Venous Disorders, Pelvic Congestion Syndrome, and Endometriosis: A Connection We Need to Talk About
When I became pregnant with my second kiddo, my OB-GYN casually dropped a fun little bombshell at my 12-week appointment: Varicose veins — down south. Way south.
The official term? Vulvar varicosities. These are varicose veins that develop in the vulvar area, and they can be related to or occur alongside pelvic congestion syndrome (PCS).
Naturally, I went home, grabbed a mirror, and... holy smokes! There they were: bulging blue veins snaking around my labia. And these were just the veins I could see! If I also had (have) PCS, it would mean other vericose veins were hidden deep inside.
But the real kicker? I started developing serious symptoms. Had I not known these rogue veins were involved, I would have sworn my endometriosis had returned with a vengeance. The severe pain, pelvic pressure, and general sense of “everything is wrong” were that bad, reminiscent of many of my symptoms from 10 years ago.
My main complaints?
Chronic pelvic pain
A heavy, dragging sensation after standing too long. This was really awful.
Symptoms lingering even after lying down!
It was eerily familiar — but different, too. This wasn’t the predictable menstrual pain or cyclical flares I associated with endometriosis. This was more of an "around-the-clock" pressure and ache, a hallmark sign of pelvic venous congestion syndrome.
It made me wonder: Had I been dealing with pelvic venous issues all along? Could some of what I blamed on endometriosis have been vascular in nature, linked to impaired blood flow or congested pelvic veins?
Pelvic Congestion Syndrome, Venous Issues, and Endometriosis: The Overlooked Link
Turns out, I’m far from alone. Lately, I’ve been getting DMs from fellow endo warriors asking, "Is there a connection between pelvic veins and endometriosis?"
The short answer: Yes. A big one.
Key Players You Might Have Heard About
Pelvic venous disorders include several specific types of vascular conditions that often overlap with or mimic endometriosis:
Pelvic Congestion Syndrome (PCS): Dilated, refluxing pelvic veins causing chronic pelvic pain
Pelvic Venous Disorders: Umbrella term for vein-related problems in the pelvis
Pelvic Varicose Veins: Varicose veins located inside the pelvic cavity or vulva
Venous Insufficiency: When blood flow struggles to return efficiently to the heart, causing pooling
Vulvar Varicosities: Visible varicose veins specifically around the vulva
Deep Pelvic Vein Issues: Hidden venous congestion without visible signs
These vein-related issues can:
Cause pelvic pain that mimics (or worsens) endometriosis pain! Talk about confusing.
Contribute to chronic inflammation in the pelvis (which may contribue to endo-ing, as I talk about in my book)
Create tissue hypoxia (low oxygen) — similar to what happens with endometriosis tissue (which I also mention at length in my book).
And here’s the kicker: They’re often linked to risk factors and chronic diseases like POTS (Postural Orthostatic Tachycardia Syndrome) and EDS (Ehlers-Danlos Syndrome), both of which disproportionately affect women with endometriosis.
How Pelvic Venous Disorders Differ from Pelvic Inflammatory Disease (PID)
As a side note, pelvic venous disorders are often confused with pelvic inflammatory disease (PID), but they are fundamentally different. PID results from bacterial infection and inflammation of the female reproductive organs, including the fallopian tubes. In contrast, pelvic venous congestion syndrome involves vascular dysfunction and blood pooling without infection. Misdiagnosing these conditions can delay appropriate treatment options.
Let’s learn about the link between these two separate but connected issues!
To dig deeper, I reached out to Kimberly Kushner (@endonaturopath), an endometriosis-focused naturopath and clinical in Australia who is, in a word, brilliant. (Also stunningly pretty, which is just rude, honestly.)
Not only does she help women navigate both endometriosis and venous insufficiency, but—like me—she has both conditions herself.
We put our research-loving heads together to bring you this deep dive because we truly believe pelvic venous disorders could be at the root of some of your worst symptoms. And, it’s quite treatable.
Understanding how to diagnose and treat these conditions could be a game-changer for many of us. So stay tuned—because if addressing venous insufficiency could make you feel a heck of a lot better, you deserve to know about it.
My Story: Living with Venous Disease, Pelvic Congestion Syndrome, and Endometriosis
(Written by Kimberly Kushner, @endonaturopath, www.endonaturopath.com)
My journey with pelvic venous disorders weaves through several other conditions, including POTS, mast cell activation disorder, and hypermobility syndrome — creating a complex web of symptoms and discoveries.
While working with an incredible specialist in EDS, POTS, and MCAS, we uncovered something unexpected through a series of detailed imaging studies: Massive bilateral pelvic varices — meaning both of my ovarian veins were severely enlarged and refluxing.
Typically, pelvic congestion syndrome primarily affects the left ovarian vein. But in my case, both sides were involved — and my right ovarian vein was described as “huge.”
This discovery helped explain why my symptoms looked so different from the classic signs of endometriosis I had experienced earlier in life.
Instead of battling severe cramping, heavy menstrual periods, and IBS-like bowel movements, my symptoms now included:
A dull, dragging pelvic pain that pulled toward my right abdomen and pubic bone
A constant, heavy sensation rather than sharp flares
Intense pressure in my ovarian region — especially when sneezing or straining
A tight, “tourniquet-like” feeling around my upper inner thighs, with pain radiating down my legs
Discomfort tracking from under my sternum, down both sides of my abdomen, and into my pelvis and flanks
Living with POTS alongside these vascular issues created additional challenges. Simple actions — standing still, changing posture, or even eating — could trigger dramatic shifts in my heart rate and blood pressure. (Abdominal vascular compressions are also part of my story, making blood flow regulation even more complex.)
Exercise, something that used to feel empowering, often became a trigger for heart rate spikes and near-fainting episodes.
How My Story Highlights the Overlap
What my case shows so clearly is that pelvic congestion syndrome and pelvic venous insufficiency don’t always behave like “typical” endometriosis. The chronic pelvic pain I experience now is more:
Positional (worse after standing or exertion)
Dull and heavy (not sharp and stabbing)
Non-cyclical (constant rather than tied to the menstrual cycle)
These vascular issues interact with connective tissue fragility, autonomic nervous system dysfunction, and hormonal influences — creating a complex web of symptoms that often gets misattributed entirely to endometriosis alone.
Understanding how pelvic blood flow, pelvic anatomy, and vascular compression impact the reproductive system has been essential in helping me manage symptoms — and in better supporting other women facing similar challenges.
Overlap Between Endometriosis Symptoms and Pelvic Venous Disorders
One of the most fascinating (and frustrating) parts of my journey has been learning how pelvic venous congestion syndrome can mimic or worsen symptoms traditionally blamed on endometriosis.
is it endometriosis, or a venous issue?
When blood in the pelvic veins becomes refluxing — meaning it flows backward instead of toward the heart — it creates a cascade of problems:
Blood pooling leads to tissue hypoxia (low oxygen levels in the pelvic organs).
Hypoxia triggers inflammatory pathways remarkably similar to those seen in endometriosis tissue.
The result is more chronic pelvic pain, more pressure, and more dysfunction across the entire pelvic cavity.
Understanding the way impaired blood flow impacts the reproductive organs, connective tissues, and even the nervous system has completely reshaped how I view endometriosis pain.
The Hormonal Connection: Estrogen and Pelvic Congestion
The hormonal connection between pelvic venous insufficiency and endometriosis is particularly intriguing.
Here’s what the research shows:
Estrogen promotes nitric oxide release, which leads to vein wall dilation and weakening.
Progesterone can further weaken the venous valves that normally prevent blood from flowing backward.
In other words, the hormonal environment created by elevated estrogen — whether circulating systemically or produced locally by endometriosis lesions through aromatase activity — can directly weaken the structural integrity of the pelvic veins.
When endometriotic tissue grows near blood vessels, the local exposure to high estrogen levels could create hot spots of vascular dysfunction.
This would explain why women with endometriosis often experience symptoms of pelvic congestion syndrome even if vascular issues aren't initially suspected. It also explains why many women find vascular symptoms improve after menopause, when estrogen therapy stops or when natural estrogen levels fall.
Comparing Endometriosis Pain vs. Pelvic Venous Pain
Pelvic venous disorders don’t just cause new symptoms — they can mimic endometriosis symptoms so closely that even experienced healthcare providers may struggle to tell them apart without the right imaging. Understanding the basic differences between endometriosis pain and pelvic venous congestion pain can help guide diagnosis and treatment:
Endometriosis Pain:
Cyclical, sharp, and hormone-driven
Peaks around the menstrual cycle
May radiate from uterus or ovaries
Pelvic Venous Pain:
Constant, heavy, and worsens with gravity
Intensifies after prolonged standing or physical exertion
Often bilateral and deeper in sensation
Pain from vascular issues often worsens as the day progresses and improves with rest or elevation, while endometriosis pain typically follows hormonal rhythms.
Beyond the Pelvis: Extrapelvic Symptoms
Pelvic venous congestion doesn’t just affect the pelvic organs — it can create extrapelvic symptoms as well:
Leg heaviness or aching, especially after standing
Tight, bursting sensations in the thighs or buttocks
Visible varicose veins in unusual places
Discomfort that improves with leg elevation
One particularly telling pattern?
Post-coital pain — a deep, dull ache that lingers after intimacy. While both endometriosis and pelvic congestion can cause pain with intercourse, venous-origin pain tends to create prolonged aching afterward, rather than sharp pain during.
For me personally, the bilateral pelvic varices — especially my enlarged right ovarian vein — create a constant pulling sensation, very different from the cramping I once associated with endometriosis flares.
Diagnosis and Medical Barriers: Getting to the Root of Pelvic Venous Disorders
Getting a diagnosis for pelvic congestion syndrome (PCS) or other pelvic venous disorders is a journey — and not always an easy one.
In my experience, standard pelvic ultrasounds often miss these vascular abnormalities. It takes specialized imaging and a trained eye to spot issues like refluxing ovarian veins, pelvic varicose veins, or signs of pelvic venous insufficiency.
Here’s what the diagnostic process typically looks like:
Step 1: Non-Invasive Imaging
Most evaluations start with non-invasive imaging, such as:
Doppler ultrasounds (both transabdominal and transvaginal) to check blood flow
CT scans to assess pelvic anatomy and blood vessel enlargement
Magnetic resonance imaging (MRI) to detect vascular congestion, pelvic anatomy changes, or related conditions like ovarian cysts
However, unless these scans are interpreted by someone familiar with pelvic venous congestion syndrome, they often come back "normal!"
That’s why I always recommend working with specialized vascular clinics or vein centers — they often have vascular sonographers who know what to look for. Google “vein centers near me” or vein specialists, etc.
Step 2: Rule Out Upstream Compression Syndromes
Before any surgical treatments like ovarian vein embolization are considered, it’s essential to rule out upstream vascular compression syndromes, including:
May-Thurner Syndrome: Compression of the left iliac vein by the right iliac artery, causing blood backup and pelvic congestion
Nutcracker Syndrome: Compression of the left renal vein between the aorta and superior mesenteric artery, leading to pelvic venous congestion
Think of it like this: Fixing pelvic varices without addressing upstream blood vessel compressions would be like patching a leak in a pipe without clearing the clog causing the pressure buildup.
Step 3: Gold Standard: The Venogram
The most definitive way to diagnose pelvic congestion syndrome is through a venogram — a specialized imaging test where contrast dye is injected directly into the veins while X-ray images track blood flow in real time.
During a venogram, your medical team can see:
Areas of backward blood flow (reflux)
Compression points along the veins
Pressure gradients between different sections
The best treatment options for your anatomy
I’m scheduled to undergo a venogram myself before my embolization procedure to get the clearest, most updated view of my pelvic veins.
Even though my non-invasive imaging showed only ovarian vein involvement, the venogram will confirm whether any other areas need to be addressed for optimal pain relief.
Treatment and Management of Pelvic Venous Disorders
Managing pelvic venous congestion syndrome requires a multi-layered approach. While procedures like ovarian vein embolization are often necessary for significant cases, there are plenty of ways to start managing symptoms naturally and conservatively as well. Katie, for example, has taken the time to meet her body where it’s at and 90% of her symptoms have resolved without embolization.
Here’s what my treatment journey has involved so far:
Positional Strategies
One of the simplest and most effective changes I made was understanding gravity’s impact on my symptoms.
Because pelvic varicose veins worsen with prolonged standing, I built small habits into my day:
Elevating my legs whenever possible
Lying down for short breaks during the day
Avoiding standing still for long periods without moving
These positional adjustments offer meaningful pain relief by reducing pressure on the pelvic veins.
Movement Modifications
Exercise is important, but it needs to be approached thoughtfully.
I’ve learned that gentle movement is key — activities that promote healthy blood flow without straining the pelvis.
Swimming (buoyancy is your best friend!)
Gentle walking with frequent breaks
Physical therapy focused on circulation and core stability
High-intensity workouts or exercises that dramatically raise intra-abdominal pressure can worsen symptoms, so I avoid them.
*A note from Katie: Increased intra-abdominal pressure (something I write at length about in my book, and this blog) can worsen Pelvic Congestion Syndrome significantly—both symptomally and pathologically. When intra-abdominal pressure rises (from incorrect core bracing when you need it, like lifting, exercising, standing up, sneezing, etc), it places downward force on the pelvic veins, which are already weakened and dilated in PCS. This extra pressure:
Impairs venous return — making blood pool even more. Yikes!
Worsens symptoms like heaviness, aching, and lower abdominal pain
May trigger flares after activities like running, HIIT, or intense core workouts
For this reason I recommend, again, fixing any “pressure related” issues you may have with therapies such as hypopressive training which radically changed my own life).
Compression Therapy
Compression garments, particularly compression tights designed for pelvic support, have been a game-changer for me.
They help:
Improve blood flow back toward the heart
Decrease pooling in the pelvic cavity
Relieve symptoms like heaviness and aching
It's important to work with a knowledgeable provider to find the right level and type of compression, especially if extrapelvic symptoms (like leg swelling or aching) are present.
*A note from Katie: this was really helpful for me too! However, make sure your compression tights aren’t just increasing intra-abdominal pressure by squeezing your lower tummy onto your pelvic floor. This can worsten symptoms. Opt for compression garments that have pelvic floor support, such as SRC brand leggings. The goal isn’t to make your lower tummy look flat, it’s to support your pelvic organs!
Ovarian Vein Embolization
For moderate to severe cases of pelvic venous congestion, embolization is often the best treatment option. I’m preparing for ovarian vein embolization myself, so here’s a quick explanation of the procedure:
A small incision is made, usually at the neck or groin.
A thin catheter is guided through the vascular system to the dilated ovarian veins.
Once in place, two techniques are used:
Coil embolization: Tiny coils are inserted to block the vein.
Sclerotherapy: A solution is injected to collapse and seal the vein walls.
The goal is to shut down refluxing veins, restore normal blood flow, and relieve pelvic congestion.
It’s a minimally invasive procedure with relatively fast recovery time — but choosing the right team and confirming that no upstream compression syndromes are missed is critical for long-term success. Please do not just sign up with your local doctor without investigating your best options!
Natural Support Strategies for Pelvic Congestion Syndrome
As a naturopath, it’s important to me to also address vascular health through gentle, targeted support.
However, there’s a crucial nuance here: Traditional vascular support strategies (like boosting nitric oxide) may actually worsen symptoms in women with pelvic venous insufficiency — because nitric oxide dilates blood vessels, which is exactly what we’re trying to avoid in weakened pelvic veins.
Instead, I focus on strengthening the vein walls and supporting microvascular integrity carefully.
My Go-To Herbal Supports:
Butcher's Broom (Ruscus aculeatus): Strengthens vein tone and supports blood return
Horse Chestnut (Aesculus hippocastanum): Helps maintain vein wall integrity
Gotu Kola (Centella asiatica): Strengthens connective tissues and vascular structure
Pine Bark Extract: Rich in OPCs (oligomeric proanthocyanidins) for vascular support
Bioflavonoids I Love:
Rutin: Supports capillary strength and vein health
Hesperidin: Helps maintain vascular integrity
Diosmin: A powerful venotonic that improves venous tone without excessive dilation
**A note from Katie: Resveratrol is the bioflavonoid that helped me personally. When I took resveratrol regularly (3x a day), the symptoms of the PCS would totally abate.
Food-Based Support:
Incorporating oligomeric proanthocyanidin OPC-rich foods provides natural vascular support. Dark fruits like black grapes, cranberries, and blueberries complement vegetables such as red cabbage and purple carrots. Organic apple skins, pumpkin seeds, and high-quality olive oil.
Important Considerations
A few cautions I always share:
Avoid nitric oxide boosting supplements (like L-arginine, citrulline) unless advised otherwise by your specialist.
Pause supplements before vascular procedures, focusing only on food-based antioxidant support in that window.
Work closely with a practitioner — even natural compounds can be powerful, especially if you're taking blood-thinning medications or preparing for embolization.
My philosophy is simple:
Natural strategies should complement, not replace, medical treatment.
A blended approach in medicine— using the best of both worlds (western and holistic) — gives the most powerful, lasting outcomes for managing chronic pelvic pain, pelvic congestion, and vascular health.
Final Thoughts: You Deserve a Full Picture of Your Pelvic Health
If there’s one thing I hope you take away from my story, it’s this:
Pelvic congestion syndrome and pelvic venous disorders are real, impactful, and too often overlooked — especially in women already navigating an endometriosis diagnosis.
Many of us with endometriosis have spent years trying to manage chronic pelvic pain, menstrual pain, bowel symptoms, and fatigue, never realizing that impaired blood flow could be a major part of the problem. Like Katie said in the introduction, many of her symptoms with endo may have been due to venous issues alone!
It’s not always “just endo.” Sometimes, it’s pelvic blood vessels struggling to do their job — creating inflammation, hypoxia, nerve sensitivity, and a vicious cycle of pain.
And here’s the hopeful part: Vascular issues are often treatable. When properly diagnosed — with the right imaging, the right team, and a full understanding of your medical history — meaningful pain relief is absolutely possible.
If you recognize yourself in any part of this story:
Dull, dragging pelvic pain that worsens with standing
A feeling of heaviness or aching in the pelvis or legs
Post-coital aching that lingers
Visible veins in unusual places
A sense that your endo pain has changed or no longer follows a classic menstrual cycle pattern
I encourage you to dig deeper. Advocate for yourself. Ask your healthcare providers about pelvic venous congestion syndrome, about specialized vascular imaging, about whether ovarian vein embolization or other treatment options might help you.
You deserve a care plan that sees your whole pelvic anatomy — not just your hormonal landscape.
You deserve to feel better.
Disclaimer
This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider before making any changes to your health regimen, pursuing diagnostic testing, or considering medical or surgical treatments. The experiences and perspectives shared here are personal and should not replace individualized medical guidance. If you suspect you have pelvic venous congestion syndrome, endometriosis, or related conditions, please speak with a healthcare provider who specializes in pelvic health.