‘Pelvic venous congestion syndrome’ is the condition you’ve probably never heard of (but which up to 40% of women experience)

woman in pain on the sofa

Credit: Getty

Strong Women


‘Pelvic venous congestion syndrome’ is the condition you’ve probably never heard of (but which up to 40% of women experience)

By Abbi Henderson

Updated 2 years ago

5 min read

Pelvic pain is common in women, but it’s rarely easy to diagnose – which is women are taking matters into their own hands.


Despite the number of women living with intense pelvic pain, it’s incredibly difficult to treat and diagnose. Why? Because although research suggests that chronic pelvic pain affects around one in six women, up to 50% of medical investigations find no obvious cause. It’s just another dismal reminder that we’re still so far behind where women’s healthcare is concerned.

You may associate pelvic pain with conditions such as endometriosis, but there’s another culprit that experts say causes chronic pelvic pain in up to 40% of women. The trouble is that so few people have heard of the condition, it can take up to 16 GP appointments to receive an accurate diagnosis. The villain in question? Pelvic venous congestion syndrome (PVCS).

What is pelvic venous congestion syndrome?

PVCS is a condition that causes veins in the pelvic areas to bulge, resulting in pelvic pain. “It’s a chronic condition [meaning it’s ongoing for at least six months], and this pain is not related to a woman’s menstrual cycle,” says Dr Gareth Nye, senior lecturer of physiology at Chester Medical School

“It is thought to be related to the veins feeding from the ovary and uterus becoming enlarged, similar to varicose veins you may see in the leg.”

woman with pelvic pain

Credit: Getty

Because they’re hidden in the lower abdomen and pelvis, the varicose veins aren’t visible through the skin’s surface – but the same issues apply as those which appear on other parts of the body.

“Just like varicose veins in the leg, if the valves in the pelvic veins fail, then the blood that should be pumped out of the pelvis and back to the heart stays inside the dilated varicose veins,” explains Professor Mark Whiteley, a consultant venous surgeon and founder of The Whiteley Clinic.

“This stops the normal blood circulation to the pelvic organs and causes the large varicose veins to push on the bladder, bowel, vagina and pelvic floor.” This pressure can trigger pelvic pain and inflammation.

What are the symptoms of pelvic venous congestion syndrome?

Because pelvic pain is so common in women, and the fact that it’s not always possible to pinpoint the cause, we don’t know exactly how many people are living with PVCS. 

“Actual numbers are hard to determine but estimates place the frequency at between 10-40% of pelvic pain cases,” says Dr Nye. Clearly, it’s a significant issue which needs urgent attention. But, research indicates that it has taken several patients more than 20 years to receive treatment after initially presenting symptoms to their GP.

Symptoms of PVCS include:

  • Pelvic pain or aching in the pelvis and lower abdomen
  • Pulling sensation in the pelvis
  • Feelings of swelling in the legs
  • Worsening in the symptoms associated with irritable bowel syndrome or incontinence

“Most women with PVCS have long-term chronic pain, which is commonly described as a dragging sensation or a chronic ache in the pelvis, and is exacerbated by standing and sitting. In some cases, the pain may also turn into a sharp stabbing sensation,” says Professor Whiteley.

He says that people with PVCS may also experience an irritable bladder and bowel because of the weight of the swollen pelvic veins are putting pressure on the bladder and rectum and are also prone to painful menstruation. You may experience heavy discomfort during or following sexual intercourse, and subsequent pregnancies, too.

Many women are being put through expensive, needless tests and then being told that there’s nothing wrong

Professor Mark Whiteley

“It is often said that PVCS only occurs in fertile women who have had at least one pregnancy. However, our latest research shows 10% of our patients with PVCS who have never been pregnant – and 25% are post-menopausal,” Professor Whiteley says.

If you’re experiencing symptoms of PVCS, it’s important to check in with your GP as soon as possible. If you struggle to get a diagnosis, as many unfortunately do, Professor Whiteley recommends scheduling an appointment with a specialist venous surgeon to explore your symptoms further.

What causes pelvic venous congestion syndrome?

There are two main causes of PVCS, according to the experts.

Venous reflux

Professor Whiteley explains that the most common reason is “simple venous reflux”. “Just like varicose veins in the legs, the one-way valves stop working in the pelvic veins allowing blood to pool. This causes the pelvic veins to dilate causing the symptoms.”

Obstruction to the pelvic veins

“An obstruction causes blood to try to find another way out of the pelvis, and this diverted blood can cause the pelvic veins to dilate, causing similar symptoms but from a different cause,” he adds. And those obstructions actually have names, including nutcracker syndrome or non-thrombotic iliac vein lesion (NIVL).

water bottle on green background

Credit: Getty

The specific cause of the dilated veins in PVCS is not thoroughly understood, but according to Dr Nye, it most commonly occurs in young women who have had at least two to three children. “We can assume it is related to the anatomical changes seen during pregnancy, specifically the ovarian vein can be compressed by the enlarging womb or enlarged because of the increased blood flow,” he says. 

“This can put pressure on the valves and vein structure leading to the condition following birth.”

Research has also shown that one in six women with leg varicose veins have PVCS which, according to Professor Whiteley, isn’t surprising, as the two conditions are linked. He does say, however, that PCS can be cured in the majority of cases, provided there’s an accurate diagnosis. 

“We can treat it using pelvic vein embolisation,” he says, which is a minimally invasive treatment which shuts off faulty veins so they can no longer pool with blood and swell.

Why does it take so long to get a PVCS diagnosis? 

On average, it takes 16 GP appointments to get an accurate diagnosis of PVCS. 

“It is becoming evident that because gynaecologists have not been brought up to diagnose this condition, a great many women who are suffering from the symptoms of PVCS are not having the appropriate investigations. Instead, they’re being put through expensive and needless tests such as MRI, CT and even laparoscopy under general anaesthetic and then being told that there is nothing wrong with them,” Professor Whiteley says. 

The gold standard test to get a diagnosis, he says, is to have a transvaginal duplex ultrasound using the Holdstock-Harrison protocol.

Because of the nature of the symptoms, Dr Nye says it can take longer to get a diagnosis. “When compared with other conditions seen in the pelvis, PVCS is often overlooked as it doesn’t impact on fertility or impact the whole body to the extent endometriosis or PCOS does.

If you think you may have PVCS, he emphasises that being aware of changes in your body is the first step. “If something doesn’t feel right you should always find out why. Unfortunately, too often women think pelvic pain is something they have to live with rather than seeking answers. This needs to be married up with better education for other healthcare professionals in understanding common pathologies women can get.”


Images: Getty

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