Quick answer
The diagnosis of pelvic congestion syndrome rests on a dedicated imaging work-up (Doppler ultrasound, MRI or phlebography) looking for dilation of the ovarian and pelvic veins. This work-up confirms the vascular cause of chronic pelvic pain before treatment.
📖 How are pelvic varices diagnosed?
The diagnosis of pelvic varices (pelvic congestion syndrome, PCS) is often made 7 years late on average. The reason: the gynaecological examination is usually normal, as pelvic varices are not visible from the outside. The diagnosis rests on a set of clinical and imaging findings.
Chronic pelvic pain in a woman who has had several pregnancies, worse when standing and at the end of the day, better when lying down, with deep dyspareunia, should suggest PCS, even with a normal gynaecological work-up.
🔍 The diagnostic examinations step by step
Pelvic and perineal Doppler ultrasound: first examination, to be performed standing and lying down. Looks for reflux in the ovarian veins (diameter > 5 mm, slow or reversed flow). Accessible, no radiation.
Pelvic MRI: confirms the pelvic varices, assesses their extent, and rules out other causes of pain (endometriosis, fibroids, adenomyosis). Gadolinium injection shows the dilated veins.
Pelvic CT scan with injection: an alternative to MRI, quick, allowing precise mapping of the ovarian and pelvic veins. Useful for planning the embolization.
Pelvic phlebography: the reference examination (gold standard), performed during the embolization itself. Complete mapping of the pelvic venous network by direct injection of contrast medium into the ovarian veins.
📋 Diagnostic criteria for pelvic congestion syndrome
The diagnosis of PCS rests on a combination of clinical and imaging criteria:
| Criterion | Diagnostic threshold |
|---|---|
| Pelvic pain | > 6 months, non-cyclical, worse when standing |
| Ovarian vein diameter | > 5 mm on Doppler ultrasound |
| Venous reflux | Reversed or stagnant flow when standing |
| Pelvic varices on MRI | Peri-uterine venous dilations ≥ 4 mm |
| Multiparity | ≥ 2 pregnancies (contributing factor) |
👩⚕️ Who should you consult for the diagnosis of pelvic varices?
Interventional radiology is the pivotal speciality for the diagnosis and treatment of pelvic varices. At Cochin AP-HP:
- A referral letter is recommended but not mandatory: the interventional radiologist can request the necessary additional examinations
- Pelvic Doppler ultrasound performed if necessary in the radiology department
- Pelvic MRI scheduled on the same site
- Phlebography and embolization performed in the same session if the diagnosis is confirmed
Frequently asked questions
My gynaecological work-up is normal: could it still be pelvic varices?
Which examinations should I ask for to diagnose pelvic varices?
Can pelvic varices be confused with endometriosis?
Is a prescription needed to consult in interventional radiology at Cochin AP-HP?
Book an appointment at Cochin AP-HP
Cochin Hospital · 27 rue du Faubourg Saint-Jacques · 75014 Paris
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🔗 Related pages
📚 Scientific references
Barat M, Soyer P, Dohan A. Diagn Interv Imaging 2025;106(10):335-336.
Le Pennec V, Douane F, Brun JL, Frandon J, et al. Diagn Interv Imaging 2025;106:356-366.
🇫🇷 French version: varices-pelviennes-diagnostic.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: July 2026.