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What if the “mystery” behind chronic pelvic pain isn’t another diagnosis—but a blood-flow problem that was never fully evaluated?

In this episode of Endo Battery, we sit down with Dr. Brooke Spencer, a board-certified interventional radiologist and venous disease specialist, to explore the often-overlooked world of vascular compression syndromes and pelvic venous disorders.

We break down May-Thurner syndrome (iliac vein compression), Nutcracker syndrome (left renal vein compression), and pelvic venous disorders—including why the term “pelvic congestion syndrome” can sometimes create more confusion than clarity.

Dr. Spencer explains how impaired venous flow can cause blood to reroute through collateral veins and why vascular problems may show up as symptoms that seem completely unrelated to the vascular system—including pelvic pain, nausea, hip and back pain, bladder and bowel symptoms, leg discomfort, fatigue, and other difficult-to-explain symptoms.

We also discuss the potential overlap between vascular compression, hypermobile Ehlers-Danlos syndrome (hEDS), POTS, dysautonomia, and long COVID, including how venous pooling and impaired venous return may contribute to symptoms such as brain fog, headaches, fatigue, heat intolerance, and orthostatic symptoms.

And then we get practical.

What can standard imaging actually see? What can it miss? Why might venography with intravascular ultrasound (IVUS) provide information that other imaging does not? And how do physicians determine when venous compression is clinically significant enough to consider treatment such as a venous stent?

We also talk honestly about the evolving evidence surrounding venous stenting, patient selection, treatment thresholds, and why long-term data—particularly in younger patients—is still developing.

If you have endometriosis or chronic pelvic pain and have ever wondered, “Does endometriosis really explain all of this?” this conversation offers another piece of the diagnostic puzzle—not a promise of a hidden diagnosis, but a framework for asking better questions and knowing what may deserve further evaluation.

This episode is about expanding the differential, understanding your vascular anatomy, and becoming a more informed participant in your own care.

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