Your Period Pains May Actually Be Pelvic Congestion Syndrome

If you suffer from intense cramps, it's easy enough to chalk it up to premenstrual syndrome (PMS). However, pelvic pain—especially chronic pelvic pain—may signify another, more serious condition: pelvic congestion syndrome (PCS).

PCS, also known as pelvic venous insufficiency, is a chronic condition affecting women of reproductive age. With this condition, varicose veins occur within the pelvic region, and these veins twist and swell up, causing dull pain similar to menstrual cramps.

Some women may wonder how to tell the difference between PCS and routine period pain.

Symptoms of PCS

PCS is difficult to diagnose because many women who have it tend to experience pain in the days leading up to their periods. This makes differentiating PCS from PMS difficult, according to Sara Twogood, M.D., a board-certified OB-GYN in Los Angeles and co-founder of Female Health Education, a healthcare company.

Experts agree, however, that the fundamental difference between PMS and PCS lies in how long, how frequently and how intensely the individual experiences pain.

"PMS can include both behavioral and physical symptoms and are always specific to the time right before a period starts and resolve completely within four days of the first day of the period," Twogood explained. "The symptoms of pelvic congestion syndrome may be more noticeable during that PMS window, but they are often described at other times of the month, too."

PMS involves pain within the lower abdominal region that may be sharp, even stabbing, according to Kiarra King, M.D., a Chicago-based, board-certified OB-GYN. But the duration of PMS is brief and generally resolves within the first few days of a woman's period, King said. This can span from three days before the onset of a period to three days after, just as the flow decreases.

'PMS can include both behavioral and physical symptoms and are always specific to the time right before a period starts and resolve completely within four days of the first day of the period.'

On the other hand, PCS pain is chronic and can feel like dull cramping in the lower abdomen, or sometimes like something sharp is being poked into the lower belly. While the pain can get more intense before and during a period, the clincher is that you feel the ache and discomfort even after a period has run its course.

Women with pelvic congestion syndrome often describe a feeling of heaviness, and symptoms may worsen throughout the day but be better in the mornings, King said.

"Some will note worsened pain post-menses, during or after sex, after prolonged walking or standing, and even enlarged veins in the vulva," she added.

PCS symptoms are generally chronic in nature, meaning they are longstanding, unlike PMS, which resolves in a few days.

Other symptoms of pelvic congestion syndrome include:

• Abnormal vaginal bleeding and/or copious amounts of clear or watery discharge
• Pain that radiates from the lower back to the thighs
• Abnormal sense of fatigue even after minor tasks
• Unusual abdominal bloating and/or fullness
• Headaches
• Mood swings or anxiety

In some cases, PCS can also be characterized by pelvic pain that occurs immediately or less than a week after a woman has given birth.

Diagnosing pelvic congestion syndrome

To come to a conclusive diagnosis of PCS, gynecologists recommend a transvaginal sonogram. This procedure looks for any issues within the reproductive system that cannot be checked with mere palpation. Your doctor may also recommend a laparoscopic examination if the sonogram results appear vague or inconclusive.

According to King, pelvic congestion syndrome is a diagnosis of exclusion, meaning doctors check for or rule out other issues, through patient history, physical exam, laboratory testing and imaging studies, before coming to this diagnosis.

Who is at risk for PCS?

Any woman of childbearing age—but more specifically those between the ages of 20 and 45—is at risk for developing pelvic congestion syndrome. A 2022 comprehensive overview on PCS published in the Annals of Medicine lists other factors to take into consideration, including:

• A history of varicose or spider veins, deep vein thrombosis or similar venous insufficiency disorders
• Having been pregnant
• A history of hormonal imbalance
• A history of inflammatory bowel disease (IBD)
• Being sexually active
• Working in an occupation that involves sitting or standing for prolonged periods of time

Treating PCS

As much as possible, gynecologists and vein specialists use a combination of drug and hormone therapy to alleviate the pain of pelvic congestion syndrome.

A progestin (a synthetic form of the female hormone progesterone) called medroxyprogesterone is one such hormonal solution. It is used together with nonsteroidal anti-inflammatory drugs (NSAIDs) or other gonadotropin-releasing hormones (GnRH) to provide pain relief and regulate a woman's reproductive system.

However, surgery is prescribed if drug and hormone therapy fail to alleviate the pain and discomfort. This surgery may be in the form of either vein embolization, where tiny sponges or adhesives are inserted into affected veins to stanch the flow of blood, or sclerotherapy, where a chemical solution is injected into affected veins to stop the flow.

Can PCS be prevented?

Pelvic congestion syndrome is an unfamiliar condition to many people. According to Twogood, since it is a vague diagnosis, it's not known if there are specific ways to prevent it.

"If someone is diagnosed with PCS, there is no way to prevent it necessarily, but symptoms may be mitigated," King agreed.

Encouraging patients to minimize prolonged standing and/or prolonged walks may help. In addition, some patients may require hormonal medications or surgery to ameliorate their symptoms.

Women can also reduce their risk by practicing good health habits, such as getting enough exercise and keeping weight and body mass index at healthy levels. Pregnant women can also wear compression or support garments during pregnancy and after giving birth.

Still, due to the ambiguous nature of PCS, it can be challenging to prevent it from occurring. Therefore, it is always best to consult your doctor on PCS symptoms and possible treatment.