Menopause symptoms can be managed.

Pelvic congestion syndrome (PCS) is a condition that causes increased pressure in the veins in your pelvic or lower abdominal area. It’s a common cause of chronic pelvic pain in premenopausal women. It’s somewhat tricky to diagnose, and as a result, many women live with this condition for years.

If you have ongoing achiness or pain in your pelvis, talk to your doctor. If your pain and discomfort are from pelvic congestion syndrome, there are effective treatments. Once diagnosis is made, the condition can often be treated by an interventional radiologist.

Here’s what you should know about the symptoms, causes, and treatments for pelvic congestion syndrome.

Symptoms of Pelvic Congestion Syndrome

The most common symptom is a dull pain, heaviness, or achiness in your lower abdominal area that lasts at least 6 months. For some women, the pain is sharp or throbbing. It might happen on one side of your pelvis, on both sides, or it can switch from side to side.

Other symptoms of pelvic congestion syndrome may include:

  • Pain that worsens toward the end of the day, especially after sitting or standing for long periods.
  • Pain that feels better if you lie down.
  • Low back pain or achiness down your legs.
  • Pain after having sexual intercourse or in the days before your period.
  • Abnormal menstrual bleeding.
  • Varicose veins in your buttocks, thighs, and vagina.
  • Clear, watery discharge from your vagina.
  • Fatigue, mood swings, headaches, and bloating.

Symptoms of pelvic congestion syndrome often vary among women. And one of the main reasons it’s hard to diagnose is because many other medical conditions can cause these symptoms.

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Causes and Risk Factors for Pelvic Congestion Syndrome

Experts believe pelvic congestion syndrome happens because of varicose veins in your ovaries or other reproductive organs. Varicose veins are veins that stretch and widen. When a vein widens, the valve that prevents blood from flowing backward can’t close correctly.

As a result, when you stand, blood flows backward and pools in the pelvic veins. That puts pressure on the veins and causes pain.

Pregnancy increases the risk of pelvic congestion syndrome because your body produces much more estrogen during pregnancy. Estrogen causes the veins in your pelvis (including varicose veins) to enlarge even more. For many women, pelvic congestion pain worsens with each pregnancy.

Pelvic congestion syndrome is most common among women 20 to 45 years old who have had multiple pregnancies. You might also be at higher risk if other women in your family have pelvic congestion syndrome.

How Is Pelvic Congestion Syndrome Diagnosed?

If you have ongoing pelvic pain, your doctor will consider all of the possible causes. These include problems with your reproductive, urinary tract, and digestive organs. They’ll likely perform:

  • A pelvic exam to check your uterus, cervix, and ovaries.
  • Bloodwork to check for pregnancy or rule out sexually transmitted diseases or other health conditions.
  • Urine tests to check your urinary tract health.
  • Pelvis imaging tests, like a CT scan or MRI, to get a better look at your pelvic and abdominal organs.
  • A Doppler ultrasound to check the blood flow in your pelvic blood vessels.
  • Venography, a type of x-ray of your pelvic veins using a special contrast dye injected through an IV. This makes your veins more visible in the x-ray.
  • Diagnostic laparoscopy, minimally invasive surgery to check for causes of your pelvic pain.

“By the time patients with pelvic congestion syndrome seek medical treatment, they have often been in pain for years. They have seen multiple specialists, and their journey to a true diagnosis has been long,” said Michael Akinyemi, MD, interventional radiologist, UPMC in North Central Pa.

Treatments for Pelvic Congestion Syndrome

Pain from pelvic congestion syndrome usually improves after menopause. In the meantime, medicines can help. Your doctor might recommend:

  • NSAIDs to relieve pain.
  • Hormone treatments to suppress ovarian function and reduce the size of varicose veins.

If these aren’t effective, your doctor might recommend an interventional radiology procedure called ovarian vein embolization to treat troublesome varicose veins. Here, an interventional radiologist uses a venography x-ray to guide a catheter from a vein in your groin, to the damaged veins. They use a coil to block the flow of blood and close off the vein.

“Post treatment, they are less dependent on medications, able to carry out their activities of daily living and return to work without pain. This embolization treatment is truly life changing,” added Dr. Akinyemi.

This minimally invasive procedure prevents blood from pooling in your pelvic veins. It’s very effective and often reduces the need for pain medicine. With ovarian vein embolization, you’ll only need conscious sedation and can return home within a few hours after the procedure.

If you live with chronic pelvic pain due to pelvic congestion, make sure you talk to your doctor about it. Even though it’s not a life-threatening condition, it certainly can impact your quality of life. With help from your medical team and proper treatment, you could live a far more comfortable life.

Merck Manual. Pelvic Congestion Syndrome. LINK

Saadat Cheema O, Singh P. Pelvic Congestion Syndrome. [Updated 2021 Jul 23]. In: StatPearls [Internet]. LINK

Merck Manual. Varicose Veins. LINK

About UPMC

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