Vascular Surgeon
Expert in the treatment of varicose veins

What is the relationship between varicose veins and pregnancy?

Are pregnancies the cause of varicose veins?

Pregnancy can be an event that causes varicose veins to appear. But if varicose veins appear during a pregnancy, it means that there is a fragile ground, very often hereditary.

Sometimes there are small varicose veins before the pregnancy, which the patient may not have noticed, which will be aggravated during the pregnancy.

It is also possible that varicose veins appear late, even after the menopause, when the veins deteriorate due to aging on a less hereditary fragility.

Do varicose veins appear after the first pregnancy?

No, there is no rule, varicose veins can indeed appear after the first pregnancy, but they can emerge only after several pregnancies, sometimes during the very last one, or even several years later.

The hereditary fragility of the venous wall is important: the more fragile the wall is at the beginning, the earlier varicose veins will appear in a woman’s pregnancy history. It is certain that the number of pregnancies increases the probability of having varicose veins, especially if there is a heredity.

It is also the hormonal sensitivity of the venous wall which is different in each patient which can explain the variable effect of pregnancies on varicose veins from one person to another (see below).

Finally, the association with other risk factors, such as long standing up at work for example, will also weaken the venous walls and will increase the risk of seeing varicose veins appear during a pregnancy.

Why do pregnancies favour the appearance of varicose veins?

The reason is essentially hormonal.
The hormones estrogen and progesterone have a powerful “vasodilator” effect, i.e. dilation of the veins. Thus, the level of these hormones increases significantly during pregnancy, and the veins can dilate very quickly when a pregnancy is initiated.

Each patient will react differently to the influence of estrogen and progesterone, depending on the sensitivity of her veins to these hormones.
This explains why some women will not have the appearance or aggravation of varicose veins during pregnancy, despite the increase in estrogen and progesterone levels, while for others this will have a major aggravating effect.

Does pregnancy increase the discomfort caused by varicose veins?

Yes, very often the pain and especially the congestion with heavy legs and fatigue are accentuated during pregnancy, sometimes even in a major way.
The color of the skin on the legs can also change during pregnancy with an appearance of red or blue spots, more or less related to the dilation of very small veins of the skin.
Finally, the risk of complications such as phlebitis is increased during pregnancy, the most delicate period being the one just after delivery, called “post-partum”. (see below)

Are veins dilated during pregnancy irreparably damaged?

No, not necessarily, as the veins are “artificially” dilated by a hormonal effect during pregnancy, they can sometimes become normal again after delivery, or rather after breastfeeding if the mother is breastfeeding.
Indeed, once the estrogen and progesterone levels have returned to a baseline, the dilated veins can return to a normal appearance.
Unfortunately, this is only very rarely true for all the veins that dilate during pregnancy, some of them remaining true varicose veins forever.
Therefore, a precise indication for treatment should never be given until the pregnancy (and breastfeeding if applicable) is over. This can only be done several weeks after the pregnancy.

How can varicose veins be treated during pregnancy?

Any surgery to treat varicose veins is contraindicated during pregnancy, with rare exceptions.
Sclerosing treatments are also contraindicated during pregnancy.
The best way to relieve the discomfort of varicose veins and congestion is to wear a compression stocking (adapted to pregnancy).
Some kinds of venotonics can also be prescribed during pregnancy, but only with medical approval.
Finally, injections of anticoagulants may be indicated, either to treat phlebitis that unfortunately appeared during pregnancy, or to prevent phlebitis in a situation at risk.

In the presence of varicose veins, is it contraindicated to have a pregnancy? Is it necessary to have surgery before or after a pregnancy?

No, the existence of varicose veins is not a formal contraindication to having a pregnancy.
However, it is logical to consider having varicose veins treated before planning a pregnancy, since we know that pregnancy can aggravate them.
Other varicose veins may appear during pregnancy even if you have had surgery beforehand, but the procedure performed will limit the damage, especially if you have been able to preserve the saphenous vein, as some studies on the ASVAL method have shown.
Finally, it is generally advisable to wait a few months after a varicose vein treatment procedure before planning a pregnancy.

In conclusion

There is undoubtedly an unfavorable relationship between pregnancy and varicose veins. It is therefore always necessary to take medical advice for a good management of this risk, especially in case of heredity.

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