Pelvic Congestion Syndrome (PCOS) is one of the known causes of chronic pelvic pain, meaning the pain has been present for more than 6 months. Chronic pelvic pain affects 15% of women, and 30% of women with chronic pelvic pain, have underlying pelvic congestion.

Other causes of chronic pelvic pain include endometriosis, fibroids and pelvic inflammatory disease. These should excluded by a gynaecologist prior to diagnosing PCOS.

Pelvic congestion typically occurs in women of child-bearing age, and refers to varicose veins within the pelvis – usually originating from the ovarian veins. The veins become enlarged or dilated within the pelvis causing symptoms.

Symptoms

  • Non-cyclical, positional lower back, pelvic and upper thigh pain
  • Difficult or painful sexual intercourse
  • Difficult or painful urination

  • Symptoms worsen throughout the day and are exacerbated by activity or prolonged standing.

  • Pain relieved by lying down.

  • High thigh veins, groin veins, vulval veins, veins underneath buttocks.

Investigations

Pelvic veins can often be seen by Duplex Doppler ultrasound. However, the diagnosis is usually confirmed by a CT Venogram (CAT scan) or MR Venogram.

Treatment

The treatment of PCOS usually involves a surgical intervention called Ovarian Vein Embolisation.

Ovarian Vein Embolisation

Embolisation is an operative procedure that refers to using coils to block the ovarian veins. This is done in an operating theatre and these veins may be accessed from the groin or the jugular vein in the neck.

The coils will cause the veins to thrombose or block off.
Foam sclerosant may simultaneously be inserted into the pelvic varices to seal these varicosities off if they are too small for coils.

It is important to note that symptoms may recur if more veins open up in the pelvis.

See other common conditions