📖 Pelvic congestion syndrome — overview
Pelvic congestion syndrome (PCS) is a chronic pelvic pain condition caused by incompetent ovarian or uterine veins leading to varicosities (dilated, tortuous veins) within the pelvis. Like varicose veins in the legs, these pelvic varicosities cause pain, particularly aggravated by standing, physical activity, or after intercourse.
PCS is estimated to be present in up to 30% of women with chronic pelvic pain — yet it remains one of the most under-diagnosed conditions in gynaecology. Many women are investigated for endometriosis, interstitial cystitis, or IBS before the vascular cause is identified.
⚡ At a glance — key figures
Chronic pelvic pain in women has many possible causes, including pelvic congestion syndrome (pelvic varicose veins), endometriosis, and other gynaecological or digestive conditions — accurate diagnosis is essential before treatment.
| Criterion | Data |
|---|---|
| Common causes | Pelvic congestion syndrome, endometriosis, adhesions, gynaecological or digestive conditions |
| Key diagnostic step | Doppler ultrasound, MRI or CT venography to document venous reflux if pelvic congestion is suspected |
| Interventional treatment | Embolization of refluxing pelvic veins when congestion is confirmed |
| Cost | Yes. At Cochin AP-HP (a French public hospital), this procedure is covered by national health insurance with no out-of-pocket fees. Contact ri.cch@aphp.fr or +33 1 58 41 46 12. |
Data validated by the team of Prof. Anthony Dohan, Department of Interventional Radiology, Cochin Hospital AP-HP.
🎯 Symptoms
- Chronic dull pelvic pain lasting >6 months, worse when standing, walking, or after prolonged sitting
- Dyspareunia (deep pain during or after intercourse)
- Pain worsening premenstrually
- Vulvar, perineal, or thigh varicose veins not explained by superficial venous insufficiency
- Urinary urgency (perivesical varicosities)
- Typically affects parous women (after pregnancies)
🔧 Diagnosis
🩻 Pelvic MRI with venous sequences
Ovarian vein diameter >6 mm, uterine vein dilation, pelvic varicosities — confirms diagnosis and maps extent for embolization planning.
🔬 Duplex Doppler ultrasound
Assesses ovarian vein reflux (>0.5 cm/s on Valsalva) and varicosity extent. Used as first-line investigation.
🩺 Catheter venography
Gold standard — performed in the same session as embolization. Demonstrates reflux and varicosity filling directly.
📋 Exclusion of other causes
Gynaecological (endometriosis, adenomyosis, ovarian cysts), urological (IC/BPS), musculoskeletal — PCS is a diagnosis made after thorough workup.
❓ Frequently asked questions
🔗 Related pages
🇫🇷 French version: varices-pelviennes-symptomes.html
✓ Why this page is trustworthy
Written by the Interventional Radiology team at Cochin Hospital AP-HP, Université Paris Cité. Medically reviewed by an interventional radiologist of the department. Last updated: August 2026.