Varicose veins are swollen, bulging veins that often occur in people’s legs and may cause cramps, heaviness, or pain. They are caused when blood is prevented from flowing normally. When your veins are fighting against gravity to get blood from your feet back to your heart, the valves that keep the blood flowing in only one direction can become weak. These weak valves allow some blood to seep back down the vein, causing pooling; this pooling can result in varicose veins. When a woman is pregnant, there is an increased amount of blood in her vascular system, which can increase the likelihood of varicose veins.
Quick Answer: Varicose veins in pregnancy are common because blood volume rises, hormones relax the vein walls and the growing uterus slows blood returning from the legs. They usually appear or worsen in the second and third trimesters, can affect the legs, vulva and pelvis, and often improve within a few months of delivery. They are rarely dangerous, but one-sided leg swelling or pain needs prompt checking for a blood clot. Veins that persist after pregnancy can be treated with minimally invasive office procedures.
A common cause for varicose veins is weight gain. Added weight means the veins need to work harder to pump the already increased flow of blood, and when combined with the increased levels of progesterone in pregnant women, the blood vessels have a hard time keeping up. Fluid retention is a common part of pregnancy and it contributes to overall weight as well as general pressure on the internal organs and skin. This pressure can constrict the blood vessels, reducing their efficiency and causing them to back up. As the fetus grows, more pressure is exerted on the uterus walls and the skin cells stretch out. As a result, varicose and spider veins may develop in the lower abdominal regions in addition to the legs of a pregnant woman.
There are ways to reduce or prevent the onset of varicose veins, however. Regular, non-strenuous exercise helps maintain blood flow. Maintaining a healthy weight will also reduce the appearance. Many women like to cross their legs while sitting, but this constricts blood flow and can contribute to varicose veins. Elevate your legs as close to heart level as possible to decrease the workload on the veins returning blood to the heart. Alternate between sitting and standing, or go for a short walk to stretch your legs throughout the day. While pregnant, wearing compression socks can also help.
If the above methods are not enough to allay varicose veins, you may want to consider varicose vein treatment. It is not recommended to treat varicose or spider veins during pregnancy, partly because most of them will subside after birth when blood flow returns to normal and the extra pressures go away. If they do not subside on their own, contact the vein specialists at Premier Vein to schedule a consultation and discuss options for varicose vein treatment.
Meet your vein specialist
Dr. Syed Raza, MD
Vascular & Interventional Radiology · Founder, Premier Vein & Vascular Center
Fellowship-trained interventional radiologist certified by the American Board of Radiology and the Royal College of Radiologists (UK). Former Chief of Interventional Radiology at UTMB Galveston and Memorial Hermann Memorial City, with 15+ years treating varicose veins, venous reflux and peripheral arterial disease.
How Varicose Veins Change Through Pregnancy
Women often ask us whether what they are seeing is normal. Vein changes in pregnancy tend to follow a fairly predictable course, and knowing it can take a lot of worry out of the experience.
First trimester
Hormone levels rise quickly in the early weeks. Some women notice new spider veins or slightly more visible blue veins on the breasts, legs or abdomen before their bump is even showing. Women who had varicose veins in a previous pregnancy often notice them reappear early.
Second trimester
Blood volume continues to climb and the uterus begins to press on the pelvic veins. Leg aching by the end of the day becomes more common, and existing veins may start to bulge more.
Third trimester
This is usually when varicose veins are at their most prominent. The weight of the uterus on the large pelvic veins is greatest, ankle swelling is common, and vulvar veins may appear. Symptoms are often worse in hot weather and after long periods of standing.
After delivery
As blood volume, hormones and pelvic pressure return to normal, many veins shrink over the following weeks and months. Veins that are still present several months after delivery, or after breastfeeding ends, are less likely to resolve on their own.
Varicose Veins in Pregnancy Beyond the Legs
The original article mentions veins in the lower abdomen. Pregnancy can also affect veins in places women do not expect, and these are worth knowing about.
- Vulvar varicose veins. Swollen veins on the labia or around the vaginal opening can cause a feeling of fullness, pressure or aching, especially later in the day. They are usually harmless and often fade within about six weeks of delivery. A supportive maternity garment, cool compresses and lying with the hips slightly raised can ease discomfort.
- Hemorrhoids. These are varicose veins of the rectum and are very common in late pregnancy and after delivery, partly because of constipation and straining.
- Veins on the back of the thigh or buttock. Veins in these unusual places can come from the pelvic veins rather than the leg veins. When they persist after pregnancy, especially with pelvic aching, they may be a sign of pelvic congestion syndrome.
What Is Normal and What Needs a Check
Most pregnancy vein changes are uncomfortable rather than dangerous. The table below helps separate the expected from the changes that should be assessed promptly.
| Usually expected in pregnancy | Should be checked by a doctor |
|---|---|
| Mild swelling of both ankles by evening that improves overnight | Swelling of one leg only, or swelling that appears suddenly |
| Aching or heaviness in both legs after standing | Pain, warmth or redness in one calf or thigh |
| New spider veins on the legs, chest or face | A hard, red, tender cord along a vein |
| Soft, bulging veins that empty when you lie down | Bleeding from a vein, or skin breaking down over a vein |
| Vulvar fullness that eases when lying down | Severe vulvar or pelvic pain, or pain with fever |
Pregnancy and the first weeks after birth raise the risk of deep vein thrombosis. A varicose vein is not the same as a clot, but any of the changes in the right-hand column deserve a same-day call to your obstetrician or a vein specialist.
Call 911 or seek emergency care if you are pregnant or recently delivered and have:
- Sudden shortness of breath, chest pain or coughing up blood
- Swelling, pain and warmth in one leg
- Heavy bleeding from a varicose vein that does not stop with firm pressure and the leg raised
- Sudden swelling of the face or hands with a severe headache or vision changes
Easing Symptoms While You Are Pregnant
The prevention steps described above also relieve symptoms once veins have appeared. A few additional, practical measures help many of our patients get through the later months more comfortably:
- Plan your day around your legs. Do errands and standing tasks in the morning, when the legs are freshest, and save seated tasks for later.
- Take short elevation breaks. Lying on your left side with your legs propped on pillows for 15 minutes can relieve heaviness quickly.
- Cool the legs. A cool shower or cool compresses on the calves can ease the warm, throbbing feeling many women notice in summer.
- Get your stockings fitted. Stockings work best when sized to your legs. Measurements taken in the morning give the most accurate fit, and sizes may need to change as pregnancy progresses.
- Protect fragile veins. Moisturize dry skin over prominent veins near the ankle and avoid scratching itchy areas, which can break the skin.
- Keep bowel movements easy with fluids, fiber and gentle activity, which reduces pressure on both pelvic veins and hemorrhoids.
Varicose veins and labor
Women with leg or vulvar varicose veins often worry about delivery. In most cases, varicose veins do not change how a baby is delivered, and they are not a reason for a cesarean section on their own. Let your obstetrician know about any large vulvar veins so the delivery team is aware of them. After birth, early walking, staying hydrated and following your doctor’s advice on clot prevention all help the leg veins recover, especially after a cesarean delivery when clot risk is higher.
How We Evaluate Pregnancy-Related Varicose Veins
Some women see us during pregnancy for symptom relief or reassurance about a clot; many more come several months after delivery. The evaluation is similar either way:
- Focused history. We ask about the number of pregnancies, when veins appeared, whether they improved after previous births, family history, prior clots, and whether you are breastfeeding or planning another pregnancy.
- Examination. We examine both legs standing, look at the skin around the ankles and ask about pelvic, vulvar or buttock veins.
- Venous duplex ultrasound. This radiation-free scan in our IAC-accredited vascular lab checks for clots and maps which valves are leaking. After pregnancy, it shows whether a main vein such as the great saphenous vein is causing the problem. Our venous ultrasound page explains what to expect.
- A clear plan. During pregnancy, the plan focuses on comfort and safety. After pregnancy, we explain whether the remaining veins are likely to improve further, whether treatment would help, and how timing fits with breastfeeding and future pregnancies.
Treating Varicose Veins After Pregnancy
As the original article explains, vein treatment is not recommended during pregnancy, partly because many veins settle on their own. Once you have recovered from delivery, the picture becomes clearer. For veins that remain, treatment is chosen according to what the ultrasound shows.
When a main vein is leaking
If a large surface vein such as the great or small saphenous vein has reflux, closing it removes the pressure that feeds the bulging branches. This is done with endovenous thermal ablation or a non-thermal method, through a single needle puncture under local anesthesia. The procedure usually takes about an hour, and most women walk out afterward and return to normal activities, including caring for a baby, within a day or two.
For bulging branch veins
Larger visible veins can be removed through tiny nicks in the skin with ambulatory phlebectomy, or closed with foam sclerotherapy. These are often done at the same visit as ablation or a few weeks later.
For spider veins
Pregnancy spider veins that have not faded can be treated with sclerotherapy, usually over a few short sessions. This is generally considered cosmetic and is best done once you are no longer breastfeeding.
Breastfeeding and timing
Many vein specialists prefer to wait until breastfeeding has finished before using sclerosing medicines, and some procedures may be scheduled around feeding. If your veins are painful or causing skin changes, we discuss options that can be done safely sooner. There is no need to rush; veins that remain will still be treatable later.
Planning Another Pregnancy
Each pregnancy places fresh strain on the vein valves, and veins that improved after a first baby often return more prominently with the next. If you plan more children, it is worth discussing with your vein specialist whether to treat now or wait. Women with painful veins, swelling or skin changes often benefit from treatment between pregnancies, while women with mainly cosmetic veins usually wait until their family is complete. Starting compression early in the next pregnancy is sensible either way.
When to See a Vein Specialist in Houston
If veins are still bulging or aching six months or more after delivery, if you had painful veins in a previous pregnancy and are planning another, or if you notice veins on the vulva, buttock or back of the thigh that have not settled, it is worth an assessment. Dr. Syed Raza, a fellowship-trained interventional radiologist at our vein clinic in Houston, evaluates pregnancy-related veins with ultrasound and offers minimally invasive treatment when it is the right time for you. Same-week appointments are usually available, and most insurance plans, including Medicare, are accepted. You can also read our varicose veins FAQs for more answers.
Talk With a Specialist at Premier Vein
Have questions about your symptoms or treatment options? Dr. Syed Raza and the team at Premier Vein & Vascular Center can evaluate your concerns and explain your options clearly. Same-week appointments are usually available, and most insurance plans are accepted.
Frequently Asked Questions
Do varicose veins during pregnancy mean I will always have them?
Not necessarily. Many pregnancy varicose veins shrink a great deal within a few months of delivery. Veins that remain after six months to a year, or that return with each pregnancy, usually reflect lasting valve damage and can be treated.
Are vulvar varicose veins dangerous during pregnancy?
Vulvar varicose veins are usually harmless and most fade within weeks of delivery. They rarely affect a vaginal birth, but tell your obstetrician about them, and seek care if they become very painful, hard or bleed.
Can I have vein treatment while breastfeeding?
Some evaluations and procedures can be done while breastfeeding, but many specialists prefer to wait until breastfeeding has ended before using sclerosing medicines. Your vein specialist will tailor the timing to your symptoms and preferences.
Why are my varicose veins worse with my second pregnancy?
Veins that stretched during an earlier pregnancy often do not fully recover, so the valves are already weaker when the next pregnancy begins. Blood volume, hormones and pelvic pressure then add to that existing weakness.
Should I see a vein specialist while pregnant?
It is reasonable if your veins are very painful, you notice a hard, tender or red vein, or you have swelling in one leg. Most other pregnancy vein changes can be managed with compression and lifestyle measures and reviewed after delivery.
Are pregnancy spider veins permanent?
Many spider veins that appear in pregnancy fade after delivery as hormone levels settle. Those that remain are harmless and can be treated with sclerotherapy later if they bother you.
How soon after giving birth can varicose veins be treated?
Most specialists suggest waiting at least a few months after delivery, because many veins continue to shrink during that time. Treatment is then planned according to the ultrasound findings, your symptoms and whether you are breastfeeding.
Trusted Health Resources
- Chronic Venous Insufficiency, Society for Vascular Surgery
- Venous Insufficiency, MedlinePlus Medical Encyclopedia (NIH)
- Varicose Veins and Spider Veins, MedlinePlus (NIH)