Varicose Veins During Menopause

Menopause brings changes throughout the body. Hot flushes, disrupted sleep and changes in menstrual cycles are widely recognised, but some women also notice changes in their legs and veins during perimenopause and after menopause.

Existing varicose veins may become more noticeable, or symptoms such as aching, heaviness, itching and ankle swelling may appear for the first time. This can understandably raise questions about whether menopause itself is responsible.

The relationship is not quite that straightforward. Hormonal changes may influence the veins, but menopause usually occurs at a stage of life when several other factors associated with varicose veins overlap. Age, family history, previous pregnancies, weight, activity levels and the condition of the valves inside the leg veins can all contribute.

For this reason, persistent changes should not automatically be accepted as part of menopause. If your legs have started aching or swelling, or previously minor varicose veins are becoming troublesome, an underlying venous circulation problem may be present and can be assessed and treated.

Varicose Veins and Venous Reflux

Healthy leg veins have the difficult job of returning blood towards the heart against gravity. Small one-way valves inside the veins help keep blood travelling upwards, while contractions of the calf muscles during walking help push blood out of the lower legs.

Varicose veins develop when superficial veins enlarge and their valves no longer close effectively. Blood can then travel backwards, known as venous reflux, increasing pressure within the affected veins. Over time, they may become enlarged, twisted and prominent beneath the skin.

This is different from simply being able to see normal veins through the skin. Small thread veins are also different from larger varicose veins, although both can occur throughout a woman’s life. Pregnancy, contraception and hormonal changes can all influence varicose and thread veins in women, particularly where there is already a tendency towards venous disease.

Some varicose veins cause few symptoms beyond their appearance. Others cause aching, heaviness, itching and swelling. Persistent problems with venous circulation can progress to chronic venous insufficiency, where raised pressure within the veins begins to affect the surrounding tissues and skin.

Menopause, Age and Vein Health

Menopause usually occurs between the ages of 45 and 55 in the UK, although the timing varies between women. This means it coincides with a period when age-related changes in the venous system may already be developing.

Vein walls and valves change over time, and the likelihood of developing varicose veins increases with age. A woman noticing them during her 40s, 50s or 60s may therefore be seeing the combined effects of ageing, inherited susceptibility, previous pregnancies and other factors rather than a condition produced solely by menopause.

Family history can be particularly relevant. Varicose veins frequently occur within families, so women with parents or close relatives affected by venous disease may be more likely to develop them themselves.

Changes in physical activity or body weight can add further pressure to the venous system. Carrying excess body weight can increase pressure within the veins of the lower limbs, while spending long periods sitting or standing reduces the assistance normally provided by regular calf muscle movement.

None of this means that developing varicose veins during menopause is inevitable. Equally, women should not assume that they have caused their veins through weight gain, lack of exercise or another lifestyle choice. Varicose veins usually develop through a combination of factors.

Previous Pregnancies

A woman’s pregnancy history remains relevant to her veins long after she has had children.

During pregnancy, blood volume increases, and the growing uterus places additional pressure on veins in the pelvis and legs. Hormonal changes can also affect venous tone. It is therefore common for varicose veins to appear for the first time during pregnancy or become more prominent with subsequent pregnancies.

Some pregnancy-related veins improve after childbirth. Others remain but cause few problems for many years.

A woman might therefore have first noticed a small varicose vein during pregnancy in her 20s or 30s, only for that vein or the underlying venous reflux to become more noticeable later in life. By the time she reaches menopause, the pregnancy itself is long past, but the changes within the venous system may remain.

Previous pregnancies are therefore an important part of the medical history when varicose veins are assessed during perimenopause or after menopause.

Hormonal Changes During Menopause

Oestrogen and progesterone influence tissues throughout the cardiovascular system, and hormonal changes have long been associated with differences in venous disease between women and men.

It is nevertheless too simplistic to say that falling oestrogen or progesterone directly causes varicose veins.

Menopause occurs alongside ageing and changes that can affect connective tissues, body composition, activity and cardiovascular health. Separating the influence of hormones from these other factors is difficult.

Hormones may therefore form one part of a much larger picture. In a woman who already has inherited susceptibility, previous pregnancy-related venous changes or faulty vein valves, changes around menopause may coincide with veins becoming more noticeable or symptomatic.

The fluctuating hormones of perimenopause can make the picture even less straightforward. Women who previously noticed changes in their veins around their menstrual cycle may also find that symptoms become less predictable as their cycle changes. Varicose vein symptoms can fluctuate during the menstrual cycle, particularly in women who already have venous insufficiency.

Leg Symptoms That May Not Be Menopause

Menopause can coincide with changes in sleep, activity and general aches and pains, so uncomfortable legs can easily be attributed to hormonal changes or ageing.

The pattern of symptoms can sometimes suggest that the veins are involved.

Venous aching and heaviness commonly become more noticeable after spending a long time standing or sitting. Legs may feel progressively heavier as the day goes on, and swelling can appear around the ankles or lower legs. Walking, resting or raising the legs may reduce the discomfort.

Varicose veins can also cause throbbing, burning or tenderness. Some women experience itching around varicose veins, particularly where the skin is beginning to become irritated.

Night time discomfort may interfere with rest. Aching, cramping and restless legs have many possible causes, but for some people varicose veins affect sleep because symptoms remain noticeable after a day spent sitting or standing.

Menopause and venous disease can exist at the same time. Persistent or worsening leg symptoms do not therefore need to be accepted automatically as another menopausal change.

Swelling

Mild ankle swelling after a long day can occur for numerous reasons. Recurrent or persistent swelling deserves more attention, particularly where varicose veins are also present.

Poor venous return allows pressure to build within the veins of the lower leg. Fluid can then move into surrounding tissues, producing swelling that is often most noticeable around the ankles.

Swelling associated with venous insufficiency often worsens later in the day and may improve overnight or after raising the legs. It can occur in both legs or be more noticeable on the side with greater venous disease.

New swelling should not automatically be assumed to be caused by varicose veins. Sudden swelling, particularly when it affects one leg, requires medical assessment to exclude other conditions.

Skin Changes

The appearance of the skin can provide important information about the progression of venous disease.

Venous hypertension can cause inflammation around the lower leg and ankle. Skin may become dry, itchy or eczematous, and brown or reddish pigmentation can develop as blood products accumulate within the tissues.

More established disease can cause the tissues around the lower leg to become firm or hardened. In advanced cases, a venous leg ulcer may develop, usually around the ankle.

These changes should not simply be accepted as part of ageing or menopause.

NICE recommends referral to a vascular service for symptomatic varicose veins and for complications including skin pigmentation or eczema caused by chronic venous insufficiency, superficial vein thrombosis and venous leg ulceration.

Varicose Veins and Blood Clots Are Different

The terms varicose veins, thrombosis and blood clots are sometimes used in the same conversation, which can cause unnecessary confusion.

A varicose vein is an enlarged superficial vein, usually associated with abnormal valve function and venous reflux. Deep vein thrombosis, or DVT, is a blood clot within a deep vein, commonly in the leg.

Varicose veins can sometimes develop superficial vein thrombosis. An affected superficial vein may become hard, painful, tender and inflamed.

DVT is a different and potentially more serious condition because part of a clot can travel to the lungs and cause a pulmonary embolism.

Sudden unexplained swelling, particularly involving one leg, should not simply be blamed on menopause or existing varicose veins. Pain, warmth, redness or tenderness associated with sudden swelling requires medical assessment where a blood clot may be a possibility.

HRT and Varicose Veins

Women with varicose veins sometimes worry that they cannot use hormone replacement therapy or that HRT will inevitably make their veins worse.

Having varicose veins is not the same as having a previous DVT, pulmonary embolism or diagnosed blood clotting disorder.

This distinction matters because much of the discussion surrounding HRT and veins concerns venous thromboembolism, rather than visible varicose veins themselves.

Current NICE menopause guidance states that venous thromboembolism risk is increased with oral HRT and that the risk associated with oral HRT is greater than with transdermal preparations. NICE advises clinicians to take individual VTE risk into account when discussing the route of HRT administration.

A personal history of DVT or pulmonary embolism, known thrombophilia, obesity and a strong family history of blood clots are therefore relevant when discussing HRT with a GP or menopause clinician.

Women should not stop HRT or change their preparation simply because varicose veins have appeared. The benefits and risks of HRT need to be assessed individually by the clinician responsible for menopause care.

Vein Health and Cardiovascular Health Are Different

Menopause is also a useful stage of life to pay greater attention to cardiovascular health, including blood pressure, cholesterol, smoking, activity and weight.

However, cardiovascular disease and varicose veins should not be confused.

Varicose veins primarily involve the venous side of the circulation, which returns blood towards the heart. The problem commonly involves faulty valves that allow blood to flow backwards and increase pressure in superficial veins.

Conditions such as atherosclerosis primarily affect arteries carrying blood away from the heart.

Lifestyle measures that support cardiovascular health can also benefit overall circulation, but reducing cholesterol or changing your diet cannot repair a faulty valve inside a varicose vein.

A balanced diet can support healthy blood flow and circulation, but individual foods, herbs or supplements should not be regarded as treatments for established venous reflux.

Weight and Varicose Veins During Menopause

Weight and body composition can change around menopause, but weight needs to be discussed carefully in relation to varicose veins.

Carrying excess body weight can increase pressure on the lower limb venous system and is associated with venous disease. Maintaining a healthy weight is therefore beneficial for general cardiovascular and vein health.

Losing weight does not, however, repair damaged venous valves or make established varicose veins disappear.

Women should not assume that developing varicose veins means they have done something wrong. A woman who exercises regularly and maintains a healthy weight can still develop significant varicose veins because of genetics, age, pregnancy history and valve dysfunction.

Exercise and Everyday Movement

Regular movement supports venous return because the calf muscles help pump blood upwards through the legs.

Walking is particularly useful because each step activates the calf muscle pump. Swimming, cycling and other regular physical activity can also support mobility, cardiovascular health and weight management.

If work or daily life involves prolonged periods at a desk or standing in one position, getting up and moving periodically keeps the calf muscles active. Jobs involving long periods of sitting or standing can make venous symptoms more noticeable, particularly where valve problems are already present.

Regular exercise can help with varicose vein symptoms, but it cannot make a faulty venous valve start functioning normally again.

This distinction is important. Lifestyle changes can support the circulation and improve comfort, but they should not be presented as a cure for established venous reflux.

Compression Stockings During Menopause

Compression stockings can help some women manage swelling, aching and heaviness associated with venous disease.

Graduated compression applies greater pressure around the ankle, with pressure decreasing further up the leg. This supports venous return and can reduce fluid accumulation in the lower limbs.

The correct type and strength of compression depend on the individual’s circulation, symptoms and medical history. Strong compression should not simply be purchased and worn without checking that it is appropriate, particularly where there may also be arterial circulation problems.

Compression can manage symptoms, but it cannot repair faulty venous valves or make an established varicose vein disappear.

For people with confirmed varicose veins and truncal reflux who are suitable for an intervention, NICE recommends interventional treatment rather than permanent compression hosiery as the primary treatment.

Can Varicose Veins Be Prevented During Menopause?

There is no guaranteed way to prevent varicose veins.

Age, genetics, previous pregnancies and existing valve problems cannot be changed. This matters because advice about varicose veins can sometimes suggest they result from poor lifestyle choices.

Regular physical activity, maintaining a healthy weight and avoiding very long periods of immobility can support venous circulation. Raising the legs when resting may reduce swelling and discomfort for some people.

These measures can help manage symptoms and support general health, but they cannot guarantee that varicose veins will not develop.

The same applies to footwear and clothing. High heels and fitted clothing are sometimes blamed for causing varicose veins, but they should not be presented as major causes of venous valve failure.

Varicose Veins Do Not Have To Be Accepted As Part Of Ageing

Some women live with troublesome varicose veins for years because they assume they are simply part of getting older.

Menopause itself does not prevent varicose veins from being assessed or treated.

Age alone does not determine whether treatment is appropriate. General health, symptoms, the veins affected and ultrasound findings are much more informative.

This is particularly relevant for women who have lived with veins since pregnancy and notice them becoming more troublesome later in life. There is no requirement to wait until symptoms become severe before discussing them with a vascular specialist.

Visible Veins Without Other Symptoms

Some varicose veins remain primarily a cosmetic concern. A prominent vein that causes no pain, swelling, itching or skin changes does not necessarily indicate advanced venous disease.

Appearance can still matter. Prominent veins may affect confidence when wearing certain clothing, exercising, swimming or going on holiday, particularly at a time when women may already be adjusting to other physical changes associated with menopause.

An assessment can establish whether visible veins are isolated or associated with underlying reflux. This is more useful than judging their significance from appearance alone.

Symptoms Worth Having Assessed

Persistent aching, heaviness, itching, swelling or increasingly prominent varicose veins are good reasons to arrange an assessment, particularly where symptoms repeatedly worsen after prolonged standing or towards the end of the day.

Skin pigmentation, venous eczema, hardening around the lower leg or a wound near the ankle that is slow to heal can indicate more established venous disease and should receive medical attention.

A hard, painful superficial vein can indicate superficial vein thrombosis.

Bleeding from a varicose vein also requires prompt medical attention. NICE recommends immediate referral to a vascular service for bleeding varicose veins.

Sudden unexplained swelling or pain affecting one leg needs a different level of attention because DVT and other causes may need to be excluded urgently.

Assessing Varicose Veins During and After Menopause

The visible vein is not always where the underlying problem begins.

A prominent vein around the calf may be receiving abnormal blood flow from a faulty superficial vein higher in the leg. Looking only at the veins visible through the skin can therefore provide an incomplete picture.

Duplex ultrasound combines conventional ultrasound imaging with information about the direction and speed of blood flow. It allows a vascular specialist to identify venous reflux, assess valve function and map the veins responsible for the problem.

NICE recommends duplex ultrasound for people being assessed within a vascular service for varicose veins. The findings are used to confirm the diagnosis, establish the extent of truncal reflux and plan treatment.

At Vein Solutions, the initial consultation for varicose veins includes clinical examination and, where indicated, an ultrasound scan to establish the type and extent of venous disease before a treatment plan is recommended.

Treating Varicose Veins After Menopause

Modern treatment usually focuses on closing the vein responsible for abnormal reflux. Blood is then redirected through functioning veins that can return it towards the heart more effectively.

For confirmed varicose veins with truncal reflux, NICE recommends endothermal ablation as the first treatment option where it is suitable. Endothermal techniques include endovenous laser treatment and radio frequency ablation. If endothermal treatment is unsuitable, NICE recommends ultrasound guided foam sclerotherapy, followed by surgery if foam treatment is unsuitable.

Other minimally invasive techniques may also be suitable depending on the anatomy of the affected veins and the individual patient. Varicose veins can often be treated without conventional surgery using procedures performed under local anaesthetic, including laser, radiofrequency, foam sclerotherapy and cyanoacrylate closure.

The appropriate treatment cannot be decided solely from the size or appearance of the veins. Ultrasound findings, symptoms, medical history, previous treatment and the pattern of reflux all influence the decision.

Varicose Vein Treatment Is Not Only Cosmetic

Many women tolerate uncomfortable veins because they regard treatment as something undertaken only for appearance.

Varicose veins can certainly be a cosmetic concern, but aching, heaviness, swelling, itching and skin changes are recognised symptoms of venous disease. NICE guidance recommends vascular referral for symptomatic varicose veins rather than limiting assessment to advanced disease.

There is also no need to wait for menopause to finish before having symptomatic veins assessed. Menopausal status is only one part of a woman’s wider medical history.

Varicose Vein Assessment at Vein Solutions

Developing varicose veins during perimenopause or after menopause does not mean hormones are solely responsible. For many women, this stage of life is when the combined effects of age, genetics, previous pregnancies and existing venous reflux become more apparent.

Lifestyle changes can support circulation and may reduce aching, heaviness or swelling, but they cannot correct a faulty venous valve.

A clinical examination and duplex ultrasound can determine whether visible veins are associated with underlying reflux and whether treatment is appropriate. This also helps separate symptoms caused by venous disease from the many other physical changes that can occur around menopause.

For women whose veins require treatment, modern minimally invasive procedures can often be performed under local anaesthetic on an outpatient basis. Treatment is selected according to the individual pattern of venous disease rather than age or menopausal status.

If veins have become increasingly prominent around menopause, or your legs regularly ache, swell, itch, or develop skin changes, a vascular assessment can determine what is happening within the veins and whether treatment is needed.

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