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Pelvic Congestion Syndrome (PCS) Overview

Pelvic congestion syndrome (PCS) affects women causing a chronic dull pelvic pain and a feeling of pressure and heaviness in the groin. PCS is often associated with varicose veins in the lower abdomen, groin, and ovaries. This condition tends to affect women aged 20 – 45 with a history of two or more pregnancies but can affect women with no history of pregnancy.

Pelvic Congestion Syndrome Causes

The cause for PCS is an increase in pressure in the veins in the pelvic region. The blood in the pelvic venous system is unable to drain properly and the pooling blood causes an increase in pressure to occur, resulting in pelvic pain.

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You Have a Choice When It Comes to Vascular Care.
Get an Appointment at VIC In 3 to 5 Days – Without a Referral!

Pelvic Congestion Syndrome Risk Factors & Symptoms

Risk Factors for PCS include:

  • Multiple pregnancies
  • Multiple birth pregnancies
  • Age
  • Family History
  • Obesity

Symptoms for Pelvic Congestion Syndrome can impact the quality of a woman’s life on many levels, both physically and mentally.

Woman at risk for pelvic congestion syndrome because she gave birth to twins


  • Chronic pelvic pain & pressure for more than six months
  • Discomfort with menstrual cycle
  • Pelvic pain during/after intercourse
  • Feeling of fullness or pain in the pelvic, vaginal, labia or perineal area
  • Swelling in the vagina, labia, or perineal area
  • The presence of varicose veins in the upper thigh, vagina, labia, or perineal area
  • Frequent urination
  • Incontinence

Pelvic Congestion Syndrome Diagnosis

A patient experiencing symptoms is the first indication that there is the possibility of PCS.  The formal steps in the process of diagnosis would be:
  • An in-depth history and physical of the patient ruling out any other medical issues
  • Undergoing a transabdominal ultrasound evaluating for ovarian vein dilation
  • An intravascular ultrasound scan (IVUS) to assess and check the blood flow in the vessels
  • A venogram where a dye is injected into the veins to observe abnormal flow within the ovarian veins

Pelvic Congestion Syndrome Treatment

A patient would begin with the most minimally invasive treatment option, which is compression hose or shorts. If the wearing of these items does not alleviate the symptoms of pain/pressure, then the next steps would be endovascular diagnosis and therapy. A venogram is performed, under sedation anesthesia, where the pelvic veins are visualized. If the ovarian vein is dilated with abnormal flow called reflux, then an embolization procedure would be completed. This essentially blocks the vein with a coil, a small metallic device, which reduces pressure and pain symptoms. In the outpatient surgical setting, minimally invasive endovascular procedures can be performed with excellent outcomes for the patient.  The benefits include:
  • No overnight hospital stay, patient can go home the same day
  • No incisions, the procedure is completed with a needle puncture groin access
  • Pain is minimal versus an open surgery
  • Rates of complication and scarring are decreased
  • Improved PCS symptoms of chronic pelvic pain

Pelvic Congestion Syndrome Prevention

While you cannot control what happens to the body, a patient knowing that they may be at a higher risk can take measures to avoid further difficulties.
  • Wearing compression hose during pregnancy
  • Maintaining a healthy weight and BMI during pregnancy
  • Maintaining a healthy BMI overall
  • Making compression hose part of your daily attire
woman lounging in chair wearing compression socks to prevent pelvic congestion syndrome

Pelvic Congestion Syndrome Progression

The main symptom to be aware of is pelvic pain lasting for more than 6 months, often starting during pregnancy or after pregnancy, that also continues to worsen over time.


During a hysterectomy, the periuterine veins are removed, which are the offending veins causing the issue of PCS.

Typically pain and pressure worsen over time; frequent bladder infections, painful intercourse, and painful periods are some of the issues facing patients.

PCS is a chronic condition that requires a medical diagnosis where an endovascular procedure can relieve symptoms.
PCS is a condition often underdiagnosed affecting women between the ages of 20 and 50 who have had multiple pregnancies.  It is estimated to affect around 15% of the US population.


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