📖 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.
🎯 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.
🔗 Related pages
🇫🇷 French version: varices-pelviennes-symptomes.html