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Pelvic congestion syndrome (PCS)

Pelvic congestion syndrome (PCS) is a condition in which veins that normally surround the uterus and ovaries become stretched, swollen, and tender. These pelvic “varicose veins,” similar to the varicose veins that commonly occur in the legs, can cause severe pressure on the female pelvic organs.

The blood in the large veins that drain the ovaries normally flows in an upward direction toward the heart. In the case of pelvic venous congestion, the valves that control blood flow in the veins are not working properly. The blood pools in the veins around the ovaries, the uterus and other pelvic structures, causing pressure and pain. PCS typically affects women age 20–50.

Symptoms of pelvic congestion syndrome

Pelvic congestion syndrome can affect women ages 20-50Chronic pelvic pain is a symptom of PCS. Chronic pelvic pain is defined as a history of pain in the pelvis, lower abdominal area, and/or lower back lasting for 6 months or longer. Other symptoms of pelvic congestion syndrome may include:

  • Varicose or prominent veins on the external female genitalia
  • Vulvar varicosities or prominent veins of the inner thighs and buttocks
  • Ovarian point tenderness (tenderness in the lower quadrants of the pelvis)
  • Pelvic, back, or leg aching/pain
  • Pain after intercourse that lasts for hours or days; you may or may not have pain during intercourse.
  • Frequent urination
  • Difficult, irregular or painful menstrual cycles

Most symptoms are worse at the end of a day. Symptoms can also occur after long periods of standing, sitting or strenuous activity. Symptoms are typically more manageable in the morning time.

Women with these symptoms should have a thorough history and physical examination with their gynecologist or physician. Other conditions that may cause chronic pelvic pain are endometriosis, uterine fibroids, uterine prolapse, interstitial cystitis and pelvic inflammatory disease. Once other sources of chronic pelvic pain are ruled out, a patient may be referred to an interventional radiologist for diagnosis and treatment of pelvic venous congestion or pelvic congestion syndrome.

Depending on each patient’s situation, the following exam(s) may be necessary to make a final diagnosis:

  • Magnetic resonance imaging (MRI)
  • Special ultrasound (US) examination
  • Pelvic venogram

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More information

For more about chronic pelvic pain and PCS, visit

Explore treatment options and common questions about PCS below.

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