All About Pelvic Congestion Syndrome: Symptoms & Treatment

Pelvic congestion syndrome (also known as ovarian vein reflux) causes long-lasting pelvic pain in 13%-40% of women.¹ This condition is often difficult to diagnose and can lead to a reduced quality of life for young women.

Causes of Pelvic Congestion Syndrome

The origin of pelvic congestion syndrome is similar to that of varicose veins in the legs. The valves in the pelvic veins fail, and the blood that should return to the heart stays in the pelvis. Inadequate blood supply to the organs in the pelvis causes the veins to swell and exert pressure on the pelvic organs. The veins commonly involved are the ovarian vein and the internal iliac vein.²

Other causes of pelvic congestion syndrome include hormone disorders, nervous system disorders, anxiety, and depression.³ Pelvic congestion syndrome symptoms often resolve completely after menopause.⁴

Pelvic Congestion Syndrome Symptoms

Chronic pelvic pain is defined as pain in the pelvic area that lasts more than six months.⁵ Pelvic venous congestion is one of the frequent causes of such distress. 

Pain caused by pelvic congestion syndrome can be on one or both sides and varies in severity. The symptoms usually are at their worst before periods. Walking, standing for long periods, and exhaustion can worsen the symptoms.⁶ 

Some women may also experience pain during or after sex, when urinating, and during their periods. This condition may cause visible, dilated veins around the vulva, buttocks, and thighs.

Pelvic Congestion Syndrome Diagnosis

A detailed history of the symptoms, their duration and severity, and their response to earlier treatment give clues to the diagnosis. The diagnosis is confirmed by a thorough physical examination, laboratory tests, and ultrasound using color Doppler and B-mode.⁷ 

Other methods like computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, and laparoscopy are also useful. The gold standard of diagnosis is transcatheter venography. 

Pelvic Congestion Syndrome Treatment

Medical treatment has fewer complications and includes hormone therapy, danazol, combined oral contraceptives, progestins, and pain medicine.⁸ If medical treatment doesn’t succeed, surgical treatment includes ovarian vein ligation or embolization and surgical removal of the uterus and ovaries.⁹

Currently, the first choice of treatment is embolization of the dilated vein. Ovarian vein embolization has a success rate of 96%-100%.¹⁰ The complications are few, and 70%-90% of people achieve long-term symptom relief.

About 15% of women between the ages of 20 and 50 have pelvic venous disorder.¹¹ If you suspect you have this disorder, you should consult your family physician or gynecologist. You can also visit a vein care specialist. Some vein specialists treat this disorder, but can refer you to an appropriate specialist if necessary. 

My Vein Treatment is an information resource for people with venous disorders. You can also use the locator to find a vein specialist near you.

SOURCES:  

1. British Society of Interventional Radiology: “Pelvic Venous Congestion Syndrome.“
2. StatPearls: “Pelvic Congestion Syndrome.“
3. CVIR Endovascular: “Pelvic venous congestion syndrome: female venous congestive syndromes and endovascular treatment options.“
4. StatPearls: “Pelvic Congestion Syndrome.“
5. CVIR Endovascular: “Pelvic venous congestion syndrome: female venous congestive syndromes and endovascular treatment options.“
6. CVIR Endovascular: “Pelvic venous congestion syndrome: female venous congestive syndromes and endovascular treatment options.“
7. StatPearls: “Pelvic Congestion Syndrome.“
8. StatPearls: “Pelvic Congestion Syndrome.“
9. CVIR Endovascular: “Pelvic venous congestion syndrome: female venous congestive syndromes and endovascular treatment options.“
10. CVIR Endovascular: “Pelvic venous congestion syndrome: female venous congestive syndromes and endovascular treatment options.“
11. Frontiers in Cardiovascular Medicine: “Insights into pelvic venous disorders.“