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Pelvic Congestion Syndrome


JoAnn V. Pinkerton

, MD, University of Virginia Health System

Reviewed/Revised Feb 2023

Pelvic congestion syndrome is long-lasting (chronic) pain in the lowest part of the abdomen (pelvis) caused by accumulation of blood in veins of the pelvis, which have widened (dilated) and become convoluted.

Pelvic congestion syndrome seems to be a common cause of chronic pelvic pain Pelvic Pain in Women Pelvic pain is discomfort that occurs in the lowest part of the abdomen. Pain that occurs externally in the genital area (vulva, or labia) is called vulvar pain. Many women have pelvic pain... read more (pelvic pain lasting more than 6 months). Pain occurs because blood accumulates in veins of the pelvis, which have dilated and become convoluted (called varicose veins). The resulting pain is sometimes debilitating. Estrogen may contribute to the development of these veins.

Many women of childbearing age have varicose veins in their pelvis, but not all of them have symptoms. Why some women develop symptoms is unknown.

Most women with pelvic congestion syndrome are aged 20 to 45 years and have had several pregnancies.

Symptoms of Pelvic Congestion Syndrome

In women with pelvic congestion syndrome, pelvic pain often develops after a pregnancy. The pain tends to worsen with each pregnancy.

Typically, the pain is a dull ache, but it may be sharp or throbbing. It is worse at the end of the day (after women have been sitting or standing a long time) and is relieved by lying down. The pain is also worse during or after sexual intercourse. It is often accompanied by low back pain, aches in the legs, and abnormal vaginal bleeding.

The pain tends to occur only on one side.

Diagnosis of Pelvic Congestion Syndrome

  • A doctor's evaluation, based on specific diagnostic criteria

  • Ultrasonography or another imaging test

  • Sometimes laparoscopy

Doctors may suspect pelvic congestion syndrome when women have pelvic pain but a pelvic examination Pelvic Examination For gynecologic care, a woman should choose a health care practitioner with whom she can comfortably discuss sensitive topics, such as sex, birth control, pregnancy, and problems related to... read more does not detect inflammation or another abnormality. For doctors to diagnose pelvic congestion syndrome, pain must have been present for more than 6 months and the ovaries must be tender when they are examined.

Ultrasonography to check for varicose veins in the pelvis can help doctors confirm the diagnosis of pelvic congestion syndrome. However, another imaging test may be needed to confirm the diagnosis. These tests may include venography (x-rays of veins taken after a radiopaque contrast agent is injected into a vein in the groin), computed tomography (CT), magnetic resonance imaging (MRI), and magnetic resonance venography.

If the pain is troublesome and the cause has not been identified, laparoscopy may be done. In this procedure, doctors make a small incision just below the navel and insert a viewing tube to directly view the structures of the pelvis.

Treatment of Pelvic Congestion Syndrome

  • Usually nonsteroidal anti-inflammatory drugs

  • Medroxyprogesterone or gonadotropin-releasing hormone agonists

  • If needed, a procedure to block blood flow to the varicose veins

Nonsteroidal anti-inflammatory drugs (NSAIDs) and medroxyprogesterone or gonadotropin-releasing hormone (GnRH) agonists (synthetic forms of a hormone produced by the body), such as leuprolide and nafarelin, may help relieve the pain. Medroxyprogesterone is a progestin (a synthetic form of the female hormone progesterone). GnRH agonists are synthetic forms of a hormone produced by the body.

If these medications are ineffective and the pain is persistent and severe, doctors may try to block blood flow to the varicose veins and thus prevent blood from accumulating there. Two procedures are available:

  • Embolization of a vein: After using an anesthetic to numb a small area of the thigh, doctors make a small incision there. Then, they insert a thin, flexible tube (catheter) through the incision into a vein and thread it to the varicose veins. They insert tiny coils, sponges, or gluelike liquids through the catheter into the veins to block them.

  • Sclerotherapy: Similarly, doctors insert a catheter and inject a solution through it and into the varicose veins. The solution blocks the veins.

When blood can no longer flow to the varicose veins in the pelvis, pain usually lessens.

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