Menopause and Varicose Veins: Causes and Care

Varicose veins become increasingly common with age, affecting more than half of women over 60.⁽¹⁾

These enlarged, visible veins — most often seen in the legs — can appear dark blue or purple and may bulge beneath the skin’s surface. They form when weakened or damaged valves allow blood to collect in the veins rather than flow efficiently back to the heart.⁽²⁾

As women transition through menopause, hormonal changes, especially declines in estrogen and progesterone, can affect vascular health. These changes may increase the likelihood or severity of varicose veins, making menopause a significant time for vascular changes. The following explores the connection between varicose veins and menopause, including causes, symptoms, risk factors, and treatment strategies.⁽²⁾⁽³⁾

Understanding Varicose Veins

What are varicose veins?

Varicose veins are a visible sign of venous insufficiency, a condition where the veins have trouble returning blood from the limbs to the heart. The veins rely on one-way valves to keep blood moving upward against gravity. If these valves weaken or become damaged, blood can flow backward and pool, stretching the vein walls. This leads to the formation of varicose veins.⁽²⁾

A milder form of this condition is spider veins, which are smaller, red or purple vessels that can also appear on the legs or face. Although spider veins are typically considered a cosmetic issue, both conditions can be uncomfortable or painful over time.⁽²⁾

Why do they develop more in women?

Women are more likely than men to develop varicose veins due to hormonal, anatomical, and reproductive factors. During pregnancy, increased blood volume and hormonal changes can put pressure on leg veins.⁽⁴⁾

Estrogen and progesterone also play direct roles. These hormones influence vascular elasticity, or the ability of blood vessels to stretch and contract.⁽⁵⁾⁽⁶⁾

The Link Between Menopause and Varicose Veins

Declining levels of estrogen and progesterone mark the menopausal transition. These hormonal shifts influence both reproductive health and vascular tone — the strength and tension of blood vessel walls.⁽⁵⁾

Lower estrogen levels can reduce the production of nitric oxide, a molecule that helps blood vessels stay flexible. Without enough flexibility, vein walls become less able to respond to changes in blood flow. As a result, blood may pool, especially in the lower legs, increasing the risk of varicose veins. Progesterone helps keep blood vessels relaxed and supports healthy circulation. As progesterone levels drop during menopause, veins may become stiffer or change in structure. One study found more progesterone receptors in the vein walls of women with varicose veins, suggesting that hormone changes during menopause might affect vein health.⁽⁵⁾⁽⁶⁾

Research published in The Journal of the American College of Obstetricians and Gynecologists suggests that hormonal changes in menopause directly affect vascular tissues, potentially worsening symptoms of chronic venous disease. Additionally, menopause is associated with slower circulation and a higher risk of blood clotting, both of which can contribute to varicose vein formation.⁽³⁾⁽⁷⁾

Perimenopause and Early Vascular Symptoms

For some women, signs of venous changes begin in perimenopause, the transitional phase before menopause. During this time, hormone levels fluctuate unpredictably, affecting many parts of the body, including the vascular system.⁽³⁾

One early sign is the appearance of blue veins, especially on the legs or chest. These veins may become more visible due to thinning skin and loss of subcutaneous tissue (the deepest layer of skin), but they can also signal changes in blood flow and venous function.⁽⁴⁾

Another common symptom is leg swelling, particularly toward the end of the day. While occasional swelling can be a normal part of aging, consistent discomfort, heaviness, or visible changes in the veins may suggest venous issues that warrant medical attention.⁽²⁾⁽⁴⁾

Vulvar Varicose Veins After Menopause

Vulvar varicose veins are swollen veins that develop around the vulva. While more common during pregnancy, they can also appear or worsen after menopause due to decreased activity, weakened vascular tissues, and changes in hormone levels.⁽⁸⁾⁽⁹⁾

These veins may cause a feeling of fullness, aching, or pressure in the pelvic region. Although not usually dangerous, they can impact comfort and quality of life.⁽⁹⁾

A related condition is pelvic congestion syndrome, which involves dilated pelvic veins and chronic pelvic pain. In postmenopausal women, this may be mistaken for other gynecologic issues. Because both vulvar varicose veins and pelvic congestion can mimic other conditions, careful diagnosis by a healthcare provider familiar with menopausal changes is important.⁽¹⁰⁾

Risk Factors for Menopausal Varicose Veins

Several factors can increase the likelihood of developing varicose veins during menopause, including the following:

Multiple Pregnancies and Vascular Stress

Pregnancy increases vein pressure and hormone exposure, which may have long-term vascular effects in certain individuals.^(2)(11)

Age and Natural Vein Degeneration

As veins age, they naturally lose strength and elasticity, making them more prone to circulation issues.⁽²⁾⁽⁵⁾

Weight Gain and Reduced Regular Exercise

Menopause is often linked with decreased physical activity levels and weight changes, both of which affect circulation.⁽²⁾

Sedentary Lifestyle

Long periods of sitting or inactivity can slow blood flow and increase pressure in the veins, especially in the legs,

contributing to varicose vein development.

Hormone Replacement Therapy (HRT)

HRT has dual effects. Estrogen may protect blood vessels, but it may also slightly increase the risk of blood clots in some women. The overall impact on vein health is still being studied, so individual risk assessment is the best course of action with HRT.⁽⁵⁾⁽⁶⁾

Emerging research is exploring how bioidentical estrogen and progesterone might support vein wall health. Some studies suggest that carefully monitored HRT may help maintain vascular elasticity, but treatment must be personalized and monitored.^(3)(5)(12)

Symptoms to Watch for

Menopausal and postmenopausal women should monitor for the following symptoms, which may indicate the presence of varicose veins or related conditions:⁽²⁾

• Leg heaviness or aching, especially after standing

• Visible spider veins or rope-like veins on the legs

• Swelling in the feet or ankles

• Skin changes, including discoloration, dryness, or ulcer formation

• Pelvic discomfort or pressure⁽¹⁰⁾

• Itching, throbbing, or burning sensations near visible veins

Treatment & Management Strategies for Varicose Veins

Managing varicose veins during menopause often involves a mix of lifestyle changes and medical treatments. The best approach depends on each person's symptoms and risk factors. With the right care, it’s possible to improve circulation, reduce discomfort, and support long-term vein health.

Lifestyle Changes

• Exercising regularly, such as walking or swimming, helps improve blood flow and strengthens muscles, which assists in venous return and elasticity.

• Elevating the legs when resting and avoiding long periods of standing or sitting can prevent blood from pooling.

• Maintaining a healthy weight supports cardiovascular health and reduces strain on the veins.

• Managing hormone levels through diet, stress reduction, or HRT can also play a supportive role.

Medical Treatment Options

• Compression therapy involves wearing special socks called compression stockings that gently squeeze the legs, improving circulation and reducing swelling.

• Sclerotherapy is a minimally invasive vein treatment in which a solution is injected into affected veins, causing them to fade over time.

• Surgical options include vein stripping, laser therapy, or endovenous ablation to remove or seal off problematic veins.

• A vascular specialist or a provider trained in menopausal care can recommend the most appropriate intervention.

Role of HRT

• HRT is widely used to relieve menopausal symptoms like hot flashes and night sweats and may also support vein health by helping maintain vascular elasticity and vein wall tone. It’s crucial to assess individual risks, including the risk of blood clots.

• Bioidentical hormones like micronized progesterone and transdermal estrogen are considered gentler alternatives for some women. These options may have a more favorable profile for vascular health, though more research is needed to confirm their long-term safety.

• HRT decisions should be made with a provider trained in menopause management. Treatment plans should consider personal health history, symptom severity, and vascular risk factors to balance benefits and risks.

Preventive Measures

• Engaging in and maintaining an active lifestyle supports circulation and reduces the risk of vein-related issues.

• Focusing on leg-strengthening exercises, like walking, calf raises, or yoga, enhances muscle tone, which assists with venous return from the legs.

• Avoiding prolonged sitting or standing and shifting positions regularly helps prevent blood from pooling in the legs.

• Avoiding smoking and alcohol use helps protect blood vessels from damage.

• Monitoring vein health during perimenopause allows for early detection of potential issues.

• Scheduling a vein assessment is recommended if there’s a family history of varicose veins or vascular conditions.

Influence of Vascular Health After Menopause

The connection between menopause and varicose veins reflects a broader shift in vascular health during midlife. Hormonal changes influence how blood moves through the veins, potentially increasing the risk of visible veins, discomfort, and chronic venous disease.

Early recognition of symptoms, along with healthy lifestyle habits and individualized care plans, can help manage and even prevent the progression of varicose veins. For those considering HRT, working with a provider trained in menopause care helps ensure that vascular and hormonal health are addressed together.

Experiencing menopausal vein changes? Discover if HRT is right for you.

Take the menopause quiz to find out whether hormone therapy could help support your vascular health and comfort.