Vulval Varicose Veins in Pregnancy: Why They Happen and How to Cope

Varicose veins of the vulva and pregnancy often go together. Many women are surprised and worried to find swollen, lumpy or bluish veins on the vulva, the outer skin and lips around the vagina, while they are expecting. They can feel heavy, achy or itchy, especially at the end of the day. The good news is that they are usually harmless and tend to settle after the baby is born. This guide explains why they happen, how to cope, what they mean for birth and when to get them checked.

What are vulval (vulvar) varicose veins?

They are widened, twisted veins on the vulva, similar to varicose veins in the legs. In pregnancy they often appear from around the middle of pregnancy and may get bigger as the weeks go on. They can be on one or both sides, and some women also have varicose veins in the legs, the upper inner thighs or the buttocks.

Varicose veins can also form inside the vagina, where they cannot be seen. These may cause a feeling of pressure or fullness.

Estimates of how common they are vary widely between studies, but they are a recognised and fairly common part of pregnancy, and they are more likely in second and later pregnancies.

Why do they appear in pregnancy?

Several changes in pregnancy put extra strain on the veins of the pelvis and vulva:

• More blood. Your blood volume rises considerably to supply the baby, so the veins carry much more blood than usual.
• Hormones. Higher levels of oestrogen and progesterone relax the walls of the veins, so they stretch more easily.
• Pressure from the womb. As the womb grows, it presses on the large veins in the pelvis, slowing the flow of blood back to the heart.
• Weak valves. The pelvic veins, including the ovarian veins, widen a lot in pregnancy. If their one-way valves stop working well, blood can flow backwards and pool in veins lower down, including those of the vulva.

A family history of varicose veins and having had several pregnancies also increase the chance.

What symptoms do they cause?

Some women have no symptoms at all. Others notice:

• Visible swollen, lumpy or bluish veins on the vulva
• A heavy, full or aching feeling in the vulva or pelvis
• Itching or soreness of the skin over the veins
• Discomfort that is worse after standing, walking or at the end of the day, and better when lying down
• Discomfort during sex

How to ease the discomfort

Treatment during pregnancy focuses on comfort. Procedures to close the veins are usually not done while you are pregnant. Things that can help include:

• Support garments. Maternity support underwear, support shorts or a pelvic support garment can press gently on the veins and ease the aching. Ask your midwife, doctor or a trained fitter which type suits you.
• Rest with your hips raised. Lying down with a pillow under your hips for a while helps blood drain out of the pelvic veins.
• Avoid standing still for long periods. Take regular breaks to sit or lie down, and avoid sitting in one position for hours.
• Keep moving. Walking and gentle exercise, such as swimming, help blood flow.
• Sleep on your side. Side-sleeping in later pregnancy takes pressure off the large veins.
• Cool compresses. A cool (not frozen) pack wrapped in a cloth may soothe soreness.
• Avoid straining. Treating constipation and avoiding heavy lifting reduces pressure in the pelvis.
• Loose, breathable clothing helps with itching and comfort.

Check with your doctor or pharmacist before taking any medicine or supplement in pregnancy. For more ideas, a Singapore vascular surgeon’s guide to varicose veins in pregnancy covers general vein care.

Can you prevent vulval varicose veins in pregnancy?

There is no proven way to prevent them completely, as hormones and blood volume changes are a normal part of pregnancy. Staying active, avoiding long spells of standing, wearing support garments if you are prone to varicose veins, and keeping to a healthy weight may reduce how troublesome they become.

What do they mean for labour and birth?

This is a common worry. Medical reviews generally agree that vulval varicose veins are not, on their own, a reason for a caesarean section, and most women with them have a vaginal birth. During birth, the baby’s head presses on the veins and they often shrink. Bleeding from a varicose vein during delivery is uncommon and can usually be controlled by the team.

In rare cases with very large veins, especially inside the vagina, your obstetrician may discuss a different plan. Make sure your midwife or obstetrician knows about the veins well before your due date so they can plan your care.

Warning signs to watch for

Vulval varicose veins are usually harmless, but tell your midwife or doctor promptly if you notice:

• A hard, hot, red and very tender lump in a vein. This can mean a clot has formed in the vein (superficial thrombophlebitis).
• Bleeding from a vein that does not stop with gentle, firm pressure.
• Sudden swelling or severe pain in the vulva.

Pregnancy and the weeks after birth also raise the risk of clots in the deep veins of the legs. Seek urgent help for a painful, swollen leg, chest pain or sudden breathlessness.

What happens after the baby is born?

For most women, the veins shrink noticeably in the first few weeks after birth, and many disappear within a few months as blood volume and hormone levels return to normal. Some take longer to settle.

In a minority, the veins do not go away, or they come back and get worse with each pregnancy. This can be a sign that the pelvic veins, especially the ovarian veins, are still refluxing. These women sometimes also have a dragging pelvic ache, pain after sex or varicose veins on the back of the thighs, which can point to pelvic congestion syndrome.

If your veins are still troublesome several months after birth, ask for an assessment. A duplex ultrasound can show whether the veins are fed by refluxing pelvic veins. Read more about vulvar varicose veins outside pregnancy, the treatment options for vulval varicose veins, and how pelvic congestion relates to pregnancy.

When to see a doctor

Mention vulval varicose veins to your midwife or doctor at your next antenatal visit, even if they do not bother you much, so they can be noted in your birth plan. See a doctor if the veins are very painful, are still present a few months after birth, or come with a pelvic ache that is worse after standing. Our pelvic symptom check can help you prepare.

Get urgent medical help for heavy bleeding, a painful swollen leg, chest pain, sudden breathlessness, or severe abdominal pain in pregnancy. In Singapore, call 995 in an emergency.

This article is general information, not personal medical advice. Please speak to a doctor about your own symptoms. How we create our content.