
  • Prior to your visit, write down questions you'd like to address with the doctor.
  • Bring someone with you to help ask questions and take notes.
  • Record all of the information given to your about your diagnosis as the doctor explains it to you- tests, treatment options, etc. 
  • Know the reasons for new medication prescriptions, their benefits, and their risks.
  • Inquire about all of your treatment options.
  • Know why any tests are done and what the results mean.
  • Ask what will happen if you don’t undergo testing or take medication.
  • Ask whether a follow-up appointment is available and note down the visit’s time, date, and reason.

Treatments for Pelvic Venous Congestion Syndrome (PVCS)

Are you looking to relieve your chronic, unrelenting pelvic pain? At Monterey Bay Vascular, our vascular surgeon treats pelvic venous congestion syndrome through minimally invasive procedure that maintain high success rates. 

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Why Monetary Bay Vascular

Pelvic venous insufficiencies can cause extremely painful symptoms in affected individuals. This condition affects up to 40% of women between ages 20 and 45. Symptoms of pelvic venous congestion should reduce after menopause. However, if you’d like to explore your minimally invasive treatment options for pelvic varicose veins, consult with our team at Monterey Bay Vascular today. We are committed to providing you with the highest quality healthcare. At our state-of-the-art facility, we offer comprehensive diagnostic testing, personalized treatment plans, and continuity of care. Contact our office to learn more about our comprehensive vascular care.