Pelvic Congestion Syndrome

Pelvic congestion syndrome is a condition that causes chronic pelvic pain. It's thought to be caused by problems with the veins in the pelvic area. The pelvic area is inside the lower part of your belly (abdomen).

Understanding veins in the pelvic area

Veins are the blood vessels that carry blood back to the heart. In some people, veins in the lower abdomen may stop working well. Blood may start to build up inside the veins. When this happens, the veins in your pelvis can enlarge and change shape, like varicose veins. This may lead to the pain and other symptoms of pelvic congestion syndrome.

What causes pelvic congestion syndrome?

Healthcare providers are still learning about the causes of pelvic congestion syndrome. Enlarged veins in the pelvis may be part of the cause. But many people have enlarged veins and no symptoms.

The syndrome happens mostly in people of childbearing age. It may be more common in people who have given birth to more than one child. The veins in the pelvis get larger during pregnancy. They can stay large after pregnancy and cause symptoms.

Hormones also may be part of the cause. Estrogen makes veins wider (dilated). This may be why the condition is not common after menopause. Estrogen levels are lower after menopause. Other hormones may also cause veins to grow wider and cause symptoms.

You may have a higher risk for pelvic congestion syndrome if you have given birth to more than one child. You may also have a higher risk if other members of your family have it.

Symptoms of pelvic congestion syndrome

The main symptom of pelvic congestion syndrome is pelvic pain that lasts at least 6 months. This pain often first starts during or after a pregnancy. It may get worse after a later pregnancy. The pain may be a heavy or aching feeling. Or the pain may be sharp. The pain is usually only on one side, often the left. At times you may feel it on both sides. The pain is often worse at the end of the day.

Some things may make the pain worse. These include:

• Standing for a long time

• Changing your posture

• Having sex

• Walking

Some people also have symptoms such as:

• Pain before or during their periods

• Feeling a sudden need to urinate

• Enlarged and distorted veins on the buttocks, external genitals (vulva), or thighs

Diagnosing pelvic congestion syndrome

Pelvic congestion syndrome is not easy to diagnose. Pelvic pain is common, and it can be caused by many things. Pelvic pain can result from problems with the reproductive system, like your ovaries and uterus. It can be caused by the urinary system, like your bladder. It can be caused by the gastrointestinal system, such as your large intestine. And it can be caused by muscles or bones. Psychological conditions, such as depression, are also linked to chronic pelvic pain. Your healthcare provider will need to consider many possible causes before diagnosing pelvic congestion syndrome.

Your primary care provider, an obstetrics and gynecology (ob/gyn) provider, nurse practitioner, or midwife may diagnose the condition. Your healthcare provider will ask about your health history and your symptoms. You will also have a physical exam. This will likely include a pelvic exam.

You may also need some tests, such as:

• Urine tests, to check for problems with your urinary system

• Blood tests, to check for pregnancy, sexually transmitted infections, and anemia

• Pelvic ultrasound, to look for growths in the pelvis

• Doppler ultrasound, to check the blood flow in the pelvic blood vessels

• CT scan or MRI for more detailed pictures

• Diagnostic laparoscopy, a minimally invasive surgery to rule out other causes of pelvic pain

• Venography, a procedure to take X-rays of the pelvic veins

Treatment for pelvic congestion syndrome

Your healthcare provider will treat you according to your symptoms. Possible treatment choices include:

• Gonadotropin-releasing hormone medicines, which may ease pain

• Progestin hormone medicines, which may also ease pain

• Sclerotherapy, to shut off damaged veins

• Embolization, to shut off damaged veins

• Surgery to remove damaged veins

• Surgery to remove your uterus and ovaries

Your healthcare provider may suggest starting with medicines. If these don't relieve your symptoms, your healthcare provider may advise a procedure to treat the condition. Your symptoms may lessen as you enter menopause.

When to call your healthcare provider

Call your healthcare provider right away if any of the following occur:

• Symptoms that don’t get better with treatment

• Symptoms that get worse

What is pelvic congestion syndrome?

Pelvic congestion syndrome is a condition that causes chronic pelvic pain. It's thought to be caused by problems with the veins in the pelvic area. This is the lower part of your belly (abdomen).

Veins are the blood vessels that carry blood back to the heart. In some people, veins in the lower abdomen may stop working well. Blood may start to build up inside the veins. When this happens, the veins in your pelvis can enlarge and change shape, like varicose veins. This may lead to the pain and other symptoms of pelvic congestion syndrome.

It happens mostly in people of childbearing age. It may be more common in people who have given birth to more than one child.

What causes pelvic congestion syndrome?

Healthcare providers are trying to understand the possible causes of pelvic congestion syndrome. Enlarged veins in the pelvis seem to play a major role. But many people have enlarged veins and no symptoms. Pregnancy may increase the risk for pelvic congestion syndrome. This is because veins enlarge during pregnancy to support the increased blood flow. This can permanently enlarge the veins and lead to symptoms.

Hormones may also play a role in pelvic congestion syndrome. Estrogen makes veins wider (dilates). This may be why the condition is not common after menopause. Estrogen levels are lower after menopause. Other hormones may also cause veins to grow wider and cause symptoms.

Who is at risk for pelvic congestion syndrome?

You may have a higher risk for pelvic congestion syndrome if you have given birth to more than one child. You may also have a higher risk if other members of your family have it.

What are the symptoms of pelvic congestion syndrome?

The main symptom of pelvic congestion syndrome is pelvic pain that lasts at least 6 months. This pain often first starts during or after a pregnancy. It may get worse after a later pregnancy. The pain may be a heavy or aching feeling. Or the pain may be sharp. Usually the pain is only on one side, usually the left side. At times you may feel it on both sides. The pain is often worse at the end of the day.

Certain factors may make the pain worse, such as:

• Changing your posture
• Having sex (both during and after)
• Standing for a long time
• Walking

Some people also have symptoms, such as:

• Pain before or during their periods
• Feeling a sudden need to urinate
• Enlarged and distorted veins on the buttocks, external genitals (vulva), or thighs

How is pelvic congestion syndrome diagnosed?

Pelvic congestion syndrome is not easy to diagnose. Pelvic pain is common and there are many different causes. Pelvic pain can result from problems with the reproductive system, like your ovaries and uterus. It can be caused by the urinary system, like your bladder. It can be caused by the gastrointestinal system, such as your large intestine. And it can be caused by muscles or bones. Mental health conditions such as depression are also linked to chronic pelvic pain. Your healthcare provider will need to consider many possible causes before diagnosing the condition.

Your healthcare provider or an OB/GYN healthcare provider may diagnose the condition. They will ask about your health history and your symptoms. You will also have a physical exam. This will likely include a pelvic exam.

You may also need some tests, such as:

• Urine tests to check for problems with your urinary system
• Blood tests to check for pregnancy, sexually transmitted infections (STIs), anemia, and other conditions
• Pelvic ultrasound to look for growths in the pelvis
• Doppler ultrasound to check the blood flow in the pelvic blood vessels
• CT scan or MRI for more detailed pictures
• Diagnostic laparoscopy to rule out other causes of pelvic pain
• A procedure to take X-rays of the pelvic veins (venography)

How is pelvic congestion syndrome treated?

Your healthcare provider can tailor your treatment according to your symptoms. Possible treatment options include:

• Gonadotropin-releasing hormone drugs, which block ovarian function and may relieve pain
• Progestin hormone drugs, which may relieve pain
• Procedures to shut off damaged veins (sclerotherapy, embolization)
• Surgery to remove damaged veins
• Surgery to remove your uterus and ovaries

Your healthcare provider may suggest starting medicines. If these don't relieve your symptoms, your healthcare provider may advise a procedure to treat the condition. Your symptoms may ease up as you enter menopause.

When should I call my healthcare provider?

If your symptoms get worse, plan to see your healthcare provider soon. Pelvic congestion syndrome itself doesn't usually lead to a medical emergency. If you have a sharp, sudden pain that doesn’t go away, see your healthcare provider right away.

Key points about pelvic congestion syndrome

• Pelvic congestion syndrome is a health condition that causes chronic pelvic pain. The condition is thought to be caused by the enlarged veins in your pelvic area.
• People of childbearing age who have had more than one pregnancy may have the highest risk for pelvic congestion syndrome.
• Pelvic pain is the main symptom. This may get worse after standing, walking, or having sex. It may start during or after pregnancy.
• You may need several tests to rule out other causes of pelvic pain.
• Hormone treatments may help symptoms.
• Procedures that block the damaged veins (embolization) or surgery to remove the ovary and tube or the uterus may be choices.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your healthcare provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your healthcare provider if you have questions, especially after office hours or on weekends and holidays.