Question: I have been told I have pelvic congestion syndrome. What does this mean?
Pelvic congestion syndrome is a common cause of ongoing pelvic pain in women under the age of 45 who have experienced two or more pregnancies. It occurs when pelvic veins - those associated with the uterus or ovaries – become enlarged, swollen or dilated.
During pregnancy, the ovarian and pelvic veins dilate to accommodate increasing blood flow to the uterus as it enlarges. Sometimes these veins fail to return to their previous size after pregnancy. The valves inside them may also become weak, allowing blood to flow backwards and pool in the vein. This can cause congestion, bulging, pressure and discomfort.
The condition is rare in women who have never experienced pregnancy, however women with polycystic ovaries, hormonal dysfunction, or varicose veins on their vulva may be more at risk.
Women with pelvic congestion syndrome typically experience deep pelvic or uterine pain, which is often described as a 'heavy' or 'dull' ache. Pain often worsens throughout the day and with prolonged standing.
Women can experience sharp pains when they change their posture, walk, lift heavy objects, or engage in other activities that increase pressure within the abdomen. They are more prone to painful menstruation and can experience pain during or following sexual intercourse, and during subsequent pregnancies.
Varicose veins in the pelvis can also cause urinary symptoms such as irritable bladder, urinary urgency, urge incontinence and an increased need to urinate during the night. These symptoms can worsen during menstruation.
Pelvic congestion syndrome is difficult to diagnose because dilated pelvic vessels are often missed during investigations. This is because women usually lie down for a pelvic examination, temporarily relieving bulging veins and thus concealing the problem.
If pelvic congestion syndrome is suspected, women may be referred to an interventional radiologist, who can perform either a modified pelvic venogram (an X-ray that involves the use of contrast dyes to reveal pelvic congestion) or an MRI (a scan that uses magnetic fields and radio waves to take pictures of the body's interior).
Treatments include the use of analgesics (for pain relief) and oral contraceptive pills (to reduce the frequency of menstruation). If symptoms are severe, women may require embolisation.
This is a non-surgical procedure that involves the radiologist injecting tiny coils and a hardening solution into the vein to collapse and permanently close it. Embolisation can often be performed at the same time as the venogram or MRI.
Surgical treatments include hysterectomy and the removal of the ovaries. Tying off or removing the affected veins is another option, but this may provide less benefit and cause side effects.
Last updated: December 2012
© Women’s Health Queensland Wide Inc. This article was reviewed by the Women’s Health Queensland Wide editorial committee. It was published in Health Journey Issue 4 2012.