These symptoms may have more than one cause. In some women, pelvic varicose veins — a condition known as Pelvic Venous Disorder or Pelvic Congestion Syndrome — may be a contributing factor that is frequently overlooked on standard investigations.
If your symptoms have persisted for six months or more without a definitive explanation, a specialist venous assessment may provide additional clarity.
Pelvic Congestion Syndrome — also referred to as Pelvic Venous Disorder (PeVD), a term adopted by international specialists in 2021 — is a vascular condition caused by varicose veins forming in and around the uterus, ovaries, and other pelvic tissues.
When the valves inside these veins weaken or fail, blood pools in the pelvic veins instead of flowing normally back towards the heart. The resulting pressure causes a characteristic pattern of pelvic pain and discomfort — typically worse when upright and improved when lying down.
Because the symptoms of PCS overlap closely with conditions such as endometriosis and fibroids, and because standard imaging may not assess vein blood flow dynamics, the condition is frequently missed or attributed to other causes. Many women live with PCS for years before a venous cause is identified.
Standard pelvic ultrasounds and MRI scans assess the structure of pelvic organs. They are not designed to measure the functional behaviour of pelvic veins — specifically, whether blood is flowing backwards and pooling where it should not be. A specialist duplex ultrasound that directly assesses vein blood flow dynamics is needed to evaluate this.
At The Venus Clinic, we perform a trans-abdominal and transvaginal duplex ultrasound — an assessment designed specifically to evaluate pelvic vein function. This is the approach used by international PCS specialists and is not routinely performed in general gynaecological practice.
If you have had investigations that returned normal results but your symptoms continue, a specialist venous evaluation may be a worthwhile next step.
Many women who contact The Venus Clinic have spent months — sometimes years — seeking answers for symptoms that have been dismissed or attributed to other conditions. We understand this journey. Here is what to expect when you reach out to us.
STEP 1
You experience ongoing pelvic pain, heaviness, or discomfort — pain that may worsen when standing and ease when you lie down. Your periods may be heavy or painful. You may have seen a gynaecologist and been told your scan is normal. Use our symptom self-assessment to identify whether your pattern may warrant a specialist venous evaluation.
STEP 2
Contact our team by phone, WhatsApp, or the enquiry form. Our team will discuss your symptoms and guide you on next steps. A GP referral is not required to make an enquiry. Your first consultation with Dr Ram involves a detailed symptom history and clinical review.
Step 3
Depending on your clinical history, a trans-abdominal and transvaginal duplex ultrasound (PCS scan) is performed to assess pelvic vein function. The findings are reviewed alongside your symptom history and a management plan is discussed with you.
Step 4
Treatment, if indicated, is tailored to your specific findings. This may include pelvic floor physiotherapy, minimally invasive vascular procedures, psychological support, or a combination of these. You are involved in every decision. Individual responses to treatment vary.
Step 5
Follow-up care is structured and ongoing. Patients have access to our network of physiotherapy and psychology partners, as well as the Venus PeVD Support Group — a patient community developed to help women navigate the emotional and practical aspects of living with chronic pelvic pain.
Pelvic Venous Disorder is a condition with physical, functional, and psychological dimensions. Effective management typically requires more than a single procedure or consultation. At The Venus Clinic, care is structured around a multi-disciplinary team.
A structured clinical assessment to evaluate pelvic vein function and identify whether a venous component is contributing to your symptoms.
Every woman with PCS is different. Treatment should be individualised based on each patient’s symptoms and venous anatomy. Not all patients require a procedure.
Physiotherapy is a key component of management for many patients, particularly those with pain related to posture, bowel and bladder function, or post-coital discomfort.
Chronic pelvic pain and repeated misdiagnosis can affect both mental health and overall quality of life. Professional support, along with a strong support network, can play an important role in recovery.
For references please go to Resources For Clinicians.
Complete resolution of symptoms
Significant symptom improvement
Reported complications (all minor)
Senior Vascular and Endovascular Surgeon
The Venus Clinic is led by Dr Sriram Narayanan (Dr Ram), a Senior Vascular and Endovascular Surgeon with over two decades of clinical experience in vascular surgery in the United Kingdom and Singapore.
Dr Ram was among the first surgeons in Singapore to develop vein stenting, intravascular ultrasound (IVUS), and duplex ultrasound assessment protocols for Pelvic Congestion Syndrome. He has published extensively on vascular disease and has served as a faculty member and trainer at international vascular and vein conferences, including training programmes in the UK and Asia focused on pelvic duplex ultrasound for PCS.
Gleneagles Hospital and Mount Elizabeth Novena Hospital
Surgical and minimally invasive vascular procedures are performed through our clinical partners at the Harley Street Heart and Vascular Centre.
Pelvic floor physiotherapy is provided in partnership with Physio Down Under, a specialist pelvic physiotherapy practice founded by Monica Donaldson and Tamara Gerdis, and established in Singapore in 2018.
Psychological support is offered through our clinical collaboration with Psych Connect, led by Dr Sanveen Kang (Principal Clinical Psychologist, formerly Adjunct Assistant Professor, Department of Psychology, National University of Singapore).
The Venus Clinic is on panel with the following corporate insurance providers.
We recommend confirming coverage details with your insurer prior to your consultation.
If you would like to discuss your symptoms or enquire about a consultation, please contact us. A GP referral is not required to make an initial enquiry.
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Led by Dr Sriram Narayanan
Director , Senior Consultant Vascular & Endovascular Surgeon
