Pelvic congestion syndrome can lead to chronic pain in the pelvic or abdominal area. Issues with the pelvic veins cause it, specifically when the veins become enlarged or dilated. Changes in pressure and blood flow can make the condition more likely.

Typically, pelvic congestion syndrome affects females of reproductive age. Pregnancy is a common underlying reason, and factors like increased blood demand and hormonal influences play a contributing role in pregnant people.

As there are many other causes of pelvic pain, it is important that a person gets the right diagnosis. This might involve using tests like imaging or laparoscopy.

Pelvic congestion syndrome can affect a person’s quality of life, but there are treatments available. Treatments can typically resolve between 68–100% of confirmed cases.

Keep reading to learn more about pelvic congestion syndrome, including what might cause it and how doctors diagnose and treat the condition. The article also answers some commonly asked questions on the topic.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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Pelvic congestion syndrome develops when there are changes in the structure and function of the veins in the pelvis. The damaged veins may affect blood flow, and may cause some blood pooling or backward blood flow.

The condition is more common in women. Up to 15% of women between ages 20 and 50 years have some degree of pelvic venous disorder. However, not everyone diagnosed with the disorder will have symptoms. Among those who do have symptoms of chronic pelvic pain, about 30% of them are diagnosed with pelvic congestion syndrome.

Learn more about pelvic pain in males here.

Many factors can play a role in pelvic congestion syndrome.

Issues with the internal iliac vein, ovarian vein, or both can cause pelvic congestion syndrome. These veins supply the pelvic region. One issue may be that the valves within these veins do not work well, or do not work at all. Physiological changes during pregnancy can also play a role in valve problems in some people.

External compression of the pelvic veins can also be a contributing factor.

Ultimately, the pelvic veins become dilated, tortured, or congested, leading to symptoms.

Learn more about the causes of pelvic pain here.

It is not possible to predict exactly who will develop pelvic congestion syndrome, but there are some factors that can make it more likely that a person will develop it.

People most at risk are those who have had multiple pregnancies. Often the condition develops during the first pregnancy, with the potential to worsen with future pregnancies.

Pelvic congestion syndrome tends to occur before menopause and during the reproductive years. Estrogen levels can also play a role. Estrogen relaxes the veins and can cause problems.

With menopause, people may experience a drop in estrogen levels. For many people, this drop may lead to symptom improvement.

There may also be a genetic component. About half of those diagnosed with pelvic congestion syndrome have a family history of the condition.

Chronic pain in the pelvic area is the primary symptom. The pain can be constant, or it can come and go. A person may also feel a sensation of heaviness in the abdomen. People can find that pain or symptoms worsen during certain times, including:

  • when they stand for a long period of time
  • during or after sex
  • during pregnancy
  • in the evening or toward the end of the day

Along with chronic pelvic pain and a feeling of pressure, other symptoms may include:

  • increased vaginal discharge
  • heavier periods
  • blood in the urine (hematuria)
  • varicose veins around the genitals
  • pain in the lower back
  • changes in bladder or bowel function

Learn more about sudden, stabbing pelvic pain here.

There are many possible reasons for chronic pelvic pain. A doctor will likely have to rule out other causes before diagnosing pelvic congestion syndrome.

Imaging tests

Imaging tests can help doctors visualize veins in the pelvis and find out what is happening within them. Specifically, ultrasound imaging can detect changes in the shape and function of the veins. Also, this test can help rule out underlying causes of pelvic pain, such as uterine problems.

Other tests that doctors may order are computed tomography (CT) scans and/or magnetic resonance imaging (MRI).


Venography is a specialized type of testing that doctors use to assess how the veins are functioning. It involves a dye being injected so the veins will show up on an X-ray.

This test can detect areas where veins are weak.


Symptoms of chronic pelvic pain may require a laparoscopy to rule out any gynecological problems. Laparoscopy involves making a small cut under the stomach and using a thin, long tube with a camera on the end (laparoscope).

In females with chronic pain, laparoscopy can identify disease in 35–83% of them, with pelvic congestion syndrome being the cause in about 20% of those with chronic pain.

The main treatment options for pelvic congestion syndrome include medications and surgical procedures. These measures can help resolve symptoms in over 68% of those diagnosed with the syndrome.


Some medications that doctors may recommend include:

  • gonadotropin-releasing hormone agonists, which stop hormone production
  • danazol, which prevents the ovaries from making estrogen
  • oral contraceptives, which regulate hormone levels
  • nonsteroidal anti-inflammatory drugs (NSAIDs), which help relieve pain and reduce inflammation
  • pain medications

If medications are not enough to help improve symptoms, some people will likely need surgery.


Often surgery requires a hospital stay.

Surgeons can close off damaged veins, which can block blood flow to the affected vein and prevent symptoms. However, for some, surgery can come with complication risks. Around 20% of people may experience an increase in recurrent pelvic pain, while 33% may experience increased residual pain.

Below are answers to some commonly asked questions on the topic:

What is the link between pelvic congestion syndrome and ovarian cancer?

While there seems to be no association between pelvic congestion syndrome and an increased risk of ovarian cancer, some characteristics may overlap. Both conditions share similar symptoms, including:

  • pain in the pelvic region
  • a feeling of fullness
  • changes in bladder and bowel function

A medical professional can help differentiate the two using tests.

Does pelvic congestion syndrome cause weight gain?

The condition is unlikely to cause weight gain. A common symptom of pelvic congestion syndrome is a feeling of abdominal fullness or bloating. For some people, this may feel like weight gain.

Can you die from pelvic congestion syndrome?

Pelvic congestion syndrome can affect a person’s quality of life, but it is typically not a life threatening condition.

It’s important that anyone with chronic pelvic pain consult a healthcare professional to ensure they receive the right diagnosis and subsequent treatment.

Pelvic congestion syndrome can cause chronic pelvic pain, especially in women before menopause. It happens when veins in the pelvis dilate or become engorged. Issues with the ovarian vein are likely to cause the condition. However, many factors can be contributors.

Some symptoms of pelvic congestion syndrome include pelvic pain, a sensation of heaviness, and pain with sex. It often starts during pregnancy, and symptoms can increase with future pregnancies.

Treatments are available that can help a person manage or resolve their symptoms. As many symptoms of pelvic congestion syndrome may overlap with those of other conditions, it is important that a person get medical help when experiencing chronic pelvic pain. This can help ensure they receive the correct diagnosis and care.