8% of Women in Their 20s, Compared With 1% of Men: Why Varicose Veins Disproportionately Affect Women
Not long ago, my mother struggled with varicose veins and eventually underwent surgery. But look around, and one thing becomes clear: vein-related problems in the legs seem to affect women far more often than men. Why is that?
Prevalence data compiled by Seoul Asan Medical Center reveals a striking pattern.
While 8% of women in their 20s have varicose veins, the figure for men in the same age group is just 1%.
By their 50s, the figures rise to 41% for women and 24% for men. In their 70s, they reach 72% and 43%, respectively. Rather than narrowing with age, the gap grows in absolute terms as the condition becomes more common in both groups.
One study also found that women account for roughly 68% of varicose vein patients in South Korea. The pattern is too pronounced to dismiss as coincidence. Ultimately, the explanation comes down to one word: hormones.
What Are Varicose Veins?
Leg veins contain valves positioned at regular intervals. These valves keep blood flowing upward toward the heart, working against gravity.
When the valves become stretched or damaged, blood flows backward and pools inside the veins. Unable to withstand the pressure, the vein walls bulge, creating the twisted, raised veins visible beneath the skin.
That is a varicose vein. An estimated 30% to 60% of adults in South Korea have some form of the condition, making it relatively common. The problem is that it is easy to dismiss as a cosmetic issue in the early stages. Left untreated, however, cumulative valve damage can cause the condition to progress to a point that is difficult to reverse.
Why Women Are More Susceptible: The Decisive Role of Hormones
The vein walls are made of connective tissue composed of collagen and elastic fibers. Estrogen relaxes this tissue, making it more prone to stretching.
That flexibility serves an important purpose during pregnancy and childbirth, but for the veins in the legs, it means less strength to withstand blood pressure. Progesterone adds to the effect by dilating the blood vessels.
When the two hormones act together, the veins stretch more easily and blood is more likely to pool inside them. Men either do not experience these hormonal factors or are affected by them to a much lesser degree.
Pregnancy is when these factors become most pronounced. As the uterus expands, it physically presses on the pelvic veins, impeding blood flow from the legs. At the same time, blood volume increases and progesterone levels rise sharply.
Seoul Asan Medical Center likewise notes that “the high incidence of varicose veins during the third month of pregnancy suggests that hormonal changes play an important role.” The more pregnancies a woman has experienced, the higher her risk—a finding consistent with the same mechanism.
The same process can occur temporarily or persistently in the days before menstruation, while taking oral contraceptives, or during hormone replacement therapy (HRT) during menopause. The postmenopausal period is particularly interesting.
Even though estrogen levels decline during this stage, the incidence of varicose veins continues to rise.
As the elasticity that estrogen helped preserve in the vein walls fades, age-related wear and tear further expose the veins’ underlying vulnerability. In other words, from the perspective of the leg veins, both too much and too little hormone exposure can be unfavorable.
Genetics, of course, remains the single strongest individual risk factor. About 80% of patients have a family history of the condition.
But even when men and women share the same genetic predisposition, women are more likely to develop the condition because they pass through the hormonal changes described above repeatedly over the course of their lives.
Lifestyle Factors Add to the Risk
If hormones set the baseline at a disadvantage, lifestyle can accelerate the process.
High heels, which physically impede circulation in the legs; tight clothing such as skinny jeans and leggings; the habit of sitting with the legs crossed; and jobs that require prolonged standing, such as retail and service work, are all factors that tend to affect women more often.
That is why fashion and lifestyle habits are often cited as reasons for the rising number of women in their 20s with varicose veins. Hormones are not something we can control, but these are factors that can be changed immediately with a conscious effort.
The Warning Signs Your Body May Be Sending
Early symptoms are easy to overlook precisely because they are so nonspecific. The legs may feel unusually heavy and tired after prolonged standing or in hot weather.
The ankles or calves may swell by evening. Calf cramps may strike repeatedly during the night. The legs may feel numb or hot.
Unexplained itching may also occur. That is often the extent of the early symptoms. Veins that bulge beneath the skin like snakes typically appear only after the condition has progressed to some degree.
Left untreated, the situation can become more serious. The condition may lead to brown or dark-red skin discoloration, hardening of the skin, nonhealing ulcers, or thrombophlebitis. The most dangerous possibility is deep vein thrombosis.
If a blood clot in a leg vein breaks loose and travels to the lungs, it can cause a pulmonary embolism, which is a medical emergency. If one leg suddenly becomes severely swollen and painful, seek medical attention immediately.
Self-assessment is for reference only and cannot replace a medical diagnosis. Still, if three or four of the following signs apply, it is worth scheduling an appointment with a vascular surgeon. Twisted veins are visible on the calf or thigh when standing.
The legs swell by evening and sock marks become unusually deep. After standing for a long time, the legs feel sore and heavy. Nighttime calf cramps recur. The skin on the legs itches or seems to be gradually changing color.
How Is It Diagnosed?
The first step is a visual examination of the shape and distribution of the veins while the patient is standing. This can provide a fairly good initial assessment, but a Doppler ultrasound is needed to determine which valves are allowing blood to flow backward and how severe the problem is.
The test is brief and painless, and it provides the key information needed to determine the appropriate treatment.
What You Can Do—From Symptom Relief to Definitive Treatment
For mild cases, a procedure may not be necessary. The key is to put on compression stockings—typically products providing 20 to 30 mmHg of pressure—in the morning before the legs begin to swell, ideally before getting out of bed. Putting them on after swelling has already developed makes them less effective.
Raising the legs about 10 to 15 centimeters above heart level while sleeping, avoiding prolonged sitting or standing, and walking or moving the calves periodically can noticeably ease symptoms. Medications that support venous circulation may also be used as an adjunct.
When symptoms are pronounced or the veins are a significant cosmetic concern, more active treatment may be considered. There are four main approaches. Sclerotherapy involves injecting a sclerosant into the affected vein to close it off. It can be completed quickly as an outpatient procedure without anesthesia or hospitalization, but the risk of recurrence is relatively higher, and compression stockings must be worn consistently for two to three weeks afterward.
Radiofrequency ablation and endovenous laser treatment involve inserting a thin catheter into the vein and using heat to close it. Because the skin incisions are minimal, scarring is rare and recovery is quick, although recurrence rates are reported to be slightly higher than with surgery.
Finally, vein stripping is a traditional surgical procedure that removes the affected vein altogether. It has the lowest recurrence rate, but requires spinal anesthesia, an overnight hospital stay, and acceptance of incision scars. The right option depends on the vein’s size and location, the severity of symptoms, the patient’s age and occupation, and cosmetic priorities. It should be chosen in consultation with a vascular surgeon after reviewing the ultrasound findings.
What You Can Do Starting Today to Help Prevent It
Varicose veins cannot be prevented completely, but it is possible to delay their onset and slow their progression.
Avoid standing or sitting in the same position for long periods, do not cross your legs, walk or move your calves regularly to activate the muscle pump, avoid wearing tight clothing and high-heeled shoes every day, maintain a healthy weight, and raise your legs slightly while sleeping.
If your job requires prolonged standing, wearing compression stockings as a preventive measure may help. If you are planning a pregnancy or are already pregnant, consult your obstetrician about when to begin wearing them.
Frequently Asked Questions (FAQ)
Why are women much more likely than men to develop varicose veins?
Estrogen relaxes the connective tissue in the vein walls, making them more prone to stretching, while progesterone dilates the blood vessels.
Women experience the effects of these two hormones repeatedly throughout their lives through menstruation, pregnancy, and menopause. As a result, they are far more likely than men with the same genetic predisposition to go on to develop the condition. Seoul Asan Medical Center data likewise shows that prevalence among women is two to eight times higher than among men across all age groups.
Does pregnancy always cause varicose veins?
No, but it does significantly increase the risk. The expanding uterus presses on the pelvic veins, progesterone levels rise sharply, and blood volume increases—all three factors occur at once.
Many cases are reported to develop from the third month of pregnancy onward. The risk is higher in people with a genetic predisposition, so it is advisable to discuss compression stockings with your obstetrician during pregnancy.
Do I need to wear compression stockings all day?
The most important thing is to put them on immediately after waking, before the legs begin to swell. Wearing them after swelling has already developed makes them much less effective. They can generally be worn until bedtime and removed while sleeping. The appropriate pressure level, measured in mmHg, depends on the severity of the symptoms, so it is best to consult a medical professional when choosing your first pair.
What happens if varicose veins are left untreated?
At first, the legs may simply feel heavy and swollen. Over time, however, untreated varicose veins can lead to skin discoloration, hardening of the skin, nonhealing ulcers, or thrombophlebitis.
In rare cases, a clot can travel to the lungs and cause a pulmonary embolism. If one leg suddenly becomes severely swollen and painful, treat it as an emergency and seek medical attention immediately.
Which is better: laser or radiofrequency treatment, or surgery?
No single method is universally superior. Vein stripping has the lowest recurrence rate, but requires hospitalization and leaves scars. Laser and radiofrequency treatments leave little to no scarring and offer faster recovery, but their recurrence rates are reported to be slightly higher than those of surgery.
The best option depends on the size and location of the veins, the severity of symptoms, and the patient’s circumstances. The decision should be made with a vascular surgeon after reviewing the ultrasound results.
Can varicose veins be cured, or do they come back?
The treated vein itself may be closed off or removed, but the underlying predisposition to varicose veins—including genetic and hormonal factors—does not disappear. New varicose veins may therefore develop in other areas. Continuing preventive measures such as wearing compression stockings and maintaining healthy habits after treatment is important for delaying recurrence.
This article summarizes general medical information and is not a substitute for a diagnosis of your symptoms or a treatment plan. For an accurate diagnosis and appropriate treatment, consult a vascular surgeon directly.
