Varicose veins and menopause

The age of menopause in Western countries is between 45 and 55, on average around 51. This is the point at which a woman has stopped menstruating for 12 months, marking the end of her reproductive years. The timing of menopause can vary considerably, however, and can occur in a woman's forties or fifties.

By the age of 58, almost all women have gone through menopause, the age at which 100% of women can be said to have experienced the cessation or irregularity of their periods due to the natural decline in reproductive hormones.

It is generally accepted that the age of onset of menopause is strongly hereditary.

The risk of varicose veins increases with age.
The frequency of varicose veins in women, depending on the study, is 10-20% under the age of 40, 20-40% between 40 and 50, and probably over 50% over the age of 60.
In fact, the age of menopause corresponds to the age at which it is most common for a woman to be treated for varicose disease. Indeed, in our experience, the average age of patients undergoing varicose vein surgery for the first time is 52.
Patients over the age of 45 account for 2/3 of women undergoing varicose vein surgery at our Institute (see chart on age groups of patients operated on).
So it's only logical that the presence of varicose veins should become a concern for patients during the menopause.

Hormonal changes during menopause can influence the relationship between varicose veins and menopause.

Some studies show that during the transition to menopause, fluctuations and eventual drops in estrogen and progesterone levels can affect the elasticity and strength of vein walls, which could contribute to the development of varicose veins.

What's more, other research seems to show that the hormonal changes associated with menopause can also influence the distribution and expression of estrogen and progesterone receptors in the venous system, which may have a further impact on the development or severity of varicose veins.

However, the interactions between hormonal changes during menopause and vascular health are complex and the subject of much debate.

High levels of estrogen and progesterone are associated with increased venous distensibility, which can contribute to increased symptoms of venous disease, particularly the sensation of heavy legs.

This explains why women suffer more than men from varicose veins, particularly during hormonal peaks, mainly during cycles (just before menstruation) and of course during pregnancy.

The natural drop in these hormones at menopause tends to reduce this harmful influence. Women tend to suffer less from heavy leg problems after the menopause, especially when they retire from a tramping job, sometimes with more time for physical activity.

The favorable effects of lower sex hormone levels and increased physical activity are offset by other factors, which can aggravate varicose disease with age:

• Aging itself, which degrades the vein wall
• The risk of thrombosis (phlebitis), which increases with age
• Weight gain, which increases the sensation of heavy legs
• Osteoarthritis or more or less disabling age-related illnesses that limit the possibility of physical activity

The fact of suffering less from varicose vein symptoms also exposes us to the risk of not seeking treatment, whereas varicose veins generally spread more slowly, exposing us to the risk of varicose disease complications (thrombosis, skin disorders) and to more complex, less satisfactory treatment.

Hormonal therapies, including hormone replacement therapy (HRT) based on different estrogens and/or progestogens, can have an impact on varicose veins:

• As we've seen, treatments containing estrogen and progesterone can increase the risk of developing varicose veins. These female sex hormones can cause the walls of the veins to dilates, which can lead to permanent venous dilatation and exacerbate the formation of varicose veins.
• Some studies suggest that postmenopausal women taking HRT (particularly those containing progesterone) may have a slightly increased risk of phlebitis.
• Hormonal therapies can lead to changes in the expression of estrogen and progesterone receptors in vein walls, potentially contributing to the development or aggravation of varicose veins.

However, it must be stressed that the impact of HRT on varicose veins is complex, including hormone type, dosage and individual patient characteristics.

While these factors must be carefully considered when prescribing HRT to patients suffering from varicose veins, they must be weighed against the many benefits of these treatments (quality of life, cerebral and cardiovascular protection, bone capital, etc.), which have now been demonstrated and justify their prescription for many patients.

It is above all the existence of a history of, or significant risk factor for, thrombosis that should prompt caution when prescribing HRT, particularly when it includes progesterone.

Menopause often coincides with the period when women start to worry about their varicose veins.

In fact, varicose veins are much more common after the age of 50, and varicose disease tends to worsen beyond that age, even if the discomfort is not necessarily greater.

It is therefore important to undergo treatment at the time of menopause, to avoid an unfavorable evolution with a risk of subsequent complications.

It has now been proven that the prescription of hormone replacement therapy during menopause is highly beneficial. However, it is generally not recommended unless there is a proven risk of thrombosis, which is why it is important to have any varicose veins treated so that the hormone treatment can be introduced under optimum conditions.