Pelvic Congestion Syndrome FAQ

What is pelvic congestion syndrome?

Pelvic congestion syndrome (PCS) is a condition in which the veins in the pelvis — particularly the ovarian and uterine veins — become enlarged, twisted, and incompetent, allowing blood to flow backward and pool rather than returning to the heart efficiently. The resulting venous pressure causes chronic pelvic pain, heaviness, and pressure. It is considered a venous cause of chronic pelvic pain and is one of the most commonly underdiagnosed conditions in women with ongoing pelvic symptoms.

What does PCS pain feel like?

The pain is typically described as dull, aching, heavy, dragging, or pressure-like — rarely sharp or stabbing. It tends to be worse at the end of the day, after prolonged standing or sitting, during or after intercourse, and around menstruation. A hallmark feature is that it improves when lying down, which reflects reduced venous pressure in the recumbent position.

How long does PCS pain last?

By clinical definition, PCS is characterized by chronic pelvic pain lasting at least 6 months. Many women have symptoms for years before receiving a diagnosis.

Is PCS common?

Pelvic venous disorders are thought to be one of the leading causes of chronic pelvic pain in women of reproductive age. Despite this, PCS is frequently missed or misattributed to other conditions, in part because pelvic veins are not routinely assessed on standard pelvic imaging and because symptoms overlap with other causes of pelvic pain.

Who gets PCS?

PCS most commonly affects women between 20 and 45. It is especially associated with pregnancy — particularly multiple pregnancies — because pelvic and ovarian veins significantly enlarge during pregnancy and may not fully recover afterward. Women with a personal or family history of varicose veins or venous insufficiency may also be at higher risk.

Does embolization cure PCS completely?

Embolization reduces or eliminates symptoms in the majority of appropriately selected patients, but it is not guaranteed to eliminate all pelvic pain — particularly if other conditions coexist. Symptom recurrence can occur and may require additional treatment. Success rates reported in the literature are generally meaningful, though patient selection matters significantly.

Is pelvic vein embolization safe during pregnancy or if I want to become pregnant?

Embolization is not performed during pregnancy. If you are planning a future pregnancy, discuss timing and implications with your specialist. The procedure targets pelvic veins, not the ovaries themselves, and is generally considered fertility-preserving — but your physician should evaluate your specific anatomy and circumstances before proceeding.

What is the difference between PCS and endometriosis?

Both conditions cause chronic pelvic pain and can coexist. Endometriosis is driven by endometrial tissue growing outside the uterus, causing inflammation and scarring, often with highly cyclical pain tightly linked to the menstrual cycle. PCS is a vascular condition driven by venous reflux, causing pressure and heaviness that varies with posture rather than just the menstrual cycle. They are not mutually exclusive — some women have both