Pelvic Congestion Syndrome and Pregnancy: Symptoms, Safety and Life After Birth

Pelvic congestion syndrome and pregnancy are closely linked. Pregnancy is the main reason the veins in the pelvis widen, and many women first notice a heavy, dragging pelvic ache while they are expecting or after the birth. If you already have pelvic congestion, you may worry about what pregnancy will do to it, or what it means for your baby. This guide explains why pregnancy affects the pelvic veins, what is safe, what happens after birth and which warning signs need urgent help.

Why pregnancy affects the pelvic veins

Pelvic congestion syndrome is pelvic pain linked to widened pelvic veins in which blood flows the wrong way. Pregnancy puts these veins under strain in several ways:

• More blood. Your blood volume rises a lot to supply the baby and placenta, so the veins carry far more than usual.
• Hormones. Higher oestrogen and progesterone levels relax the walls of the veins, so they stretch more easily.
• Pressure. The growing womb presses on the large veins higher up, which slows blood draining out of the pelvis.
• Stretched valves. The ovarian veins can widen by up to about half in pregnancy. Once a vein is that wide, its one-way valves may no longer close properly.

After birth, the veins usually shrink back, but not always fully. Each pregnancy adds to the strain, which is why pelvic congestion is more common in women who have had two or more children.

Symptoms during pregnancy

Many pregnant women have pelvic aches, so it can be hard to tell what is from the veins. Symptoms that point towards pelvic vein congestion include:

• A dull, heavy or dragging ache low in the pelvis, often on one side
• Pain that builds through the day or after standing, and eases when lying down
• A feeling of fullness or pressure in the vulva or vagina
• Varicose veins on the vulva, upper inner thighs or buttocks
• Aching after sex

These symptoms often get worse as the pregnancy goes on and the womb grows. They can also overlap with other common pregnancy problems, such as pelvic girdle pain (pain at the front or back of the pelvis joints), round ligament pain and constipation.

Is pelvic congestion syndrome dangerous during pregnancy?

On its own, pelvic congestion is not usually dangerous for you or your baby. The widened veins affect blood draining away from the pelvis, not the blood supply to the womb or placenta.

The real caution is about what else could be causing pain. In pregnancy, pelvic or tummy pain can sometimes be a sign of a problem that needs prompt care, such as an ectopic pregnancy in early pregnancy, a urine infection, early labour or a problem with the placenta. Never assume new pain is “just the veins”. Tell your midwife or obstetrician, especially if the pain is new, severe, one-sided in early pregnancy, or comes with bleeding, fever or tightenings.

Can pelvic congestion syndrome cause miscarriage?

There is no good evidence that it does. Most miscarriages happen because of a problem with the developing pregnancy, often a chance difference in the baby’s chromosomes, and are not caused by anything the mother did or has. Any bleeding or cramping in pregnancy should still be checked promptly.

What is safe in pregnancy

Treatment during pregnancy is about comfort. The procedures and medicines used for pelvic congestion are not used while you are pregnant:

• Embolisation is not done in pregnancy. It uses X-rays and contrast dye close to the womb, so it waits until after birth. A pregnancy test is done before the procedure.
• Hormonal treatments for pelvic congestion are not used, because they act on the ovaries and hormones.
• Ultrasound is safe and can be used if your doctor needs to look at the veins. CT scans and venograms are generally avoided.

Things that many women find helpful:

• Rest with your hips raised. Lying down with a pillow under your hips for a while helps blood drain from the pelvic veins.
• Avoid long spells of standing. Take regular breaks to sit or lie down.
• Support garments. Maternity support shorts, support underwear or a pelvic support garment can press gently on the veins. Ask your midwife or a trained fitter which type suits you.
• Keep moving. Walking and swimming help blood flow without adding strain.
• Sleep on your side in later pregnancy, to take pressure off the large veins.
• Avoid straining. Treating constipation and avoiding heavy lifting lowers pressure in the pelvis.

Check with your doctor or pharmacist before taking any painkiller or supplement in pregnancy, because some common painkillers are not suitable.

Vulval varicose veins in pregnancy

Varicose veins on the vulva are fairly common in pregnancy and often go together with pelvic vein congestion. They usually settle after birth. We cover them in detail, including what they mean for labour, in our guide to vulval varicose veins in pregnancy.

Blood clots in pregnancy and after birth

Pregnancy and the weeks after birth raise the risk of a blood clot in the deep veins (deep vein thrombosis, or DVT). The risk is highest just after birth, especially after a caesarean. A clot is still uncommon, but it is serious if it travels to the lungs (pulmonary embolism).

There is no clear evidence that widened pelvic veins on their own cause dangerous clots. But some things that often go with it, such as several previous births and severe varicose veins, are listed as risk factors. Your midwife or obstetrician will assess your clot risk during pregnancy and after birth, and may advise extra measures if your risk is higher. Our sister site explains deep vein thrombosis in more detail.

Get urgent help for any of these:

• Pain, swelling, warmth or redness in one leg, usually the calf or thigh
• Sudden breathlessness or difficulty breathing
• Chest pain or tightness, especially when breathing in
• Coughing up blood
• Feeling very unwell, faint or collapsing

In Singapore, call 995 in an emergency.

Pelvic congestion syndrome after pregnancy

For most women, the pelvic veins shrink over the weeks and months after birth, and the ache eases.

In some women the veins stay wide. The ache continues, or settles and then returns in the next pregnancy, often a little worse each time. Pelvic congestion can also appear for the first time after a pregnancy.

Pelvic heaviness postpartum

A heavy or dragging feeling after birth is common, and veins are only one possible cause. Others include:

• Weak or stretched pelvic floor muscles, which often improve with pelvic floor exercises
• Pelvic organ prolapse, where the womb, bladder or bowel drops down. It can feel like a bulge or something “coming down”, often worse at the end of the day
• Healing after a tear, episiotomy or caesarean

A doctor or a women’s health physiotherapist can examine you and help work out the cause. If the heaviness is worse after standing, eases when lying down and comes with vulval or thigh veins or pain after sex, ask whether your pelvic veins should be checked. See how pelvic congestion syndrome is diagnosed.

Future pregnancies after treatment

Because the veins often shrink on their own after birth, treatment is usually only considered once they have had time to settle, typically several months later. Ask your doctor whether breastfeeding affects the timing. Some women prefer to wait until their family is complete, because a later pregnancy can widen the pelvic veins again.

If you have had ovarian vein embolisation and become pregnant again:

• The coils stay in place permanently and are not known to cause problems in pregnancy
• Tell your obstetrician that you have had the procedure
• Symptoms may return as the pregnancy widens other pelvic veins

For questions about conceiving, timing after embolisation and IVF, see pelvic congestion and fertility. A Singapore vascular surgeon’s collection of articles on women’s vein health also covers pregnancy and hormones.

When to see a doctor

Mention pelvic aching or vulval veins to your midwife or obstetrician at your next antenatal visit. After birth, see a doctor if a heavy pelvic ache lasts more than a few months, comes back with each pregnancy, affects sex or daily life, or you notice a bulge in the vagina. Our pelvic symptom check can help you prepare.

Get urgent medical help for heavy vaginal bleeding, severe or one-sided tummy pain in early pregnancy, fever with pelvic pain, regular tightenings before 37 weeks, a painful swollen leg, chest pain or sudden breathlessness. In Singapore, call 995 in an emergency.

This article is general information, not personal medical advice. Please speak to a doctor about your own symptoms. How we create our content.