Pelvic Congestion Syndrome (PCS) is a condition causing chronic pelvic pain. This pain arises from varicose veins deep within the pelvis, often involving the ovarian and internal iliac veins. When the valves within these veins fail, blood flows backward and pools, causing the veins to swell and become engorged. This venous insufficiency leads to a dull, aching sensation. Many women diagnosed with PCS are concerned about whether the condition affects their ability to conceive and carry a pregnancy to term.
PCS and the Likelihood of Conception
Conception is generally possible for women with Pelvic Congestion Syndrome, as the condition is primarily a disorder of pain and blood flow, not a direct cause of infertility. PCS does not typically block the fallopian tubes or prevent the ovaries from releasing eggs. The core issue of PCS is venous insufficiency, meaning the veins struggle to return blood efficiently from the pelvis back to the heart.
A key challenge is that PCS can cause discomfort or pain during and after sexual intercourse, a symptom known as dyspareunia. This pain may indirectly reduce the frequency of intercourse. Furthermore, emerging research suggests that sustained venous congestion and increased pressure in the pelvic veins might create a less favorable environment for conception.
The altered blood flow dynamics could potentially affect the delicate hormonal balance required for regular ovulation or impact the function of the fallopian tubes. Increased pressure in the pelvic veins may also slightly impair uterine blood flow. However, most women with PCS who have had prior pregnancies have demonstrated their overall reproductive capability.
While limited studies have explored a direct link between PCS and unexplained infertility, they suggest that treating the venous congestion may improve fertility outcomes for some patients. It is important to differentiate PCS from other anatomical or hormonal causes of infertility, such as endometriosis or Polycystic Ovary Syndrome. A diagnosis of PCS should prompt a comprehensive fertility workup to rule out other co-existing issues that could be the true source of any conception challenges.
Managing PCS Symptoms During Pregnancy
Once conception occurs, the pregnancy itself often increases the severity of PCS symptoms due to significant physiological changes in the body. Total blood volume can increase by 30 to 50 percent during pregnancy, placing greater strain on the already compromised pelvic veins. Hormonal shifts, specifically elevated progesterone levels, cause the walls of the veins to relax and further dilate, exacerbating the pooling of blood.
As the uterus grows, it exerts direct pressure on the major veins in the pelvis and abdomen, which restricts blood flow return and intensifies the venous congestion. This increased pressure can cause pain to worsen, particularly in the second and third trimesters. Symptoms that may have been mild before pregnancy can become more pronounced, including the appearance of varicose veins on the vulva, buttocks, or upper thighs.
Management strategies during gestation focus on minimizing discomfort and supporting the venous system, as interventional procedures are typically avoided. Simple lifestyle adjustments are often the first step, such as avoiding prolonged periods of standing or sitting, which worsen blood pooling. Elevating the hips or lying on the left side can help relieve pressure on the inferior vena cava, promoting better blood return from the lower body.
Wearing maternity compression garments or specialized support hose can provide external counter-pressure to aid blood flow and reduce swelling in the legs and external varicosities. Pain relief must be carefully managed with a healthcare provider, utilizing medications deemed safe for the developing fetus, such as acetaminophen. The underlying venous dysfunction in PCS, combined with the naturally increased risk of blood clots during pregnancy, necessitates close monitoring for deep vein thrombosis (DVT).
The condition of venous stasis, or slow blood flow, created by the engorged pelvic veins can contribute to a slightly elevated risk of clot formation. Any signs of one-sided leg swelling, redness, or tenderness should be immediately reported to a physician. While the absolute risk remains relatively low, a vascular specialist may recommend prophylactic measures, such as low-molecular-weight heparin, especially for those with severe symptoms or additional risk factors.
Addressing PCS Through Medical Treatment
For women who have completed their family planning or whose pain is unmanageable, definitive medical treatments for PCS are highly effective. The primary treatment is a minimally invasive procedure called pelvic vein embolization (PVE). This procedure is performed by an interventional radiologist who guides a thin catheter into the faulty veins and uses coils or sclerosing agents to block them off.
Blocking the insufficient veins redirects blood flow to healthy veins, immediately reducing pressure and congestion. This approach is highly successful at alleviating the chronic pelvic pain associated with the condition. Hormonal therapies, such as progestins, may also be prescribed to suppress ovarian function and reduce the hormone-induced dilation of the veins.
Given that PVE is a non-surgical procedure with a short recovery time, it is often the preferred method for long-term pain relief. However, the decision to undergo embolization is usually deferred until after a woman has finished having children. This is because a subsequent pregnancy could potentially cause new varicose veins to form, though the procedure itself is not known to impair future fertility.
Consulting with a vascular specialist or interventional radiologist is an important step when planning conception or seeking treatment for severe PCS. They can assess the extent of the venous disease and discuss the timing of treatment, ensuring that any intervention aligns with the individual’s family goals. Surgical options, such as vein ligation or hysterectomy, are rarely considered and typically reserved for cases where less invasive treatments have failed.