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Pelvic Congestion Syndrome

What is pelvic congestion syndrome?

Varicose veins in the pelvis, notably those around the ovaries, abnormally expand in a condition known as Pelvic Congestion Syndrome (PCS). Veins normally return deoxygenated blood to the heart, but when blood flow is restricted, blood accumulates and dilates veins. Blood flow obstruction can be caused by faulty or absent venous valves, tumor or other blood vessel compression, or both. Pregnancy alone can lead to PCS. Because less estrogen is present in menopausal women and estrogen dilates veins, PCS does not happen during this time. Similar to other varicose veins that develop in the legs, PCS-related swollen veins are found there.

Up to 30% of women who experience chronic pelvic discomfort with no other known reason also have PCS. Even though some women may have swollen pelvic veins, PCS cannot be diagnosed in these cases until there has been persistent pelvic pain for at least six months.

Risk Factors

  • Pregnancy, especially after multiple pregnancies
  • Increased estrogen

Symptoms

  • Chronic pelvic pain that does not cycle, unlike pain with menstrual cramps
  • Dull, aching pain or heaviness, but may occasionally have sharp pain
  • Pain worse when upright or as day progresses
  • Pain worse during menstrual periods
  • Pain worse during or after sexual intercourse
  • Varicose veins in pelvis more common on left side
    • Not usually visible because varicose veins are usually around the ovaries
    • Varicose veins may rarely appear on the buttocks, thighs, and vulva

Diagnosis

The doctor will examine the pelvic area physically and will also use the following methods to check for varicose veins:

  • Ultrasound
  • MRI
  • CT scan
  • Venography (X-ray with contrast agent to visualize veins)

Treatments

Patients experiencing symptoms can have embolization, an outpatient surgery. The enlarged pelvic veins are reached by inserting a thin catheter into the femoral vein and using X-ray guidance. A sclerosing agent is administered to close the vein after tiny coils are inserted into the swollen pelvic veins. Patients can start their regular daily routines right away.