Pelvic Congestion Syndrome (PCS) is an under-recognised and important cause of chronic pelvic pain in women. PCS is frequently linked to ovarian vein incompetence and pelvic venous insufficiency. It primarily affects multiparous women of reproductive age, often presenting with dull, non-cyclical pelvic pain that worsens with standing, menstruation, or sexual activity. Associated features include vulval varices, leg varicosities, and significant impairment of quality of life. The pathophysiology of PCS centres on venous reflux within the ovarian and internal iliac veins, driven by hormonal influences and mechanical strain. Resultant venous hypertension leads to pelvic varices contributing to chronic pelvic pain. Diagnosis relies on a multimodal approach and high index of suspicion. Ultrasound can detect dilated refluxing ovarian veins, while CT or MR venography defines anatomy and excludes alternative pathology. Catheter venography remains the gold standard, demonstrating reflux and cross-pelvic filling. Endovascular management, particularly ovarian vein embolisation (OVE), has emerged as the preferred treatment. The refluxing ovarian veins are selectively catheterized and embolised with various treatments employed to deal with pelvic varices. Technical success rates exceed 95%, and clinical improvement in pain is reported in 70–85% of patients, with durable long-term outcomes. Complications are rare but include coil migration, incomplete embolization, or thrombophlebitis. Current guidelines from interventional radiology and vascular societies support embolisation as first-line therapy in appropriately selected patients. Advances in imaging, embolic materials, and multidisciplinary care are likely to further refine outcomes. PCS represents a growing area of clinical need. A multidisciplinary approach engaging closely with pelvic pain specialists maximises awareness, accurate diagnosis, and treatment of PCS.