Pelvic Congestion Syndrome (PCS)

Pelvic Congestion Syndrome (PCS) is a condition in which chronic pelvic pain is caused by enlarged, congested veins in the pelvis. Similar to varicose veins in the legs, the veins around the uterus and ovaries can become pathologically enlarged and fail to carry blood back to the heart efficiently.

Symptoms often persist for months to years and are frequently described as dull, dragging or pressing. Because the symptoms resemble many other gynaecological conditions, PCS is often recognised late – it is one of the important but frequently overlooked causes of chronic pelvic pain in women.

Important information:

Symptoms

The leading symptom of Pelvic Congestion Syndrome is chronic, often dull or dragging pelvic pain that can persist for months to years.

Chronic, usually dull or dragging pelvic pain (present for more than 6 months)
Pain that worsens with prolonged standing or sitting, and during menstruation
Relief of symptoms when lying down
Visible varicose veins around the vulva, groin or thighs
Pain during or after intercourse
Back pain and a feeling of heaviness in the lower abdomen

PCS - what exactly does it mean?

In Pelvic Congestion Syndrome, the valves of the ovarian veins or other pelvic veins no longer work properly, causing blood to pool and flow backwards.

As a result, the veins become permanently enlarged – similar to varicose veins in the legs. The congested veins can press on surrounding nerves and organs, causing the typical chronic pain.

Who is affected?

PCS mainly affects women of reproductive age, often after at least one pregnancy – during pregnancy, blood volume and pressure on the pelvic veins increase significantly, which can permanently damage the veins.

A family history of varicose veins or venous weakness also increases the risk, as does having had multiple previous pregnancies.

How is PCS diagnosed?

Since there is no single test that proves the diagnosis, it is usually established step by step. After a detailed conversation and a gynaecological examination, an ultrasound (transvaginal, if necessary with Doppler) is typically used first to visualise the enlarged veins.

The finding can be confirmed with magnetic resonance imaging (MRI) or venography, in which contrast medium is injected into the veins to precisely show blood flow and any congestion.

Are there risk factors?

Factors that increase risk include several previous pregnancies, a family tendency towards varicose veins or venous weakness, hormonal influences (oestrogen), and prolonged standing in everyday life or at work.

Frequently Asked Questions

Frequently asked questions relating to Pelvic Congestion Syndrome.

When should I see a doctor?

As a general rule: see your gynaecologist promptly if you experience one or more of the following symptoms:

What happens at the doctor's?

First, a detailed conversation about your medical history takes place, followed by a gynaecological examination.

Important points include:

How and when does the pain occur, and what relieves or worsens it?
How many pregnancies have you had so far?
Do you already have known varicose veins in your legs?
Is there a family history of venous disease?

Further assessment usually continues with an ultrasound, supplemented by MRI or venography if needed.

What can be done about PCS?

Both medical and minimally invasive treatment options are available. The right treatment path depends on the severity of symptoms, whether family planning is complete or still desired, and the findings on imaging.

Consulting a specialist is necessary to clarify which approach is right for you.

Is PCS treatable?

Yes. Catheter-based embolisation in particular is considered a highly effective standard therapy: in the vast majority of patients, symptoms improve significantly and lastingly within a few weeks.