Understanding Pelvic Congestion Syndrome and Your Treatment Options
Pelvic Congestion Syndrome is a common cause of chronic pelvic pain in
women, caused by enlarged veins in the pelvis that allow blood to pool.
This can create a dull, aching heaviness that worsens after standing,
during or after intercourse, or around menstruation.
Traditional treatment starts with pain medications or hormonal therapy,
which may manage symptoms but don’t fix the underlying vein problem.
Major surgery, like hysterectomy or vein ligation, is effective but involves
long recovery and significant impact on the body.
We specialize in minimally invasive Pelvic Vein Embolization. Using a tiny
catheter, our interventional radiologists seal the diseased veins, allowing
blood to reroute to healthy veins. The procedure preserves fertility, has a
high success rate, and most patients return to normal activities within 1–3
days.
PCS embolization is ideal for women with chronic pelvic pain related to
dilated pelvic veins who want a safe, effective, non-surgical solution.
Ready to take the next step?
Explore the tabs below to learn more about your options. If you’re ready to
take control of your health, schedule your appointment online or call our
office—we’re here to help you get back to your life.
What is Pelvic Congestion Syndrome?
PCS (also called pelvic venous insufficiency) occurs when enlarged, varicose veins in the pelvis cause blood to pool, leading to chronic pelvic pain. It often affects veins around the uterus and ovaries, similar to varicose veins in the legs.
Who Gets PCS?
- Most common in premenopausal women (ages 20–50)
- Women who have had multiple pregnancies
- Those with family history or certain vein anatomy
Common Symptoms:
- Chronic pelvic pain >6 months (dull, aching, or heavy)
- Pain worse with standing or at day’s end
- Pain during/after intercourse or orgasm
- Pain worse around menstruation; improves when lying down
- Painful periods (dysmenorrhea)
- Urinary urgency, frequency, or discomfort (without infection)
- Visible varicose veins on vulva, inner thighs, or buttocks
- Lower back, hip, or leg heaviness
Causes:
- Straining during bowel movements
- Chronic constipation or diarrhea
- Sitting on the toilet for long periods
- Low-fiber diet
- Pregnancy and childbirth
- Obesity
- Heavy lifting
- Aging (weakened supportive tissues)
These symptoms are real, not “in your head,” and effective treatments exist.
Diagnosis & Non-Invasive Treatments
Diagnosis:
- Detailed symptom history and physical exam
- Imaging:
- Transvaginal ultrasound with Doppler (first-line)
- CT or MRI venography
- Pelvic venography (gold standard; can combine with treatment)
Important: Laparoscopy often misses PCS due to vein compression during the procedure.
Conservative Treatments:
- Pain relief: NSAIDs (ibuprofen, naproxen)
- Hormonal therapy: Short-term estrogen-suppressing medications
- Venoactive medications (e.g., micronized flavonoids)
- Compression garments
Surgical Options:
- Major surgery like hysterectomy or ovarian vein ligation is rarely needed
- Discuss surgical options with a gynecologist or surgeon if less invasive treatments aren’t effective
What is Embolization?
- Standard minimally invasive treatment for PCS
- Blocks refluxing ovarian and pelvic veins to stop blood pooling and relieve pain
- Performed by an interventional radiologist in an outpatient setting
Procedure Details:
- Small catheter inserted via neck or groin
- Imaging confirms abnormal veins
- Coils, foam, plugs, or glue are used to close refluxing veins
- Typically 1–2 hours; monitored 1–2 hours post-procedure
- Most return to normal activities in 1–3 days
Effectiveness:
- Technical success: 84–100%
- Symptom improvement: 75–83%
- Pain decreases 70–90%, often noticed in 1–3 months
- Long-term relief maintained in most patients for 5+ years
Safety:
- Mild pelvic discomfort for 1–3 days
- Bruising at catheter site, transient low-grade fever
- Rare complications: blood clots, allergic reactions, coil migration (<2%)
- No reported impact on fertility, ovarian function, or menstruation
Am I a Candidate? / Next Steps
Good Candidates for Embolization:
- Chronic pelvic pain >6 months, worse with standing, intercourse, or menstruation
- Imaging confirms dilated pelvic veins with reflux
- Tried conservative treatments without relief
- Want to avoid major surgery
- Premenopausal women aiming to preserve fertility
Not Ideal Candidates:
- Postmenopausal women
- Pelvic pain with other identifiable causes (endometriosis, fibroids)
- Certain venous obstructions (nutcracker or May-Thurner syndrome) that need prior treatment
- Severe kidney disease or active pelvic infection
Recovery & Follow-Up:
- Go home same day; mild discomfort 1–3 days
- Return to normal activities in 1–3 days
- Follow-up at 1, 3, 6, 12 months to monitor symptom relief
- Repeat embolization possible if symptoms recur (5–9%)
Next Steps:
- Don’t ignore chronic pelvic pain; it is treatable
- Ask your gynecologist about PCS and request transvaginal Doppler ultrasound
- Consider evaluation by an interventional radiologist for embolization
- Discuss all options, including surgical alternatives, with your doctor
Pelvic vein embolization offers safe, lasting relief from PCS, with rapid recovery and preserved fertility—helping you return to normal life.