Pelvic Congestion Syndrome

Pelvic congestion syndrome (PCS) is a condition where the veins in the pelvis get big and cause pain.

It’s more common in women, and about 40% of visits to the gynecologist for pelvic pain might be because of PCS.

Symptoms can get worse when you stand for a long time, have sex, or during your period. They include:

  • Cramps like when you have your period
  • Dull or sharp pain in your lower belly or back
  • Feeling heavy or full in your pelvic area
  • Feeling tired
  • Headaches
  • Pain during sex
  • Pain in your pelvis that lasts a long time
  • Swollen veins in your legs or around your private area

We’re still figuring it out, but it’s probably because of how blood moves in your pelvis. Sometimes, the veins get too big, and the valves that usually keep blood flowing the right way don’t work well. This makes blood go back and get stuck, which hurts. Here are some reasons why the veins might get messed up with PCS:

  • Pregnancy: When you’re pregnant, your blood vessels get bigger to handle all the extra blood for the baby. This might cause lasting damage to the veins even after you have your baby.
  • Estrogen: After menopause, when estrogen levels drop, PCS is less common. So, estrogen might play a role. It could affect your blood vessels and make them more likely to have problems leading to PCS.

PCS is probably caused by a mix of different things working together.

Your doctor will ask about your symptoms and do a check-up, including a pelvic exam, to see where the pain is coming from.

Your doctor might use imaging tests to check for PCS and other possible causes of pelvic pain:

  • Ultrasound: This is usually the first test. It shows if your veins are big and if your blood is flowing the right way.
  • MRI or CT scan: These give more detailed pictures of your veins. They can also show if there are other issues like endometriosis causing your pain.
  • Pelvic venography: This is a more detailed test where they put a special dye in your veins to see them better on X-rays. It helps find where the veins are big and how blood is flowing.
  • Laparoscopy: Sometimes, they might do surgery to look inside your belly and see if your veins are big. But this isn’t always needed.

Doctors have a few ways to help with PCS:

  • Managing pain: They might give you medicine or suggest wearing special socks to help with the pain.
  • Hormonal therapy: This is another option to help manage symptoms.
  • Medical procedures: If medicines don’t work, your doctor might do a procedure to fix the veins:
  • Ovarian vein embolization or sclerotherapy : They block the veins causing problems by putting in tiny coils, glue, or foam.
  • Laparoscopy: They tie off the veins to stop blood from flowing the wrong way.
  • Bilateral salpingo-oophorectomy: In rare cases, they might remove some pelvic organs if you’re not planning to have more kids.

You may see different doctors for treatment, including a gynecologist, gastroenterology (GI) specialist, pain specialist, interventional radiologist, and physical therapist. Your provider or care team will likely recommend medications to manage your symptoms before recommending surgery.

It depends on your insurance, but usually, you can see an interventional radiologist without a special referral if you suspect you have pelvic congestion syndrome.