Pelvic Congestive Syndrome

Pelvic congestive syndrome (PCS) is a common condition that afflicts women, especially those of reproductive age, causing steady pain in the pelvic region that lasts more than six months. The subspecialized physicians at The Vein Specialists can provide much needed relief through treatments ranging from medications to a minimally invasive procedure.

About Pelvic Congestive Syndrome

PCS is a condition that occurs when there is a persistent accumulation of blood in the veins of the pelvis, causing chronic pelvic pain. This condition is mostly seen in women who have had multiple pregnancies or those who have pelvic varicose veins. PCS can bring prolonged discomfort and decreased quality of life, yet diagnosis can be challenging, as the symptoms can be similar to those of endometriosis or uterine fibroids.

Risk Factors

There are several risk factors that may make women more susceptible to PCS:

  • Childbearing age (typically 20 - 45)
  • Previous pregnancy/s (risk increases with more than one pregnancy)
  • Obesity
  • Polycystic ovaries
  • Hormonal increases or dysfunction
  • Fullness of leg veins
  • Family History


Symptoms of PCS may include any of the following:

  • Dull, aching, or "dragging" pain in the pelvis or lower back for more than six months — √ā¬†especially pain that worsens throughout the day or when standing (pain may subside when lying down)
  • Feeling of fullness or bloating in the pelvic region
  • Heightened discomfort during menstrual cycle
  • Discomfort during or after sexual intercourse
  • Varicose veins in the upper thighs, vagina, labia, vulva, or perineal region
  • Irritable bowel syndrome
  • Irritable bladder or painful urination


The Vein Specialists will review health and family history and perform a pelvic exam to determine where the pain originates. Imaging also may be utilized, including ultrasound, CT, and/or MRI, to generate visuals of internal organs and tissues. Finally, pelvic venography may be used if/when imaging is inconclusive. A catheter is used to inject a contrast material to make abnormalities more visible on imaging.


The first recommended course of treatment for PCS is usually hormone suppressant medication. By blocking estrogen, a hormone that is known to exacerbate painful symptoms, patients can sometimes find relief. Additionally, medical-grade compression garments can release pressure and ease discomfort.

If these methods are unsuccessful, The Vein Specialists offer an outpatient, minimally invasive procedure called ovarian vein embolization (OVE). During an OVE procedure, a radiologist will make a small incision in the groin area and insert a catheter (a thin, flexible tube) into the femoral vein, which is located in the thigh. The catheter is then guided up to the ovarian vein using imaging techniques such as ultrasound or fluoroscopy. Once the catheter is in place, the radiologist will inject a material called an embolic agent, which is designed to block the blood flow in the vein. This stops the accumulation of blood in the pelvic veins and reduces the pressure and pain. OVE usually is performed on an outpatient basis, meaning the patient can go home the same day. It is generally considered safe and effective, with minimal risks of complications. Some patients may experience mild pain, bruising, or swelling at the site of the incision, but these symptoms usually resolve on their own within a few days.

You have questions. We have answers.

Below you'll find answers to some of the questions we are commonly asked by patients. Please contact us at (828) 670-8346 with any additional questions or concerns.

How long does the ovarian vein embolization procedure take?
The OVE procedure usually takes about one to two hours.
Is ovarian vein embolization painful?
OVE is usually performed under local anesthesia, so the area where the catheter is inserted will be numbed. You may feel some discomfort or pressure during the procedure, but it should not be painful.
What is the recovery time for ovarian vein embolization?
You may be able to go home the same day of the procedure, and normal activities can be resumed within a few days. You may experience some mild pain, bruising, or swelling at the site of the incision, but these symptoms usually resolve on their own within a few days.