For many women, discovering they’re pregnant is followed by a less exciting discovery: the appearance of varicose veins.
Up to half of women experience abnormal dilation, or enlargement, in the superficial veins of their legs and lower extremities while pregnant for reasons that make sense, but do not make them easier to tolerate.
“Superficial veins are veins that are close to the skin’s surface,” explains Dr. Robert Fenning
, interventional cardiologist at Penn Presbyterian Medical Center. “Superficial veins of the legs have one-way valves that help blood move up the leg against gravity to drain blood back up to the heart. When a woman is pregnant, a number of physiological factors occur, including the growth of the uterus in the abdomen that exerts a downward force on venous blood flow, leading to enlarging those veins and making them visible.” In addition to their appearance, which can be distressing, varicose veins can be intensely painful, and are accompanied by redness and swelling. While varicose veins rarely pose serious risks to physical health, they are an unwelcomed distraction for women preparing for a new bundle of joy.
Is my belly the only cause?
Varicose veins aren’t exclusive to pregnancy, but pregnancy can signal their arrival – or make them worse. The reason: during pregnancy, the blood volume in a woman’s body increases by as much as 20 percent, while the number of veins remains the same, meaning more work for your body’s vascular system.
Add spikes in progesterone and in the hormones that relax the ligaments in the pelvis and smooth muscle cells in the vein walls, and it makes sense that blood’s upward journey gets tougher during pregnancy. These factors all create one vicious cycle: veins dilate causing backpressure against valves that in turn causes veins to dilate even more, making the valve less effective.
What can I do about them?
Dr. Fenning encourages conservative therapy like elevating your legs at the end of each day and limiting the time you spend standing or walking.
Compression stockings are another popular and effective treatment that pose little to no risk of side effects. Worn under clothing, they encourage upward pressure that helps blood successfully leave the legs and move up to the heart. Compression stockings come in a variety of sizes, strength levels, and styles ranging from knee high to thigh high.
You can buy compression stockings over the counter or online, but they tend to be a lower strength,” Dr. Fenning says. “A prescription to a medical supply store can connect you to stronger options.
Just be careful they’re not too strong.
Compression stockings are graded, or ranked, by a pressure value measured in millimeters of mercury (mmHg). I recommend 20-30 mmHg strength stockings, which is a moderate to high-pressured stocking. 8-15 mmHg strength is the lowest and may not be powerful enough, and 30-40 mmHg strength may be so powerful they are tough to tolerate.
Dr. Fenning discourages elective vein procedures during pregnancy, noting that varicose veins almost always fade after giving birth, and sometimes resolve completely.
Try to be patient, because varicose veins generally take about twelve weeks after you deliver to fade or disappear. Around the four month point, you’ve probably seen all of the improvement you’re going to see and can consider seeing a vein specialist.
When to Worry (Spoiler: Rarely)
While varicose veins might seem like a cosmetic issue, that does not mean you shouldn’t point them out to your ob/gyn, especially if they’re causing pain or discomfort. In very rare cases, venous insufficiency, or the failure of the veins to adequately return blood to the heart, can result in skin breakdown. In other uncommon scenarios, varicose veins become acutely inflamed, causing severe pain and potential blood clots.
But in the vast majority of outcomes, women walk away from pregnancy with a beautiful baby – and varicose veins that, if not gone entirely, are less painful than they were while pregnant, and far less likely to catch someone’s eye.
If you suffer from varicose veins, in-person vein screenings are available at Penn Presbyterian Medical Center and Penn Heart and Vascular Center Cherry Hill. Additionally, through Penn Connected Care, we now offer virtual visits for patients that need a screening for vascular conditions, including varicose veins. To schedule a screening, call 800-789-7366.