Pelvic varicose veins in women: what to look out for

2026-11-08

• Pelvic varicose veins are widened veins in the pelvis, seen most often in women who have had several pregnancies.
• Typical signs are a dragging pain and heaviness low in the abdomen that get worse when standing and ease when lying down.
• Enlarged veins on the labia, perineum, buttocks or inner thigh can be a clue.
• Many conditions cause pelvic pain, so only a doctor can make the diagnosis after an examination.
• Sudden severe lower abdominal pain, fever or bleeding means calling an ambulance (103) urgently.

A dragging pain low in the abdomen that arrives in the evening after a day on your feet. Heaviness and fullness in the pelvis before a period. Discomfort during or after intimacy. Many women live with this for years and go from doctor to doctor, while blood tests and a routine scan find nothing in particular.

One possible cause of these complaints is pelvic varicose veins. They are talked about less than varicose veins in the legs, and the diagnosis is often made late. This article offers general information about the condition and what to watch for. Please remember: you cannot diagnose yourself from a description — that is a job for a doctor.

What are pelvic varicose veins?

The pelvis contains a dense network of veins that drain blood from the uterus, ovaries, bladder and rectum. As in the legs, some of these veins have valves, and their walls can stretch.

If the valves — especially those in the ovarian veins — stop working properly, blood begins to flow the wrong way and pools. The veins widen and become twisted, leading to what is known as pelvic congestion syndrome. Today doctors group such conditions under the umbrella term pelvic venous disorders.

Why do pelvic varicose veins develop?

The mechanism is not fully understood, but several factors make it more likely:

• several pregnancies and births: during pregnancy blood volume rises, and pelvic veins widen under the influence of hormones and pressure from the womb;
• hormonal factors — female sex hormones affect vein tone, which is why the condition is seen mainly in women of childbearing age;
• an inherited weakness of vein walls and varicose veins in close relatives;
• long hours of standing or sitting at work, and chronic constipation with straining;
• occasionally, compression of large veins by neighbouring vessels, which a doctor may find during tests.

Which symptoms should make you take notice?

The symptoms vary, and sometimes widened pelvic veins cause no trouble at all and are found by chance. Women most often describe the following:

• a dull, aching or dragging pain low in the abdomen, lower back or groin that lasts for months;
• pain and heaviness that worsen after long periods of standing, at the end of the day, and before or during a period;
• relief when lying down;
• discomfort during or after sex;
• sometimes, a frequent urge to pass urine.

There are visible signs too. Enlarged veins may appear on the labia, the perineum, the buttocks, or the inner or back of the thigh. Sometimes it is exactly this kind of unusual leg varicose vein that tells a doctor the source of the problem lies higher up, in the pelvic veins.

Why is a medical examination so important?

Chronic pelvic pain is a common complaint with many possible causes: endometriosis, inflammatory disease, ovarian cysts, adhesions, and bowel or bladder conditions. Many of them are treated quite differently. That is why the first specialist is usually a gynaecologist, who rules out gynaecological causes. Do not feel shy about sharing sensitive details — pain during intimacy, links with your cycle, problems passing urine: they matter a great deal for an accurate diagnosis.

The pelvic veins are assessed with Doppler ultrasound, including a transvaginal scan, and where needed with CT or MRI. Your doctor decides which tests you need. A phlebologist or vascular surgeon and a specialist in endovascular procedures may also be involved in tests and treatment. We explained what a phlebologist does in our article on which doctor treats veins and when to see one.

How are pelvic varicose veins treated?

Treatment is tailored to each woman: a lot depends on how severe the symptoms are, why the veins have widened and whether she plans a pregnancy. If the veins are enlarged but cause no trouble, watchful waiting is often enough. Incidentally, men can also have widened veins in the pelvis and scrotum — a varicocele — but that is a separate topic dealt with by a urologist.

For significant pain, a doctor may suggest a minimally invasive procedure called embolisation: working through a small puncture in a vein under X-ray guidance, the specialist places materials in the enlarged veins to close them off. European guidelines regard this as an option for carefully selected patients, although the quality of evidence is still limited. Enlarged veins on the legs and perineum that are linked to the pelvic veins are treated separately, for example with sclerotherapy.

Painkillers and hormonal medicines, if needed, should only be prescribed by a doctor. Do not choose medicines for pelvic pain on your own.

What can you do yourself?

Lifestyle changes do not remove enlarged veins, but they can help you feel better and support your veins in general. There is little data on their effect on the pelvic veins specifically, but these habits are safe and beneficial:

1. Move every day: walking and swimming improve blood flow back to the heart.
2. If you work on your feet, take breaks and sit or lie down for a little while when you can.
3. Keep your bowel movements regular and soft: straining raises pressure in the abdomen and the pelvic veins.
4. Maintain a healthy weight.
5. When the pain gets worse, rest lying down with a pillow under your legs: many women find this helps.

If you also have varicose veins in your legs, it is worth understanding chronic venous insufficiency: the two conditions share many mechanisms and prevention rules.

Pregnancy and enlarged pelvic veins

Enlarged veins on the labia and perineum often appear during pregnancy. They usually shrink noticeably or disappear after the birth. Be sure to tell your obstetrician about them: they will assess the situation and advise you on what to do during pregnancy and delivery. Any medicine during this time should be taken only on a doctor's advice. Read more in varicose veins in pregnancy.

The bottom line

Pelvic varicose veins are a real cause of chronic pelvic pain — worth knowing about, but not worth fearing. If pain low in your abdomen keeps returning for months and worsens towards evening, do not just put up with it or diagnose yourself: start with a gynaecologist and have the tests. A clear answer to the question of why it hurts is already halfway to relief.

Sources: 1. De Maeseneer MG, Kakkos SK, Aherne T, et al. ESVS 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg. 2022;63(2):184–267.

• Chronic venous insufficiency: what it is and how it shows up
• Varicose veins in pregnancy: why veins struggle and what helps
• Thrombophlebitis symptoms: when you need urgent help