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What is pelvic congestion syndrome?

Written by: Dr Leto Mailli
Published: | Updated: 07/05/2019
Edited by: Laura Burgess

Pelvic congestion syndrome, or chronic pelvic pain, is a condition where women experience pain in their lower abdomen due to underlying incompetence and dilatation of ovarian and/or pelvic veins. Pelvic venous congestion syndrome can cause chronic pelvic pain in up to 40% of women. 


What are the symptoms of the pelvic congestion syndrome?

The symptoms or signs can be the following:

  • Pelvic pain or pressure in the lower abdomen
  • Heaviness in the pelvis and legs
  • Pain becoming worse while standing or weight lifting. Lying down relieves the symptoms
  • Painful menstruation that often aggravates the above symptoms
  • Pain during or after intercourse
  • Worsening of the above symptoms during pregnancy
  • Visibly dilated and occasionally sore veins around the genitals, thighs and buttocks.
  • Recurrence of previously treated varicose veins in the legs

If a woman has more than two of the above-mentioned symptoms there is an increased likelihood of suffering from pelvic congestion syndrome.


What are the ovarian and pelvic veins?

The principle is similar with that of varicose veins in the legs. The valves normally existing within the veins, enabling the blood to be pushed upstream towards the heart, become less elastic and non-functioning. As a result, the blood stagnates at the legs and the veins become dilated and we can often see them as tortious bulging and knotty veins that can be painful especially when standing.

The same veins exist within our pelvis and their valves can also fail to push blood towards the heart. That means that the blood pools within the pelvis due to gravity causing the veins to swell. These dilated, incompetent veins are hidden within our pelvis causing pelvic pain but we are unable to see them. Occasionally they may be visible and are usually seen around the genitals (vulva, vagina), the inner aspect of the thigh, the buttock or down the legs.

What is the cause of pelvic congestion syndrome?

We do not really know why some women develop pelvic congestion syndrome while others are not. There is definitely a genetic element as usually a mother or grandmother had similar symptoms. Pelvic congestion syndrome (pelvic pain) seems to affect young women, more often those having 2-3 children. It is believed that during pregnancy, the increase in oestrogen levels may have an effect on the vein walls, rendering them weaker. Structural and anatomic changes of veins may also make them susceptible to develop varicosities.

How can I confirm the diagnosis of PCS?

Pelvic venous congestion syndrome can be diagnosed by typical symptoms or by the presence of visible varicose veins. The diagnosis may, however, require further investigation with magnetic resonance imaging (MRI) or computed tomography (CT). The most sensitive method though is via percutaneous venography. Treatment of pelvic congestion syndrome and varicose veins in the pelvis, vulva and vagina is achieved by pelvic vein embolisation, which can be advised by a specialist

By Dr Leto Mailli
Interventional radiology

Dr Leto Mailli is a leading diagnostic and interventional radiologist in Surrey and London, whose area of expertise lies in the endovascular management of peripheral arterial disease, venous disease, vascular malformations and embolization procedures. She also holds a particular interest in gynaecological procedures such as uterine artery embolisation, pelvic congestion syndrome and postpartum haemorrhage.

In 2000, Dr Mailli qualified from Prague University and undertook her training in radiology at the University Hospital of Athens. She underwent her interventional radiology fellowship at Guy’s and St Thomas’ Hospital, London. Dr Mailli has a PhD and a Master’s degree in interventional radiology and has won several clinical and research grants.

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