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Pelvic Congestion Syndrome

By JoAnn V. Pinkerton, MD, Professor of Obstetrics and Gynecology and Division Director, Midlife Health Center; Executive Director, University of Virginia Health System; The North American Menopause Society

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Pelvic congestion syndrome is chronic pain exacerbated by standing or sexual intercourse in women who have varicose veins in or near the ovaries.

Pelvic congestion syndrome is a common cause of chronic pelvic pain. Varicose veins and venous insufficiency are common in the ovarian veins but are often asymptomatic. Why some women develop symptoms is unknown. Most women with pelvic congestion syndrome are aged 20 to 45 yr and have had multiple pregnancies.

Symptoms and Signs

Pelvic pain develops after pregnancy. Pain tends to worsen with each subsequent pregnancy.

Typically, the pain is a dull ache, but it may be sharp or throbbing. It is worse at the end of the day (after women have been sitting or standing a long time) and is relieved by lying down. The pain is also worse during or after sexual intercourse. It is often accompanied by low back pain, aches in the legs, and abnormal menstrual bleeding.

Women may also have varicose veins in the buttocks, thighs and vagina.

Some women occasionally have a clear or watery discharge from the vagina.

Other symptoms may include fatigue, mood swings, headaches, and abdominal bloating.

Pelvic examination detects tender ovaries and cervical motion tenderness.


  • Clinical criteria

  • Ovarian varicosities, detected during imaging

Diagnosis of pelvic congestion syndrome requires that pain be present for > 6 mo and that ovaries be tender when examined.

Ultrasonography is done but may not show varicosities in women when they are recumbent.

Some experts recommend additional tests (eg, venography, CT, MRI, magnetic resonance venography) if necessary to confirm pelvic varicosities. Pelvic varicosities may be confirmed by selectively catheterizing specific veins and injecting a contrast agent (venography).

If pelvic pain is troublesome and the cause has not been identified, laparoscopy is done.


  • Usually NSAIDs

NSAIDs can be tried. If they are ineffective and if the pain is severe, embolization or sclerotherapy may be considered.

Varicosities detected during venography may be embolized with small coils or an embolic agent after local anesthesia and IV sedation are used. This procedure reduces the need for analgesics by up to 80%.