Pelvic Congestion Syndrome Explained: A Common Cause of Chronic Pelvic Pain

Have you or someone you know ever experienced persistent pelvic discomfort? It is a common issue, affecting up to 15% of American women and globally impacting 43.4% of women between the ages of 15 and 50. Pelvic Congestion Syndrome (PCS) frequently is the cause of this discomfort. So, what exactly is PCS, and what potential solutions are available to address this issue?

Chronic pelvic pain can be an unsettling experience, and at Coastal Vascular & Interventional, we understand what it’s like to have PCS. Here are some of the indicators, underlying causes, and treatment alternatives.

Pelvic Congestion Syndrome: What is It? 

Pelvic congestion syndrome is a medical issue that causes ongoing discomfort in the pelvic region due to abnormalities in blood vessels. This condition is located in the lower abdominal area. 

PCS occurs when the veins responsible for returning blood to the heart are unable to function properly. This leads to blood buildup and the enlargement of the pelvic veins, which is similar to that of varicose veins and causes pain and other symptoms associated with pelvic congestion syndrome.

Pelvic Congestion Syndrome Symptoms

Pelvic congestion syndrome usually causes persistent pelvic discomfort lasting at least six months. This discomfort typically begins during or after pregnancy and may worsen with subsequent pregnancies. 

The pain can be either a dull, heavy ache or a sharp pain, usually felt on the left side but sometimes bilateral. Pain may increase due to changes in posture, sexual activity (both during and after), extended standing, or walking. Pain generally reaches its peak towards the end of the day.

Other symptoms may include:

• Pain that occurs before or during menstrual cycles.
• An abrupt urge to urinate.
• The presence of enlarged and distorted veins in the buttocks, external genitalia (vulva), or thighs

What Causes Pelvic Congestion Syndrome?

Although the exact cause of PCS is not yet known to experts, it is thought to be related to blood flow problems in the pelvic and ovarian veins. Pain in the pelvic area, which is commonly associated with PCS, occurs due to malfunctions in the veins within the pelvic and ovarian regions. Normally, blood flows from the pelvic veins to the heart through the ovarian veins, with vein valves preventing reflux and the backward flow of blood contributing to this process.

However, vein dilation or widening disrupts this process in the case of PCS, making the valves ineffective in preventing backward blood flow. As a result, the veins become engorged and twisted, causing blood to accumulate in the pelvic veins and causing discomfort as the veins stretch to accommodate the increased blood volume. 

Hormonal fluctuations, particularly those that occur during pregnancy, are also believed to play a role in the development of PCS.

Who is Affected by Pelvic Congestion?

Pelvic congestion syndrome (PCS) is a condition that mainly affects women aged 20 to 45 who have given birth several times. Women with a family history of varicose veins, varicose veins themselves, or PCOS (Polycystic Ovarian Syndrome) are at higher risk of developing this syndrome. It’s worth noting that postmenopausal women rarely experience pelvic congestion syndrome.

How is Pelvic Congestion Syndrome Diagnosed?

Diagnosing pelvic congestion syndrome can be challenging because there are several potential causes of pelvic pain. This discomfort can arise from different bodily systems, such as the reproductive system (including the uterus and ovaries), the urinary system (including the bladder), and the gastrointestinal system (including the large intestine). 

Other factors, such as issues with muscles or bones and mental health conditions like depression, can also contribute to chronic pelvic pain. As a result, healthcare providers must carefully assess multiple factors before making a definitive diagnosis.

A healthcare professional or an OB/GYN doctor typically performs the diagnostic process for pelvic congestion syndrome. This process involves a comprehensive discussion regarding the patient’s medical history and symptoms and a thorough physical examination, often including a pelvic exam. Additionally, the following tests may be required:

• Urine tests to evaluate urinary system function
• Blood tests to screen for underlying conditions, including pregnancy, sexually transmitted infections (STIs), and anemia
• Pelvic ultrasound to identify any growths or abnormalities in the pelvis
• Doppler ultrasound to assess blood flow in the pelvic blood vessels
• CT scan or MRI for more detailed imaging of the pelvic region
• Diagnostic laparoscopy to rule out other potential causes of pelvic pain
• Venography, a procedure that uses X-rays to visualize the pelvic veins, may also be necessary to assist with diagnosis.

Treatment for Pelvic Congestion Syndrome

Individualized treatment for pelvic congestion syndrome is based on the patient’s specific symptoms. 

Ovarian vein embolization (OVE) is one of the most effective treatments for PCS. This minimally invasive procedure blocks off the affected veins and restores normal blood flow. After the procedure, relief is typically seen within 2-4 weeks, and the success rate of OVE is 98-100% in pelvic congestion cases. OVE provides a safer, less invasive, and faster recovery option than surgery, enabling patients to resume normal activities shortly after treatment.

Other available options include gonadotropin-releasing hormone drugs, which block ovarian function and may provide pain relief for pelvic congestion syndrome. 

Progestin hormone therapy may also help reduce pain. Sclerotherapy and embolization can close off problematic veins, reducing symptoms. 

In severe cases, surgery may be recommended to remove damaged veins or even the uterus and ovaries.

Initially, healthcare providers may suggest medication as a conservative approach. If medication fails to adequately alleviate symptoms, your doctor may recommend procedural interventions. It’s important to note that the onset of menopause may reduce the symptoms of pelvic congestion syndrome.

How Menopause Affects Pelvic Congestion Syndrome

PCS is influenced by hormonal changes, especially during menopause. Since estrogen can make veins wider, the hormone drop during menopause might help reduce the swelling of veins in the pelvis, easing the pain. This link suggests that menopause could bring some relief to women dealing with pelvic congestion syndrome.

Still, how menopause impacts this condition can vary greatly from one person to another. Some might find significant relief, while others see little change in their symptoms. This difference highlights the need to talk to a doctor about pelvic pain and get a personalized care plan. 

Next Steps for Chronic Pelvic Pain

Suffering from chronic pelvic pain or suspected pelvic congestion syndrome can be distressing. However, there’s no need to endure it alone. Coastal Vascular & Interventional has a team of experienced vascular surgeons who can provide you with the necessary relief. You don’t have to let PCS take over your life; our experts can help you reclaim your comfort and well-being through personalized treatment plans. So, book an appointment today and take the first step towards a better life.