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Pelvic Congestion Syndrome and Ovarian Cancer: Are They Connected?

Medically reviewed by Leonora Valdez, M.D.
Written by Emily Wagner, M.S.
Posted on September 29, 2023

Pelvic pain, gastrointestinal problems, and urinary issues — these are all symptoms of ovarian cancer and another condition known as pelvic congestion syndrome (PCS). Despite the shared symptoms, there doesn’t appear to be a link between these two conditions. If you’re living with pelvic congestion syndrome, you can rest assured it doesn’t seem to raise your risk of ovarian cancer.

In this article, we’ll cover what pelvic congestion syndrome is, the common symptoms of pelvic congestion syndrome and ovarian cancer, and how each condition is treated. If you’re experiencing any of the symptoms discussed below, it’s time to make an appointment with your doctor or gynecologist (a specialist who treats conditions affecting the female reproductive system).

What Is Pelvic Congestion Syndrome?

Pelvic congestion syndrome is a chronic condition that causes pain in your pelvis — the large bone structure at the base of your spine, connected to your legs. Also known as pelvic venous insufficiency, this condition is diagnosed when you experience pain unrelated to pregnancy or your menstrual cycle for at least six months.

Your body’s veins are responsible for carrying blood in your body back to your lungs and heart. Within these blood vessels, tissue flaps known as valves keep blood moving in the correct direction. People with pelvic congestion syndrome have faulty veins that let blood flow backward and pool, known as reflux. When blood collects in the pelvic and ovarian veins, they begin to dilate (widen) and twist.

According to Cleveland Clinic, chronic pelvic pain is a common complaint at the gynecologist’s office. Around 40 percent of visits involve reports of pain, and up to about 30 percent may be related to pelvic congestion syndrome.

Symptoms of Pelvic Congestion Syndrome and Ovarian Cancer

Since both conditions affect the ovaries and pelvic area, pelvic congestion syndrome and ovarian cancer can share similar symptoms. When diagnosing pelvic congestion syndrome, your doctor will have to rule out ovarian cancer and other causes of pelvic pain.

In pelvic congestion syndrome, the extra blood pooled in your ovarian and pelvic veins leads to painful symptoms. In ovarian cancer, the tumor pushes on nearby organs, causing pelvic discomfort and bloating.

Shared symptoms of pelvic congestion syndrome and ovarian cancer include:

  • Pelvic and abdominal pain
  • Dyspareunia (pain during or after intercourse)
  • Changes in bowel movements, including constipation
  • Urinary symptoms, like urgency, frequent urination, or peeing accidentally when coughing or putting stress on the bladder

When living with pelvic congestion syndrome, you may experience dull, heavy achiness. In some cases, the pain may be sharp or intense. The pain tends to get worse at the end of a long day, especially if you were mostly sitting or standing.

You may find you’re in more pain around the time of your menstrual cycle. Some individuals with pelvic congestion syndrome also have large, twisted varicose veins in their legs, pelvis, vagina, and vulva.

With ovarian cancer, on the other hand, fluid buildup can press on your stomach. You may feel full quickly, even after small meals. As a result, you may lose weight, feel more fatigued than usual, or have an upset stomach.

Causes and Risk Factors of Pelvic Congestion Syndrome and Ovarian Cancer

Despite sharing some similar symptoms, pelvic congestion syndrome and ovarian cancer don’t have the same risk factors and causes. There’s also no evidence that pelvic congestion syndrome increases the risk of ovarian cancer or vice versa.

Risk Factors

Certain conditions and factors can raise your risk of pelvic congestion syndrome and ovarian cancer, but they generally don’t overlap.

Pelvic congestion syndrome mainly occurs during the reproductive years (before menopause), usually from 20 to 45, while ovarian cancer (depending on the type) can develop anytime. However, half of all ovarian cancers show up at age 63 and older, according to the American Cancer Society.

When you go into menopause, you begin to have reduced levels of the sex hormone estrogen — which seems to play a different role in these conditions. Pelvic congestion syndrome is uncommon after menopause, which is when ovarian cancers typically occur.

Other PCS risk factors include:

  • Varicose veins
  • Polycystic ovarian syndrome
  • Previous pregnancy

Known risk factors for ovarian cancer include:

  • Family history of breast, ovarian, or colorectal cancer
  • Previous breast cancer diagnosis
  • Pregnancy after age 35 or never reaching full term (delivering before 39 weeks)

Causes

Having one of these conditions doesn’t appear to raise your risk of the other. Doctors believe that pelvic congestion syndrome may be due to faulty pelvic and ovarian veins. Ovarian cancer develops when your ovarian cells grow uncontrollably because of changes or mutations in their DNA.

Vein changes that cause pelvic congestion syndrome tend to occur during pregnancy, when your body makes about 50 percent more blood to support the growing fetus. Your blood vessels widen to accommodate the extra blood, which can stretch out and weaken the vein walls in your pelvis and ovaries while damaging the valves.

Doctors and researchers believe ovarian cancer is caused by a number of factors, including hormonal changes, exposure to cancer-causing substances, and genetic mutations. Most gene changes that lead to ovarian cancer are acquired during a person’s lifetime, but some mutations can be passed down through family members — such as BRCA1 and BRCA2 mutations.

Diagnosing and Treating Pelvic Congestion Syndrome

If you’re experiencing any PCS symptoms, it’s best to talk to your doctor or gynecologist. They can run imaging tests to check your pelvic and ovarian veins. You’ll likely start with an ultrasound to check for dilated veins.

Diagnostic Tests for Pelvic Congestion Syndrome

Your doctor may then use pelvic venography, the gold standard for diagnosing pelvic congestion syndrome. With this method, a catheter (a long, thin tube) is inserted into a vein in your groin and guided to your pelvis. Venography can reveal twisted or dilated pelvic veins that are causing your PCS symptoms.

MRI or CT scans may also be used to show twisted or dilated veins. These imaging tests can also rule out other conditions related to pelvic pain, including ovarian cancer and endometriosis.

Treatment and Outcomes With Pelvic Congestion Syndrome

After you receive a PCS diagnosis, your doctor will work with you to create a treatment plan. Pelvic congestion syndrome is a chronic condition that has no cure, but it can be well managed with medical procedures to prevent blood from pooling in your pelvic and ovarian veins.

One of the best ways to treat pelvic congestion syndrome is to close off the dilated and twisted veins so that blood can’t pool there. Your doctor may recommend an ovarian vein embolization or sclerotherapy. These techniques use a catheter to deliver small metal coils, chemicals, or glue to produce blood clots and seal off the affected veins. Studies have reported symptom relief for 58 percent to 100 percent of people with pelvic congestion syndrome who used these treatments.

Your doctor may also prescribe medications to suppress your hormones. These drugs help relieve PCS pain and discomfort, but they don’t treat the root cause. Examples include:

  • Medroxyprogesterone injection (Depo-Provera)
  • Gonadotropin hormone-releasing hormone analogs, such as goserelin
  • Etonogestrel implant (formerly sold as Implanon)

Talk to Your Cancer Specialist

If you’re experiencing new or worsening signs of pelvic congestion syndrome or ovarian cancer, speak with your cancer specialist or cancer care nurse as soon as possible. They can help you find out what’s causing your symptoms and manage them so you can feel your best.

Talk With Others Who Understand

On MyOvarianCancerTeam, the social network for people with ovarian cancer, more than 6,000 members come together to ask questions, give advice, and share their experiences with others who understand life with ovarian cancer.

Are you living with pelvic congestion syndrome or ovarian cancer? Was it challenging to get the correct diagnosis? Share your story in the comments below, or start a conversation by posting on your Activities page.

Posted on September 29, 2023
All updates must be accompanied by text or a picture.

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Leonora Valdez, M.D. received her medical degree from the Autonomous University of Guadalajara before pursuing a fellowship in internal medicine and subsequently in medical oncology at the National Cancer Institute. Learn more about her here
Emily Wagner, M.S. holds a Master of Science in biomedical sciences with a focus in pharmacology. She is passionate about immunology, cancer biology, and molecular biology. Learn more about her here

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