Dr. Pritee Sharma
Vascular & Endovascular Surgeon
Pelvic Vein Clinic · Hyderabad

Persistent Pelvic Pain Isn't Always Hormonal.It Could Be a Vein Disorder.

Many women live with chronic pelvic pain for years without realizing the underlying cause may be Pelvic Congestion Syndrome (PCS). Dr. Pritee Sharma provides expert diagnosis and minimally invasive treatment for pelvic venous disorders.

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Medical illustration of the female pelvic venous anatomy showing the uterus, ovaries and dilated ovarian veins
Featured In

Featured in The Times of India

The Times of India feature: Persistent pelvic pain? Don't ignore it; the cause may lie in your veins — with Dr. Pritee Sharma
The Times of India health feature, August 2026.
The Times of India · August 2026

“Persistent pelvic pain? Don't ignore it; the cause may lie in your veins”

In this health feature, Dr. Pritee Sharma explains how chronic pelvic pain in women is repeatedly attributed to hormones or stress while the real cause — Pelvic Congestion Syndrome — goes undiagnosed for years. She discusses the case of a 35-year-old software professional who lived with lower abdominal pain for nearly five years despite previous varicose vein treatment, the symptom pattern that should raise suspicion, the imaging needed to confirm it, and why minimally invasive ovarian vein embolization allows most women to return home the same day.

“Pelvic pain is a symptom, not a diagnosis, and should not be dismissed. Early recognition of PCS can spare years of unnecessary suffering and repeated ineffective treatments.”— Dr. Pritee Sharma, Consultant Vascular & Endovascular Surgeon
Read more about Pelvic Congestion SyndromeRead the original article on Times of India ePaper All media coverage
The condition

What is Pelvic Congestion Syndrome?

Pelvic Congestion Syndrome is chronic pelvic pain caused by veins that have lost the ability to drain blood out of the pelvis. The ovarian and internal iliac veins carry blood upward against gravity using delicate one-way valves. When those valves fail, blood flows backwards and pools around the uterus and ovaries. The veins stretch, their walls become irritated, and the surrounding nerves register a constant dull, dragging ache.

It is the same disease you can see in a varicose leg — only hidden. That is why women with pelvic congestion so often also have vulval, buttock or inner-thigh veins, and why leg varicose veins that keep returning after otherwise successful treatment should always prompt a look at the pelvis.

Symptoms characteristically build through the day. Mornings are tolerable; by evening, after hours of standing, commuting or sitting at a desk, the heaviness is at its worst and only improves when you lie down. Pain intensifies before periods and frequently during or after intercourse. Because the pattern is postural and cyclical rather than constant, it is easily attributed to hormones, stress or fatigue.

Pelvic congestion is a treatable vascular condition, not a diagnosis of exclusion. Once the refluxing vein is identified on imaging, it can be permanently closed in a day-care procedure — and the majority of correctly selected women experience meaningful, lasting relief.

Illustration comparing a healthy vein with working valves to a dilated diseased vein with leaking valves and pooled blood
Healthy vein with competent valves (left) versus a dilated vein with valve failure and pooled blood (right).
Recognise it

Common symptoms of pelvic venous disease

If three or more of these describe your experience — and especially if the pain is worse standing and better lying down — a pelvic venous assessment is worthwhile.

  • Chronic pelvic pain

    A dull, dragging ache low in the abdomen lasting longer than six months, often described as heaviness rather than a sharp pain.

  • Pain before periods

    Discomfort that builds in the days leading up to menstruation as pelvic veins engorge under hormonal influence.

  • Pain after standing

    Symptoms worsen through the working day, after long hours standing, travelling or sitting, and settle when you lie down.

  • Pain during or after intercourse

    Deep dyspareunia, or an ache that begins during intercourse and lingers for hours afterwards, is a classic venous pattern.

  • Pelvic heaviness or fullness

    A sensation of pressure or bearing down in the pelvis, sometimes with urinary urgency or bloating.

  • Lower back and hip ache

    Congested pelvic veins refer pain to the sacrum, buttock and upper thigh, which is often mistaken for a spine problem.

  • Visible pelvic, vulval or thigh veins

    Prominent veins on the vulva, buttock, inner thigh or behind the knee — and varicose veins that return after leg treatment.

The diagnostic gap

Why PCS is so often misdiagnosed

Pelvic congestion sits in the space between specialties. Its symptoms overlap almost perfectly with gynaecological, gastrointestinal and urinary disorders, so women are investigated repeatedly along those pathways while the venous system is never imaged.

It is mistaken for a gynaecological condition

Cyclical pain, deep dyspareunia and pelvic heaviness overlap almost completely with endometriosis, adenomyosis, ovarian cysts and chronic pelvic inflammatory disease. When a laparoscopy is normal, the pain is often labelled unexplained rather than investigated as venous.

It is mistaken for a gastrointestinal problem

Bloating, lower abdominal discomfort that worsens through the day and variable bowel habit lead many women down an irritable bowel syndrome pathway, with endoscopy and dietary trials that never address the underlying vein.

It is mistaken for a urinary condition

Pelvic pressure and urinary urgency without infection are frequently treated as recurrent urinary tract infection, interstitial cystitis or an overactive bladder.

It is mistaken for a spine or musculoskeletal issue

Referred sacral, buttock and thigh ache that is worse on standing invites lumbar imaging, physiotherapy and sometimes injections before the veins are ever imaged.

It is dismissed as hormonal or stress-related

Because symptoms fluctuate with the cycle and worsen with fatigue, many women are told the pain is hormonal, psychological or simply part of being a woman — and stop seeking answers.

Standard scans are not designed to look for it

A routine pelvic ultrasound performed lying down, without Valsalva and without interrogating the ovarian veins, can look entirely normal in a woman with significant reflux. The diagnosis needs a scan specifically aimed at the venous system.

Risk profile

Who is at risk?

  • Two or more pregnancies — pelvic vein diameter increases substantially during pregnancy and may not fully recover
  • Age between 20 and 45 years, when ovarian hormonal activity is highest
  • Family history of varicose veins or valve weakness in the veins
  • Existing leg varicose veins, especially veins that recur after previously successful treatment
  • Occupations requiring prolonged standing or long seated hours — teachers, nurses, IT professionals, retail and hospitality staff
  • Polycystic ovarian disease and other conditions associated with pelvic vein dilatation
  • Anatomical vein compression such as May-Thurner syndrome (left iliac vein) or nutcracker syndrome (left renal vein)
  • Previous pelvic surgery, pelvic inflammatory disease or pelvic trauma
Seek review sooner

Pelvic pain lasting more than six months, a normal laparoscopy with continuing symptoms, varicose veins that recur after leg treatment, or visible vulval veins after pregnancy all warrant a dedicated venous assessment rather than another round of the same tests.

Urgent care is needed for sudden severe pelvic pain, fever with pain, heavy abnormal bleeding, or a rapidly swollen and painful leg.

Precision first

How we diagnose pelvic congestion syndrome

  1. 1

    Clinical assessment

    A structured pain history — timing, posture, cycle relationship, obstetric history and previous vein treatment — combined with examination for vulval, thigh and buttock varicosities. This step alone reclassifies many women who have been investigated for years without a venous explanation.

  2. 2

    Doppler ultrasound

    A painless duplex scan of the abdomen, pelvis and legs measures ovarian vein diameter, demonstrates reversed (retrograde) flow on Valsalva manoeuvre, and maps any leg reflux feeding from the pelvis.

  3. 3

    Transvaginal ultrasound

    Performed where appropriate, it visualises dilated para-uterine and para-ovarian veins at close range and helps exclude fibroids, adenomyosis, ovarian cysts and endometriomas.

  4. 4

    CT venography

    A contrast CT provides a complete road map of the ovarian, renal and iliac veins, identifies compression syndromes, and rules out non-venous abdominal causes of pain.

  5. 5

    MR venography

    Radiation-free cross-sectional imaging that is particularly useful in younger women and where soft-tissue detail of the uterus and ovaries matters alongside the venous anatomy.

  6. 6

    Catheter pelvic venography

    The reference standard. Through a tiny vein puncture, contrast is injected directly into the ovarian and internal iliac veins to confirm reflux and pelvic varices — and, in the same sitting, treatment can be delivered.

Vascular Doppler ultrasound assessment of the pelvic veins being performed on a patient in a consultation room
Targeted venous Doppler — the first and most informative test in suspected pelvic congestion.
Treatment

Treatment options for pelvic venous disorders

Lifestyle modification

First-line measures that reduce venous pressure in the pelvis and are advised for every patient, whether or not a procedure follows.

  • Break up long standing or seated periods with short walks every 45 to 60 minutes
  • Daily calf-pump exercises and 30 minutes of brisk walking to improve venous return
  • Elevate the legs and hips for 15 minutes twice daily, especially in the evening
  • Graduated compression hosiery or supportive shorts for symptomatic relief during long days
  • Weight optimisation, adequate hydration and management of constipation, which raises intra-abdominal pressure

Medication

Medical therapy can reduce venous congestion and pain while diagnosis is confirmed, and is useful for women who prefer to defer a procedure.

  • Venoactive agents such as micronised purified flavonoid fraction to improve venous tone
  • Simple analgesics and short courses of anti-inflammatory medication for flare-ups
  • Hormonal suppression in selected patients, prescribed in consultation with your gynaecologist
  • Treatment of coexisting conditions — anaemia, thyroid disease, constipation and pelvic floor dysfunction

Ovarian vein embolization

The definitive minimally invasive treatment for pelvic congestion syndrome. The refluxing ovarian and pelvic veins are sealed from the inside so blood is redirected into healthy channels; the uterus and ovaries continue to drain normally.

  • Performed through a pinhole vein puncture in the neck or groin under local anaesthesia with light sedation
  • A fine catheter is steered into the ovarian vein; venography confirms the abnormal reflux
  • Micro-coils, and sometimes a sclerosant or vascular plug, permanently close the faulty vein
  • Both sides and the internal iliac branches can be treated in the same sitting when required
  • Typical procedure time 45 to 90 minutes; no surgical cut, no stitches, no scar

Minimally invasive adjuncts

Pelvic veins rarely exist in isolation. Where imaging shows an associated compression or leg reflux, these are addressed as part of one plan.

  • Iliac vein stenting for May-Thurner compression causing pelvic and left leg symptoms
  • Endovenous laser ablation or foam sclerotherapy for the leg and vulval veins fed by the pelvis
  • Staged treatment so each step is judged on symptom response before the next is considered

Recovery expectations

Ovarian vein embolization is a day-care procedure. Most patients in Hyderabad are admitted in the morning and discharged the same evening.

  • Two to four hours of observation after the procedure, then discharge with oral medication
  • A cramping ache for 3 to 7 days as the treated veins settle — expected, and controlled with tablets
  • Desk work in 2 to 3 days; light exercise in one week; gym and long travel at 2 to 4 weeks
  • Symptom improvement is typically gradual over 4 to 12 weeks as pelvic congestion resolves
  • Meaningful, lasting relief is reported in roughly 75 to 85 percent of correctly selected patients
  • Structured review at 6 weeks and 6 months, with repeat Doppler where indicated
Medical illustration of ovarian vein embolization: a catheter placed in the dilated ovarian vein with micro-coils sealing the faulty vein
Ovarian vein embolization — micro-coils permanently seal the refluxing vein through a pinhole puncture.

Your treatment pathway

  1. 01
    Consultation

    Structured pain history, obstetric history and examination for pelvic, vulval and thigh veins.

  2. 02
    Targeted imaging

    Venous Doppler with Valsalva, transvaginal ultrasound where appropriate, and CT or MR venography.

  3. 03
    Confirmation

    Catheter pelvic venography confirms reflux and pelvic varices — the reference standard.

  4. 04
    Embolization

    The refluxing ovarian and pelvic veins are sealed through a pinhole vein puncture, same sitting.

  5. 05
    Same-day discharge

    Two to four hours of observation, then home the same evening with oral medication.

  6. 06
    Structured follow-up

    Review at 6 weeks and 6 months with repeat Doppler where indicated.

Recovery timeline

  1. Day 0

    Day-care procedure, observed for a few hours, discharged the same evening.

  2. Day 1–3

    Cramping pelvic ache controlled with tablets; light walking encouraged from day one.

  3. Day 2–3

    Most patients return to desk work and normal household activity.

  4. Week 1

    Light exercise resumes; avoid heavy lifting and strenuous core work.

  5. Week 2–4

    Gym, long travel and full activity; the treated veins have settled.

  6. Week 4–12

    Progressive relief of heaviness, standing pain and dyspareunia as congestion resolves.

Expertise

Why choose Dr. Pritee Sharma

Consultant Vascular & Endovascular Surgeon

Pelvic venous disease is managed by a surgeon who treats veins every day — from diagnosis and imaging interpretation to the procedure itself and long-term follow-up.

DNB Gold Medalist

Dr. Pritee Sharma is a DNB Gold Medalist in vascular surgery, with more than two decades of clinical experience in vascular and endovascular care.

Featured in The Times of India

Her clinical work on pelvic congestion syndrome was featured in The Times of India, highlighting how often chronic pelvic pain in women is a missed vascular diagnosis.

Extensive minimally invasive experience

A high-volume practice in endovenous ablation, embolization, venous stenting and complex endovascular reconstruction — the same skill set that makes precise ovarian vein embolization possible.

Hospital affiliation

Procedures are performed at Renova Century Hospital, Banjara Hills, Hyderabad, with a dedicated cath lab, modern imaging and day-care recovery facilities.

Patient-first, women-centred approach

Unhurried consultations, a written plan, transparent costs and a female specialist who takes chronic pelvic pain seriously rather than attributing it to hormones or stress.

Full profile and credentials
Patient reviews

What patients say on Google

Verified Google reviews from women treated for pelvic congestion syndrome and other venous conditions by Dr. Pritee Sharma in Hyderabad.

4.9
250+ Google reviews

  • “I had chronic pelvic pain for almost six years and was told repeatedly that nothing was wrong. Dr. Pritee Sharma was the first doctor who scanned my pelvic veins properly and explained pelvic congestion syndrome to me. Two weeks after the embolization, the heaviness was gone. I finally feel heard and well.”

    Sushmita R.
    Banjara Hills, Hyderabad · Ovarian vein embolization · Jun 2026

  • “Very thorough consultation — she took a full history, did the ultrasound herself and drew out what was happening in my veins. The day-care procedure was painless and I was back at work in three days. Rare to find this level of patience in a specialist.”

    Kavitha M.
    Kondapur, Hyderabad · Pelvic vein embolization · May 2026

  • “Laser treatment for varicose veins on both legs. Walked out the same evening, no stitches, no long hospital stay. She followed up personally to check on the swelling. Excellent vascular surgeon in Hyderabad.”

    Ramesh K.
    Secunderabad · Laser varicose vein treatment · Apr 2026

  • “Two hospitals advised amputation for my father's diabetic foot. Dr. Sharma restored the blood flow with an angioplasty and saved his leg. Her calm explanation kept our whole family steady through a frightening week.”

    Lakshmi D.
    Kompally, Hyderabad · Diabetic limb salvage · Mar 2026

  • “Treated for deep vein thrombosis with careful monitoring and clear medication guidance. She never rushes an appointment and answers every question in plain language. The team at Renova Century is very organised.”

    Anil R.
    Jubilee Hills, Hyderabad · DVT treatment · Feb 2026

  • “I came for a second opinion before agreeing to open surgery elsewhere. Dr. Sharma reviewed my scans in detail and offered a minimally invasive option that worked. Honest, unhurried and genuinely expert advice.”

    Fatima S.
    Madhapur, Hyderabad · Vascular second opinion · Jan 2026
Read all Google reviews
Answers

Pelvic Congestion Syndrome FAQs

Medically reviewed by Dr. Pritee Sharma, Consultant Vascular & Endovascular Surgeon · Last reviewed 10 August 2026.

What exactly is pelvic congestion syndrome?

Pelvic congestion syndrome (PCS) is chronic pelvic pain caused by dilated, incompetent veins around the uterus and ovaries. The one-way valves in the ovarian and pelvic veins fail, blood flows backwards and pools, and the stretched veins produce a heavy, dragging ache that worsens through the day.

How common is pelvic congestion syndrome?

Venous congestion is considered one of the more frequent causes of chronic pelvic pain in women of reproductive age, and is thought to account for a substantial share of cases where laparoscopy finds no explanation. It remains under-diagnosed because it is rarely looked for.

Is pelvic congestion syndrome the same as varicose veins?

It is the same disease process in a different location. The valves fail, pressure rises and the vein dilates — in the legs you can see the result, in the pelvis you can only feel it. This is why women with pelvic congestion often also have leg, vulval or buttock varicosities.

Why do my varicose veins keep coming back after leg treatment?

Recurrent leg or vulval veins after technically successful treatment are a strong clue that the source lies higher, in the pelvis. Unless the refluxing pelvic vein is treated, it keeps refilling the leg veins. Any woman with recurrent veins deserves a pelvic venous assessment.

Does pregnancy cause pelvic congestion syndrome?

Pregnancy is the single biggest contributor. Pelvic vein diameter increases markedly to support the pregnancy and hormonal changes soften the vein wall. In most women this reverses; in some the veins remain dilated and the valves never work properly again, which is why symptoms often begin after a second or third pregnancy.

Which tests confirm the diagnosis?

A targeted Doppler ultrasound is usually the first test, supported by transvaginal ultrasound where appropriate and CT or MR venography for the full venous map. Catheter pelvic venography is the reference standard and allows treatment in the same sitting.

My pelvic scan was reported normal. Could I still have PCS?

Yes. A routine scan performed lying flat, without Valsalva manoeuvre and without specifically measuring the ovarian veins, can miss significant reflux. The scan has to be designed to answer the venous question.

What is ovarian vein embolization?

It is a minimally invasive, image-guided procedure in which the faulty ovarian and pelvic veins are permanently sealed from inside using micro-coils and sometimes a sclerosant, through a pinhole vein puncture. There is no surgical incision, and blood is simply redirected into healthy veins.

Is the procedure painful?

The vein puncture is numbed with local anaesthetic and light sedation keeps you comfortable. Most patients describe pressure rather than pain during the procedure. A cramping ache for a few days afterwards is expected and is controlled with oral medication.

How long does recovery take?

It is a day-care procedure. You are usually discharged the same evening, back at desk work within two to three days, and cleared for the gym at around two to four weeks. Symptom relief builds gradually over four to twelve weeks.

How successful is embolization?

In correctly selected patients, meaningful and lasting improvement in pelvic pain is reported in roughly 75 to 85 percent of cases. Careful patient selection — confirming that the veins, and not another condition, are driving the pain — is what determines the outcome.

Will embolization affect my fertility or hormones?

The procedure closes an abnormal drainage vein, not the ovarian artery or the ovary itself. Ovarian blood supply and hormone production are preserved, periods continue normally, and pregnancy after embolization is well described. Always tell your doctor if you are planning a pregnancy so timing and imaging can be adjusted.

Will it push me into early menopause?

No. Embolization does not remove or devascularise the ovaries and is not associated with early menopause. Hormone-related symptoms after the procedure usually have another explanation and should be reviewed.

What are the risks?

Risks are low but real and are discussed in detail before consent: bruising at the puncture site, post-embolization cramping, transient nausea, contrast reaction, coil migration (uncommon), and rarely infection or vein thrombosis. Radiation dose is kept as low as reasonably achievable.

Can the veins come back after treatment?

The treated segment is permanently closed. Occasionally, other pelvic vein branches — most often the internal iliac tributaries — become symptomatic later and can be treated in a second, short session. This is why structured follow-up matters.

Do I need to stop working or arrange help at home?

Plan for two to three quiet days. Most women in Hyderabad take the procedure day and the following day off, avoid heavy lifting for a fortnight, and continue normal household activity from the second day.

Can PCS and endometriosis exist together?

Yes, and they frequently do. If your endometriosis has been treated but pain that is worse on standing and after intercourse persists, a venous assessment is reasonable. Treating both conditions in a coordinated way gives the best result.

Is there any non-procedural treatment that helps?

Compression support, structured walking, leg and hip elevation, venoactive medication, analgesia and pelvic floor physiotherapy all help symptoms, and are the right starting point for mild disease or where a procedure is not currently preferred. They control symptoms rather than correct the vein.

What does treatment cost in Hyderabad, and does insurance cover it?

Cost depends on whether one or both sides are treated, the number of coils used and the hospital category; the consultation and Doppler assessment are a small fraction of the total. Because PCS is a recognised medical condition, many insurance policies do consider ovarian vein embolization. Our team provides a written estimate and helps with pre-authorisation before you commit.

Which doctor treats pelvic congestion syndrome?

A vascular and endovascular surgeon or interventional radiologist with dedicated pelvic venous experience, working alongside your gynaecologist. Dr. Pritee Sharma is a Consultant Vascular and Endovascular Surgeon and DNB Gold Medalist in Hyderabad with extensive experience in minimally invasive venous procedures.

When should I seek an urgent review?

See a doctor promptly for sudden severe pelvic pain, fever with pain, heavy abnormal bleeding, a rapidly swollen or painful leg, or pain associated with fainting. These need immediate assessment rather than an outpatient appointment.

How do I book a pelvic vein assessment?

Call the clinic, message us on WhatsApp, or use the appointment form on the contact page. Bring any previous scans, laparoscopy reports and a short diary of when your pain is worst — it makes the first consultation far more productive.

Patient education

Read more about pelvic vein health

Related vascular care
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Get a clear answer about your pelvic pain

One focused consultation and a targeted venous scan are usually enough to confirm or rule out pelvic congestion syndrome. Bring your previous scans and reports.

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Address
Renova Century Hospital, Road No. 12, Banjara Hills, Hyderabad 500034, Telangana
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This page is for information only and is not a substitute for professional medical advice. Please consult a registered medical practitioner before starting any treatment.