Pelvic Congestion Syndrome

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