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Pelvic veins incompetence may cause varicose veins formation in the lower extremity due to leak points of the pelvic circulation. This observation is particularly frequent in recurrence cases especially in multi parity. The cause of pelvic vein dilatation is still not clear. Traditional mechanism for varicose veins formation referred to leg varices cannot be transferred to pelvic circulation where a strong efficient pumping mechanism and a high hydrostatic column is missing. An alternative explanation is possible if hormonal factors are considered to contribute to vasodilatation (estrogen is a potent vasodilator), and pelvic veins are naturally exposed to high doses of ovarian hormones. Pelvic veins dilatation/hypertension , rich in estrogens, may be directed through leak points to leg veins where estrogens effect of vasodilation is maintained. Then, at every Valsalva like action, some blood rich in estrogens passes in the leg network giving rise, among others, to perineal veins dilatation, recurrence after groin dissection for SFJ high ligation, intermittent leg pain/discomfort. Estrogens sampling studies could confirm this hypothesis and guide alternative treatments

Varicose veins in women with Pelvic Congestion Syndrome: the hypothesis of the hormonal pathogenesis