Pelvic congestion syndrome (PCS) involves chronic pelvic pain unrelated to menstruation or pregnancy. It involves problems with blood flow in your pelvic veins. Blood flows backwards, causing your veins to swell and twist. Researchers aren’t sure what causes PCS, but it’s likely that changes to your veins during pregnancy and estrogen play a role.
Pelvic congestion syndrome — also called pelvic venous insufficiency — is a chronic pain condition associated with blood flow problems in your pelvic veins. “Chronic” means pain lasting longer than 6 months that isn’t associated with either your menstrual cycle or pregnancy.
The pelvic pain associated with PCS often involves faulty veins in your ovaries and pelvis. The veins dilate (widen) and may become twisted and overfilled with blood. As a result, blood may pool in your pelvis and feel painful.
You’re more likely to have PCS if you’re between ages 20 to 45 and have given birth more than once. Other risk factors include:
It’s rare for people who’ve gone through menopause to have pelvic congestion syndrome.
Approximately 40% of gynecological visits involve chronic pelvic pain complaints. It’s estimated that up to 30% of these are likely related to pelvic congestion syndrome.
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
The pelvic pain you experience with PCS may feel dull, achy or heavy. Less commonly, the pain may feel sharp and intense. You may notice the pain on the left side only (most common), on the right side of your body or both sides. Often, pain starts during or soon after pregnancy. It may worsen with future pregnancies.
The pain associated with PCS may feel worse:
Other symptoms include:
Researchers don’t know what causes pelvic congestion syndrome. Still, problems with blood flow in your ovarian veins and the veins in your pelvis play a role.
Normally, blood flows upward from your pelvic veins and toward your heart via the veins in your ovaries. Structures called valves in your veins prevent blood from flowing backward. Backflow of blood is called reflux.
With PCS, veins are so dilated (widened) that the valves don’t prevent reflux. Blood flows backward through the veins, causing them to become overly filled and twisted. Blood pools in your pelvic veins and causes pain. The pain may result from the stretching your stressed veins must do to contain the extra blood. It’s also possible that the misshapen veins touch nearby nerves in your pelvis, triggering pain.
There are a few possible reasons that veins become structurally unsound with PCS:
PCS likely results from various interrelated factors.
Your healthcare provider will ask about your medical history and symptoms. You’ll likely have a physical exam that includes a pelvic exam. Your provider will check for tenderness in your ovaries, cervix and uterus to try and pinpoint where the pain originates.
Imaging can help your provider rule out other conditions that cause chronic pelvic pain and identify any irregularities in your veins potentially related to PCS. Imaging procedures include:
Diagnosing pelvic congestion syndrome can be challenging because many people without pelvic pain have stressed veins similar to those who do experience pain. Imaging studies have shown that people with chronic pelvic pain and those without it may have distorted blood vessels and backflow of blood.
Even if imaging shows that your veins are dilated, you don’t need treatment unless you’re experiencing chronic pain.
Pelvic congestion as a cause of pelvic pain is a diagnosis that’s generally given after all other causes of pelvic pain have been excluded.
There isn’t a cure for pelvic congestion syndrome, but medications and medical procedures can help ease your symptoms.
You may see different healthcare providers for treatment, including a gynecologist, gastroenterology (GI) specialist, pain specialist and physical therapist. Your provider or care team will likely recommend medications to manage your symptoms before recommending surgery.
Medications that suppress estrogen production can lessen the pain associated with pelvic congestion syndrome. They include:
Your provider may perform a medical procedure if medications don’t ease your symptoms. These include:
Pelvic congestion syndrome isn’t preventable.
Pelvic congestion syndrome isn’t life-threatening. Depending on the severity of your pain, it can disrupt your life and keep you from activities you enjoy. See your healthcare provider if your pelvic pain is compromising your quality of life.
Although there isn’t a standard treatment for pelvic congestion syndrome, the outcomes associated with interventions to provide pain relief are excellent. For instance, 75% of people who receive ovarian vein embolization experience pain relief. Recurrence happens in only 5% of these cases.
A note from Cleveland Clinic
It may take some patience to pinpoint what’s causing your pelvic pain. Indeed, many conditions can cause pain in your pelvis. It may take a few tests and maybe even a few specialists working collaboratively to diagnose your PCS. The good news is that medications often relieve symptoms. If medicine doesn’t work, your healthcare provider can recommend procedures that can help. Don’t delay when it comes to seeking care and experiencing relief.
Last reviewed by a Cleveland Clinic medical professional on 09/27/2022.
Learn more about our editorial process.