Fibroids and pelvic congestion can both cause pelvic pain and pressure, but they usually behave differently. Fibroid symptoms tend to center on heavy or long periods and a feeling of bulk or pressure. Pelvic congestion, caused by enlarged, backed-up veins in the pelvis, tends to cause a dull, aching pain that builds over the day and with standing, often with an ache after sex, and sometimes visible varicose veins on the vulva, buttocks or upper thighs. Imaging is what tells them apart, and the tests are not the same for each.
If fibroids turn out to be the cause, our main page on uterine fibroid embolization (UFE) explains one treatment option.
Two different problems: muscle growths vs vein reflux
Fibroids are noncancerous growths of the muscle wall of the uterus. ACOG describes them as the most common type of growth found in a woman's pelvis.
Pelvic congestion is a vein problem. Valves in the ovarian or pelvic veins stop working well, so blood flows backward and pools, and the veins enlarge. A 2026 review estimates that this may account for up to 30% of cases of chronic pelvic pain. Doctors now increasingly group it under the broader term pelvic venous disorders.
Both can cause pelvic pain, and they can be hard to tell apart without testing. Because pelvic pain has many possible causes, including endometriosis, adenomyosis and bowel or bladder conditions, a careful evaluation matters before choosing any treatment.
How the symptoms usually differ
| Feature | Fibroids | Pelvic congestion |
|---|---|---|
| Periods | Heavy, longer or more frequent periods are a hallmark; can lead to anemia | Bleeding is not the main feature |
| Pain pattern | Dull, heavy, aching pain in the abdomen or lower back; may be sharp | Noncyclical, positional pain that worsens through the day and with standing or activity |
| Pressure | Bulk symptoms: pressure, frequent urination, constipation | Heavy, dragging feeling in the pelvis |
| Sex | Pain during sex can occur | Pain during sex and a prolonged ache afterward are typical |
| Visible veins | No | Sometimes varicose veins on the vulva, buttocks or back of the thighs |
| Main test | Pelvic ultrasound; MRI before UFE | Ultrasound clues; venography usually needed to confirm reflux |
The fibroid column draws on ACOG's patient information. The pelvic congestion column draws on a 2013 review in Seminars in Interventional Radiology, which describes noncyclical, positional lower back, pelvic and upper thigh pain, pain with sex and prolonged postcoital discomfort, worsening through the day and with prolonged standing. A 2026 review in the Journal of Clinical Medicine calls the ache after sex and pain worsened by prolonged standing pathognomonic, meaning highly characteristic, features. For a fuller list of fibroid symptoms, see fibroid symptoms.
How doctors tell them apart
Testing for fibroids
Fibroids are usually found with a pelvic ultrasound. If UFE is being considered, the CIRSE 2015 guideline names contrast-enhanced MRI as the preferred imaging test before UFE. Our article on fibroid diagnosis with ultrasound and MRI covers this in detail.
Testing for pelvic congestion
Pelvic vein problems are easy to miss on standard pelvic imaging, partly because the veins can look less enlarged when you are lying down. The 2026 review notes that specific ultrasound markers, combined with the typical symptoms, can help identify it early, and that laparoscopy has limited sensitivity for it. The 2013 review says that venography, an X-ray of the veins with contrast dye, is usually necessary to confirm reflux in the ovarian veins.
If your imaging shows fibroids but your symptoms sound more like the pelvic congestion column, it is reasonable to ask whether pelvic veins have been looked at.
Questions about your treatment options? Dr. Fox can help.
Book a ConsultationThis article is part of our Fibroid Treatment Guide.
A new way of naming pelvic vein problems
In 2021, an international working group of the American Vein & Lymphatic Society (AVLS) published the SVP classification for pelvic venous disorders. It describes each patient by Symptoms (S), Varices (V) and Pathophysiology (P), which covers anatomy, blood-flow pattern and cause. The authors called older labels such as pelvic congestion syndrome, May-Thurner syndrome and nutcracker syndrome misleading, and recommended using SVP along with the CEAP system for leg veins. You may see "pelvic venous disorder" on reports from doctors who use this system. Note that this classification came from the AVLS working group; it is not a Society for Vascular Surgery guideline.
How each is treated
Fibroids
Fibroid treatment ranges from medication to procedures that keep the uterus (UFE, myomectomy, radiofrequency ablation) to hysterectomy. Our fibroid treatment guide compares them.
Pelvic congestion
The main procedure for pelvic congestion is also an embolization, but of veins rather than arteries. A catheter is guided into the refluxing ovarian or pelvic veins, which are then closed with coils, plugs or a sclerosing medicine. The 2011 clinical practice guideline of the Society for Vascular Surgery and the American Venous Forum suggests this approach (GRADE 2B), which in the GRADE system means a weaker recommendation based on moderate-quality evidence.
The evidence is encouraging but limited:
- A 2016 systematic review of 1,308 women (21 case series and 1 small randomized trial) found early substantial pain relief in about 75% of women, generally sustained over time. Coil migration happened in less than 2%. The authors rated the evidence quality as low.
- A 2022 meta-analysis of 20 studies and 970 patients treated with coil embolization found an average pain improvement of about 5.5 points on a 10-point scale. Pain returned in 5.9% to 25% of patients at 1 to 2 years.
So while UFE and pelvic vein embolization use similar catheter techniques, they target different blood vessels and treat different problems. One does not treat the other.
What if you have both?
Fibroids are very common, so some women with pelvic congestion will also have fibroids. When symptoms are mixed, the goal is to work out which problem is driving which symptoms before treating, so that you do not have a procedure for the wrong cause. Heavy bleeding points more toward fibroids; positional pain that builds through the day points more toward the veins. If the cause is unclear, a second look at the imaging, or added vein testing, can help.
Fox Vein & Vascular also treats vein conditions that affect women; see vein treatment for women. To learn more about another condition often confused with fibroids, read adenomyosis vs fibroids.
When to get help quickly
Most pelvic pain from fibroids or pelvic veins is long-standing and can be evaluated at a routine visit. Seek urgent care for sudden, severe pelvic pain, pain with fever, very heavy bleeding with dizziness or fainting, or a possible pregnancy with pain or bleeding. ACOG notes that fibroids that grow rapidly or start breaking down can cause pain, and a fibroid on a stalk can twist and cause pain, nausea or fever.
Frequently Asked Questions
Can pelvic congestion be mistaken for fibroids?
Yes. Both can cause pelvic pain and pressure. Heavy bleeding points more toward fibroids, while pain that worsens with standing and through the day, and an ache after sex, point more toward pelvic vein reflux.
Does UFE treat pelvic congestion syndrome?
No. UFE blocks the arteries feeding fibroids. Pelvic congestion is treated, when needed, by embolizing the refluxing veins, which is a different procedure.
How is pelvic congestion diagnosed?
Symptoms and specific ultrasound findings raise suspicion, and a 2013 review says venography, an X-ray of the veins with contrast, is usually needed to confirm reflux in the ovarian veins. Laparoscopy is not sensitive for it.
Does pelvic vein embolization work?
In a 2016 review of 1,308 women, about 75% had early substantial pain relief, though the evidence quality was rated low. The 2011 SVS/AVF guideline suggests embolization for pelvic congestion (GRADE 2B).
What is a pelvic venous disorder?
It is the newer umbrella term for pelvic vein problems, including what used to be called pelvic congestion syndrome. A 2021 AVLS working group introduced the SVP classification to describe them.
Keep Reading
- Uterine Fibroid Embolization (UFE) in New York City
- Adenomyosis vs Fibroids: Symptoms, Imaging and Why the Difference Matters
- Fibroid Symptoms: 9 Signs to Know
- Fibroid Diagnosis: Ultrasound vs MRI
- Can Fibroids Cause Back and Leg Pain?
- Am I a Candidate for UFE? A Practical Checklist
- Fibroid Treatment Guide: every option, compared
Sources
- Durham and Machan, Semin Intervent Radiol, 2013 — pelvic congestion syndrome
- Krambeck and Tesch, J Clin Med, 2026 — pelvic congestion syndrome review
- Gloviczki et al., J Vasc Surg, 2011 — SVS/AVF clinical practice guidelines for varicose veins and chronic venous disease
- Meissner et al., J Vasc Surg Venous Lymphat Disord, 2021 — the SVP classification for pelvic venous disorders (AVLS working group)
- Daniels et al., J Vasc Interv Radiol, 2016 — systematic review of embolization for pelvic congestion (1,308 women)
- Sutanto et al., J Vasc Surg Venous Lymphat Disord, 2022 — meta-analysis of coil embolization for pelvic venous insufficiency (970 patients)
- ACOG patient FAQ — Uterine Fibroids (last reviewed December 2025)
- van Overhagen and Reekers, Cardiovasc Intervent Radiol, 2015 — CIRSE standards of practice for uterine artery embolization
Medically reviewed by David Fox, MD, FACS, RPVI. This article is general information, not a substitute for a medical evaluation.
Living with heavy periods, pelvic pressure or other fibroid symptoms? Schedule a consultation with Dr. David Fox at Fox Vein & Vascular in Manhattan to find out whether uterine fibroid embolization is right for you. Call (212) 362-3470 or request a UFE consultation online.
