Pelvic pain among women is really common. It’s associated with menstrual cramps, ovulation, PMS, ovarian cysts, fibroids, UTIs, giving birth and a number of other situations. Since there are so many causes of pelvic pain and because some of them aren’t indicative of a serious problem, but rather something natural, like ovulation, it could be easy to dismiss them. (Yet another reason it’s important to pay attention to your body and know the difference between what’s normal for you and what seems out of place.)
Pelvic congestion syndrome is one of those conditions that can look like a lot of other things, like pregnancy, irritable bowel syndrome or an STI. PCS’s symptoms include pain during sex (which can indicate an STI), a dull ache in the abdomen that gets worse when you stand and as the day goes on and is also amplified at the onset of your period and during and after sex.
PCS can also mean you don’t get your period at all, which of course might make you think you’re pregnant. In addition, patients report cravings and bloating, so this combination of symptoms can often trip up doctors, who might also suspect pregnancy.
A 2017 article in Cosmopolitan U.K. featured Heather, a 24-year-old woman who had been seeking a diagnosis for months before doctors finally came up with PCS, which overwhelmingly impacts women and is often thought to be another condition, such as polycystic ovaries and endometriosis.
“It’s a condition that often goes undiagnosed and is something women may be experiencing but may brush it off,” says Dr. David Greuner, a varicose vein specialist in New York City. “Some physicians may not understand the condition or they mistakenly think there’s no treatment.”
Physicians might also miss PCS because it’s not typically taught to gynecological students according to Dr. David Beckett of The Whiteley Clinic.
What’s actually going on when you have PCS, also known as pelvic vein incompetence and pelvic venous insufficiency? It’s basically when varicose veins, which are veins that become enlarged and twisted and usually occur in the legs, happen internally, in this case, in your lower abdomen and pelvis and in some cases in the vagina. These veins become painful and swollen.
One of the causes of PCS could be pregnancy, but other causes are not known, although women with PCS have a larger uterus and a thicker endometrium. (If you have PCS and you get pregnant, it might not affect giving birth, but the pain of the condition during pregnancy is likely to be intense.) It’s usually not found in a gynecological exam, but instead diagnosed via an MRI, a CT scan or an ultrasound. If the symptoms of PCS seem relevant to you, you might consider asking your GYN to pursue this kind of testing.
“Up to 15 percent of all women have varicose veins in the abdominal area, but not all have symptoms,” says Dr. Pratik Patil, an internal medicine physician. This is not great news because people tend to seek treatment for something once it’s bothering them, and not knowing you have PCS makes early intervention impossible.
Treatment for PCS includes pain management with anti-inflammatory drugs as well as hormonal medications that reduce blood flow in the veins. There’s also a procedure called embolization in which blood to the veins is stopped by intentionally plugging them and sealing them off, which is done if other methods don’t work. You get local anesthesia while a catheter is inserted into your shoulder or arm, and the catheter is guided to the vein by means of an X-ray. It’s a minimally invasive procedure that you can recover from quickly.
“One of the reasons we don’t hear much about PCS is because Western medicine doesn’t have a lot of treatment options, and it can be highly specific and unique to a patient,” says Dr. Elizabeth Trattner, an integrative medicine practitioner. PCS and other sources of pelvic pain can be diagnosed by means of traditional Chinese medicine.
“By checking pulses, looking at a tongue and taking a thorough history, we can make a TCM diagnosis and help women get stronger and have less pain,” Trattner says. “Also, we are able to address fertility issues as well and in conjunction with herbal preparations specific for that patient. We also will make dietary and lifestyle recommendations as well that will help alleviate pain.”
Although it won’t be as quick as the embolism procedure, acupuncture can be used to treat PCS effectively. And lacking other major treatment options, the best thing you can do is pay attention to your body and check in with your doctor if something doesn't look or feel right.
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