According to Yale Medicine, the causes of chronic pelvic pain vary but most patients are only evaluated for endometriosis, uterine fibroids, problems with the ovaries, and bowel and bladder problems. Vascular causes of chronic pelvic pain are often overlooked but may be the culprit in a large number of these patients. The more frequently discussed “pelvic congestion syndrome” is similar to varicose veins in the legs in that the valves in the ovarian veins that help return blood to the heart against gravity become weakened and don’t close properly. This allows blood to flow backward and pool in the vein causing pressure and bulging. In the pelvis, it can cause pain and affect the uterus, ovaries, and vulva. While not all women experience symptoms, up to 15 percent of women, generally between the ages of 20 and 50, have varicose veins in the pelvis.

More recently, it has been discovered that iliac vein compression or May Thurner may cause pain more often than ovarian vein problems. In these patients, the compression can be seen on CT scan or MRI, but is often not commented on by the radiologist and varices are often absent and so the diagnosis is not made.