Pelvic congestion syndrome: the current state of the literature

Arch Gynecol Obstet. 2016 Feb;293(2):291-301. doi: 10.1007/s00404-015-3895-7. Epub 2015 Sep 24.


Purpose: Pelvic congestion syndrome is an uncommon poorly understood and frequently misdiagnosed disorder of the pelvic venous circulation, which causes chronic pelvic pain in women in premenopausal age. This condition has typical features, such as pelvic varicosities, pelvic pain worsened by prolonged standing, coitus, menstruation, and pregnancy.

Methods: The precise etiology of this syndrome remains uncertain, and it is probably multifactorial. Valvular insufficiency, venous obstruction, and hormones all may play a role in the development of congestion of the pelvic veins.

Results: Pelvic pain and venous varices are often both present in premenopausal women, but not necessarily causally related. Furthermore, incompetent and dilated pelvic veins are a common finding in asymptomatic women. As such, it is challenging but important to determine which patients have chronic pelvic pain specifically related to pelvic congestion syndrome in order to treat them properly.

Conclusions: Once the syndrome has been accurately diagnosed, medical, surgical, or minimally invasive endovascular treatments can improve symptoms in a high percentage of cases. This updated nonsystematic review of the literature explores the pathophysiology, clinical features, diagnostic investigations, and treatment option of this complex condition that affects young women with considerable implications for their daily social and psychological condition.

Keywords: Chronic pelvic pain; Pelvic congestion; Pelvic varices; Pelvic venous insufficiency; Sclero-embolization.

Publication types

  • Review

MeSH terms

  • Adult
  • Chronic Pain / diagnosis
  • Chronic Pain / therapy
  • Diagnostic Imaging / methods*
  • Embolization, Therapeutic / methods*
  • Female
  • Humans
  • Pelvic Pain / diagnosis*
  • Pelvic Pain / etiology
  • Pelvic Pain / therapy*
  • Pelvis / blood supply
  • Syndrome
  • Treatment Outcome
  • Uterine Diseases / complications
  • Varicose Veins / complications
  • Varicose Veins / diagnosis*
  • Varicose Veins / therapy*
  • Veins