What is pelvic congestion syndrome?
Pelvic congestion syndrome (PCS) is a condition where veins in the lower abdomen, especially around the ovaries, become enlarged and twisted, similar to varicose veins. These swollen veins cause a dull, aching pain that’s often worse after standing, during or after sex, or in the days leading up to a period.
PCS is thought to be one of the causes of chronic pelvic pain in women, particularly in those who have had multiple pregnancies. Although not life-threatening, it can have a big impact on quality of life.
Because PCS is less well-known than other vein conditions, it’s sometimes misdiagnosed or dismissed. If you’ve had ongoing pelvic pain without a clear cause, it’s worth discussing PCS with a healthcare professional.
How pelvic congestion syndrome develops
Just like varicose veins in the legs, pelvic congestion syndrome happens when valves in the veins stop working properly. Instead of helping blood flow back to the heart, these weakened valves allow blood to pool in the pelvic veins. This leads to increased pressure and the veins become enlarged or twisted over time.
The hormonal changes that occur during pregnancy, combined with the increased pressure from a growing uterus, can stretch or weaken these veins. Even after pregnancy, the veins may not return to their normal size or function, leaving them permanently damaged.
The result is a build-up of pressure and pooling blood in the pelvic region, which can trigger persistent discomfort or a heavy, dragging sensation.
Who is affected?
Pelvic congestion syndrome mostly affects women of childbearing age, especially those who have had two or more pregnancies. However, it can affect women of any age, and symptoms may become more noticeable in the 30s and 40s.
You may be more likely to develop PCS if you:
- Have had multiple pregnancies
- Have a family history of varicose veins
- Experience hormonal changes that affect blood vessels (e.g., due to oestrogen)
- Have polycystic ovary syndrome (PCOS)
- Have previously been diagnosed with pelvic or ovarian vein issues
While PCS is more commonly diagnosed in women, men can experience a similar condition affecting veins in the scrotum, known as a varicocele.
Signs and symptoms of pelvic congestion syndrome
PCS symptoms can vary, but most people describe a dull, aching or throbbing pain in the lower abdomen or back. The pain often worsens after certain activities or at particular times of the day.
Common signs and symptoms
You might notice:
- Pelvic pain: Dull or aching pain that lasts more than six months, often worse later in the day.
- Pain during or after sex (dyspareunia): Discomfort may last for hours afterwards.
- Pain when standing or sitting for long periods: Especially after a busy day.
- Worsening pain during menstruation: Hormonal changes can make symptoms more intense.
- Lower back pain: A constant or radiating ache that may come and go.
- Visible varicose veins: Around the vulva, thighs, or buttocks in some cases.
When symptoms may worsen
Symptoms are often worse:
- After long periods of standing or sitting
- After physical activity or lifting
- Following sexual intercourse
- In the days before your period starts
The pain usually improves when lying down, as this reduces the pressure in the pelvic veins. For many people, understanding these patterns can help identify PCS and differentiate it from other types of pelvic pain. If your symptoms follow this cycle or remain unexplained, it’s worth discussing with a specialist who can assess for pelvic vein problems.
Causes and risk factors
Common causes
The exact cause of PCS isn’t always clear, but it’s usually linked to a combination of anatomical, hormonal, and lifestyle-related factors. The most common causes include:
- Valve failure in pelvic veins: Veins in the pelvis have one-way valves that help blood flow back to the heart. If these valves weaken or become damaged, blood can flow backward and pool in the veins, causing them to enlarge.
- Pregnancy: This is a major contributing factor. During pregnancy, a woman’s blood volume increases, and the expanding uterus puts pressure on pelvic veins. Repeated pregnancies can cause the veins to stretch and not return to their original state.
- Hormonal changes: Oestrogen, which is higher in women of reproductive age, can relax vein walls, making them more likely to stretch. PCS is rare after menopause when hormone levels decline.
- Obstructions or vein compression: Some people have anatomical abnormalities such as May-Thurner syndrome or Nutcracker syndrome, where veins are compressed by nearby arteries or organs, leading to increased vein pressure and pooling.
- Lack of movement: A sedentary lifestyle can contribute to poor circulation in the pelvic area, worsening vein dysfunction over time.
PCS may not always be caused by a single factor, but rather a mix of changes in blood flow, vein pressure, and hormonal influences over time.
Risk factors you should know
You’re more likely to develop PCS if you:
- Have had multiple pregnancies: Each pregnancy increases the stress on your pelvic veins, which may become stretched or damaged over time.
- Are aged 20–45 years old: PCS tends to develop during the reproductive years when oestrogen levels are highest and vein walls may be more prone to relaxing.
- Have a family history of varicose veins: Genetics can influence the strength and structure of your vein walls and valves, making some people more prone to venous issues.
- Have high oestrogen levels: Oestrogen weakens vein tone, so hormonal fluctuations or the use of oestrogen-containing medications like hormone replacement therapy (HRT) or some contraceptives may raise your risk.
- Spend long periods sitting or standing: Occupations or routines that limit movement can reduce blood flow and increase vein pressure in the pelvis.
- Have known anatomical abnormalities: Conditions such as Nutcracker or May-Thurner syndrome can compress veins and lead to PCS symptoms.
- Have been diagnosed with pelvic or ovarian vein insufficiency in the past: This may signal an underlying predisposition to poor vein health in the area.
Understanding your risk can help you and your doctor decide whether PCS is a possible cause of chronic pelvic discomfort and take early steps toward diagnosis and management.
How pelvic congestion syndrome is diagnosed
Clinical examination
Your doctor will begin by asking about your symptoms and medical history. They may examine your abdomen and pelvic area to check for tenderness or visible varicose veins.
Because PCS symptoms overlap with many other conditions, it’s important to rule out other causes of pelvic pain first, like endometriosis, fibroids, or urinary issues.
Diagnostic tests
Imaging is key to diagnosing PCS. Tests may include:
- Pelvic ultrasound: Often used as a first step, especially transvaginal ultrasound.
- CT or MRI scans: Help show the size and structure of pelvic veins.
- Venogram: A special X-ray using dye to highlight abnormal veins and valve issues.
These tests help confirm if pelvic vein enlargement is present and guide decisions about treatment.
Treatment options for pelvic congestion syndrome
There is no cure for PTS, but treatment can ease symptoms and improve quality of life. Most treatments focus on improving circulation, reducing swelling, and preventing complications.
Conservative management
Conservative management is often the first step in treating PCS, especially if your symptoms are mild or if you prefer to avoid procedures. The goal is to relieve symptoms and support vein health through lifestyle and medical strategies that do not involve surgery.
- Pain relief: Simple painkillers like ibuprofen or paracetamol can help ease discomfort. These medications are generally safe for short-term use and can provide relief during flare-ups.
- Lifestyle adjustments: Making changes such as avoiding long periods of standing or sitting, wearing supportive undergarments, managing stress, and maintaining a healthy weight can reduce pressure in the pelvic veins and improve symptoms over time.
- Hormonal treatments: In some cases, your doctor may recommend hormone therapy, such as progestin-based medication, to lower oestrogen levels. This can help reduce the swelling in affected veins, particularly if your symptoms worsen with your menstrual cycle.
- Physical activity: Gentle exercises like walking, yoga, or swimming can improve circulation and prevent blood from pooling in the pelvis.
- Leg elevation and posture awareness: While more commonly used for leg vein issues, being mindful of posture and occasionally lying down with your pelvis elevated can help with blood flow.
These strategies are non-invasive and may be effective for some individuals. Your doctor may recommend a trial of conservative tactics before considering treatment, or use it alongside other therapies for a more well rounded approach.
Surgical procedures
If conservative options aren’t enough, your doctor may recommend a minimally invasive procedure. These are usually considered when symptoms are ongoing, imaging shows pelvic vein issues, or your quality of life is affected despite trying other treatments.
- Pelvic vein embolisation: A common option when scans confirm dilated or refluxing veins. A small coil or foam is used to seal the faulty vein and redirect blood flow. Ideal for people with persistent pain and confirmed vein incompetence.
- Sclerotherapy: Often paired with embolisation or used for smaller surface veins. Helpful when visible varicose veins, such as vulval varicosities, contribute to symptoms.
- Surgical ligation: Less common, this is an option when other treatments haven’t helped or when embolisation isn’t suitable. It involves tying off the problem veins to stop pooling.
These procedures are done under local anaesthetic and don’t usually require a hospital stay. Most people recover quickly and notice a significant reduction in symptoms, often within a few weeks. and don’t require a hospital stay.
What to expect during and after treatment
During treatment
If you have a pelvic vein embolisation, it will usually be done as a day case. You’ll be awake but given a local anaesthetic, and a small tube will be inserted through a vein, often in your groin, to access the pelvic veins.
The faulty veins are then sealed using coils, foam, or medical glue. The procedure takes about an hour, and you can usually go home the same day.
Aftercare and recovery
Recovery is typically quick. You might feel some cramping or tiredness for a few days, but this settles down. Most people return to work and normal activities within a week.
Pain relief may be needed initially, and your healthcare provider will give you guidance on what to expect. Follow-up scans may be recommended to check treatment success.
Follow-up and long-term care
Long-term care involves monitoring your symptoms and vein health, especially if you've undergone treatment. Your doctor will work with you to track progress, adjust your care plan as needed, and watch for signs of recurrence or new vein problems.
- Routine check-ups: Follow-up appointments typically include a review of symptoms and, in some cases, imaging to confirm that treated veins remain closed and that no new areas of reflux have developed.
- Ongoing symptom management: You may continue to use pain relief or hormonal treatments, particularly if your symptoms fluctuate with your menstrual cycle.
- Lifestyle guidance: Your care team might provide advice on exercise, weight management, and posture to reduce pressure on pelvic veins.
- Compression therapy: If advised, wearing supportive garments or compression underwear can help improve comfort and prevent symptoms from returning.
In some cases, additional treatments may be considered if symptoms persist or worsen over time. Most people benefit from a combination of medical care, self-management strategies, and regular reviews to support long-term wellbeing. Your doctor may suggest lifestyle changes, compression support, or further treatment if symptoms return.
Preventing pelvic congestion syndrome
While there’s no guaranteed way to prevent PCS, there are proactive steps you can take to lower your risk, especially if you’ve had multiple pregnancies or a family history of vein problems. Prevention focuses on improving circulation, supporting vein health, and managing hormone levels.
- Maintaining a healthy weight: Carrying excess weight places added pressure on pelvic veins, increasing the likelihood of valve weakening or vein enlargement.
- Staying active: Regular physical activity encourages healthy blood flow and prevents blood from pooling in the pelvic area. Activities like walking, swimming, or yoga can be particularly helpful.
- Avoiding long periods of standing or sitting: If you have a sedentary job or lifestyle, try to move around every 30–60 minutes. Shift positions regularly and consider using a footrest or leg support.
- Managing hormone levels: If you’re taking hormone-based medications such as the contraceptive pill or HRT, speak to your doctor about whether they could affect your vein health and what alternatives might be available.
- Wearing supportive garments: Compression shorts or underwear may offer extra pelvic support and help alleviate discomfort in people at higher risk.
- Seeking early treatment for pelvic pain: Don’t ignore persistent symptoms. Early diagnosis and management can help prevent vein damage from worsening.
Making these adjustments can be especially useful if you’ve had PCS before, are planning a pregnancy, or are experiencing unexplained pelvic pain. Talk to your GP or a vein specialist if you're concerned about your risk.
When to seek medical advice
Signs you shouldn't ignore
You should speak to your GP or a vein specialist if you:
- Have chronic pelvic pain that’s lasted more than 6 months
- Notice the pain gets worse when standing or after sex
- Experience heaviness or pressure in your pelvis
- Have visible varicose veins in your lower abdomen, thighs, or vulva
Early advice can help confirm the cause of your symptoms and guide you toward the most appropriate treatment.
Doctors who treat this condition
Related
Varicose Veins
Deep Vein Thrombosis
Chronic Venous Insufficiency
References
- https://www.nhs.uk/conditions/pelvic-pain/ [accessed 11.07.2025]
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6992113/ [accessed 11.07.2025]
- https://www.nice.org.uk/guidance/ng88 [accessed 11.07.2025]
- https://www.bmj.com/content/371/bmj.m4107 [accessed 11.07.2025]
- https://www.veinforum.org/condition/pelvic-congestion-syndrome/ [accessed 11.07.2025]
