Why Some Women Choose Embolisation for Pelvic Congestion Syndrome Instead of Surgery

Medicine Made Simple Summary 

Pelvic Congestion Syndrome (PCS) is a condition that causes chronic pelvic pain in women, often mistaken for menstrual or lower back pain. It happens when veins in the pelvis become enlarged and twisted, similar to varicose veins in the legs. Traditionally, surgery was used to remove or tie off these veins. Today, a minimally invasive treatment called embolisation can relieve pain without large cuts or long recovery times. This guide explains what PCS is, how embolisation works, and why many women now choose it over surgery.

1. Understanding Pelvic Congestion Syndrome (PCS)

Imagine veins in your pelvis as small highways carrying blood back to your heart. When the valves in those veins weaken or stop working properly, blood pools in the pelvis. This leads to vein swelling and pressure, causing a dull, aching pain.
This condition is called Pelvic Congestion Syndrome.

PCS often affects women who’ve had more than one pregnancy, though it can occur at any age. Hormonal changes, pregnancy, and even genetics can weaken vein walls. The result is constant or recurring pelvic pain that worsens after long periods of standing, during menstruation, or after intercourse.

Many women spend years being misdiagnosed with back pain, endometriosis, or urinary problems before PCS is correctly identified.

2. Common symptoms women notice

The hallmark symptom of PCS is chronic pelvic pain that lasts for six months or more. It’s usually described as a dull, heavy, or throbbing ache low in the abdomen or back.

Other common symptoms include:

• Pain that gets worse when standing or sitting for long periods

• Pain during or after sexual intercourse

• Visible or bulging veins near the vulva, buttocks, or upper thighs

• Heaviness or pressure in the pelvis

• Occasional urinary frequency or discomfort

Because symptoms overlap with many other conditions, diagnosis can be tricky. That’s why imaging—especially with interventional radiology—is crucial.

3. How doctors diagnose Pelvic Congestion Syndrome

Diagnosis begins with a detailed conversation about your symptoms and medical history. Your doctor may start with ultrasound to check for enlarged pelvic veins. If PCS is suspected, further imaging—such as CT venography, MRI, or a specialized test called pelvic venography—confirms the diagnosis.

During venography, a contrast dye is injected into the veins so the doctor can see the pattern of blood flow on live X-rays. This not only confirms PCS but also helps plan treatment if embolisation is needed.

These imaging techniques are done by interventional radiologists—doctors who specialize in diagnosing and treating blood vessel problems through tiny punctures instead of open surgery.

4. Traditional surgery and its limitations

In the past, treating PCS meant surgically tying off or removing the affected veins (a procedure called ovarian vein ligation). While effective, it involved incisions, longer recovery, and potential scarring.

For many women, surgery wasn’t an ideal option—especially those with multiple children, those planning pregnancy, or those with other medical conditions that made surgery riskier. Post-surgical recurrence could also occur if new veins developed or if smaller veins were missed during the operation.

These limitations led doctors to develop a safer, less invasive option: pelvic vein embolisation.

5. What is embolisation and how does it work?

Pelvic vein embolisation is a minimally invasive, image-guided procedure that blocks abnormal veins in the pelvis to stop blood from pooling. Here’s how it’s done:

• The interventional radiologist inserts a thin catheter into a vein—usually through the groin or neck.

• Using X-ray guidance, the catheter is guided into the enlarged pelvic veins.

• A special dye (contrast) maps out the veins, confirming which ones are causing the congestion.

• The doctor then places tiny coils or plugs, sometimes with a liquid sealing agent, to block those veins.

• This reroutes blood flow to healthy veins, relieving pressure and pain.

The procedure usually takes 45 to 90 minutes, and patients are awake but sedated for comfort. Most go home the same day.

6. Why embolisation is becoming the preferred option

More women are choosing embolisation for several reasons:

Minimally invasive:
There are no large incisions—just a small puncture the size of a grain of rice. Recovery is faster, and scarring is minimal.

Quick recovery:
Most women resume normal activities within a few days, compared to weeks with surgery.

Preserves fertility:
Since no reproductive organs are removed or altered, future pregnancy remains possible.

Less pain, fewer complications:
Because it targets only the problem veins, the surrounding tissue and organs remain untouched.

High success rate:
Studies show 85–95% of women experience significant or complete relief from pain after embolisation.

Repeatable if needed:
If new veins become problematic later, the procedure can be repeated safely.

7. What to expect before, during, and after the procedure

Before the procedure

You’ll meet with your interventional radiologist to discuss your symptoms and review imaging results. Blood tests ensure your kidneys and clotting functions are normal.
You may be asked to fast for a few hours before the procedure and avoid certain medications, especially blood thinners.

During the procedure

You’ll lie on a special table in the radiology suite. Local anaesthetic numbs the skin, and mild sedation helps you relax.
Through a small puncture (in the neck or groin), the doctor inserts a catheter into your veins. X-ray images guide it precisely into the pelvic veins.
Once confirmed, coils or medical glue seal off the faulty veins. You might feel mild pressure or warmth, but no sharp pain.

After the procedure

You’ll rest for a few hours for observation. Most women go home the same day.
Some experience mild cramping or backache for a few days—this is normal and managed with medication.
You can usually return to light work or normal activity in 2–3 days.

Full symptom improvement can take a few weeks to months, as swollen veins shrink and blood flow normalises.

8. Are there any risks?

Pelvic vein embolisation is considered very safe. Complications are rare but can include:

• Minor bruising or soreness at the puncture site

• Temporary back or pelvic pain

• Allergic reaction to contrast dye (uncommon)

• Coil migration or incomplete vein closure (very rare)

The benefits far outweigh the risks for most patients. Your doctor will discuss any personal factors that could influence your safety or recovery.

9. Comparing embolisation and surgery

While both options aim to relieve pain by closing abnormal veins, the approach differs drastically.

Surgery requires general anaesthesia, larger incisions, and hospitalisation. Embolisation, in contrast, uses local anaesthesia, no major cuts, and minimal downtime.
Success rates are similar, but embolisation carries fewer complications and preserves fertility.

In multiple studies, women reported faster pain relief, lower recurrence, and higher satisfaction after embolisation compared to surgery.

10. What questions should you ask your doctor?

Before deciding on treatment, ask:

• How confident are we that my symptoms are from pelvic congestion and not another condition?

• Am I a good candidate for embolisation?

• What type of embolic material will be used?

• How long will recovery take for me personally?

• What is your experience and success rate with this procedure?

• Will I need follow-up imaging after treatment?

An open discussion ensures you’re informed and comfortable before proceeding.

11. Life after embolisation

Most women notice significant pain reduction within weeks. Many say they feel “lighter” and can finally stand, walk, or exercise without constant discomfort.
Menstrual pain may also improve, and varicose veins in the pelvis or thighs often fade.
Your doctor will schedule a follow-up ultrasound or MRI after a few months to confirm that blood flow has normalized and symptoms have resolved.

Some women may need repeat embolisation years later, but this is uncommon. Maintaining good vein health—regular exercise, avoiding prolonged standing, and managing weight—can also help.

Conclusion 

If you’ve been living with unexplained pelvic pain, heaviness, or varicose veins in the pelvic region, ask your doctor about Pelvic Congestion Syndrome.
Modern image-guided embolisation offers safe, effective, and long-lasting relief—without the risks of surgery.
Before agreeing to invasive procedures, consult an interventional radiologist who performs pelvic vein embolisation regularly. They can confirm your diagnosis and explain exactly how this treatment works for women like you.

Taking that first step toward clarity and relief could help you regain comfort, confidence, and control over your daily life.