Purpose: Pelvic congestion syndrome (PCS) is an underappreciated cause of chronic pelvic pain, considered a diagnosis of exclusion. Women who suffer from PCS often have debilitating pains for years and are reviewed by general surgeons, gynaecologists, and physicians before finding a vascular surgeon. The underlying aetiology is complex; ovarian vein incompetence is the most common finding, however compressive pathologies such as Nutcracker or May-Thurners may actually be the instigator. This presentation discusses the work-up and key considerations for PCS and examines the use of ovarian vein coiling in its management. Methods: A retrospective analysis of all venograms +/- coiling performed in a single centre between June 2021-2024 was conducted. Outcomes of clinical improvement (using a modified venous clinical severity score), and adverse events were recorded. Results: A total of 11 patients underwent venograms, 7 of whom received ovarian vein coiling. All patients received some pre-operative imaging (CT venogram or mesenteric/pelvic US), followed by a diagnostic venogram. During the diagnostic procedure, intravascular ultrasound and/or pullback pressures were used as adjuncts to exclude Nutcracker or May-Thurners. Of the 7 patients who received ovarian vein coiling, 6/7 cases had symptom improvement. Of those primarily complaining of pelvic pains 3/4 had significant improvement in pain score (-2 or -3). Most patients had remaining varicosities which required sclerotherapy to ameliorate. One patient had May-Thurners syndrome and underwent iliac vein stenting to good therapeutic effect, and another had a convincing Nutcracker on venogram and IVUS and was referred for autotransplantation/transposition of the left ovarian vein. There were no adverse events. Conclusion: Ovarian vein coiling is an effective method for treating PCS from a refluxing ovarian vein, however a Nutcracker and/or May-Thurners phenomenon must be excluded first.