Varicose veins in pregnancy are common, uncomfortable and mostly temporary. They also occur in a place nobody warns about, and the silence around that causes more alarm than the veins themselves.
The short answer: increased blood volume, relaxed vein walls and uterine pressure on the pelvic veins raise venous pressure, and the valves in leg veins give way. They appear in the legs, the vulva and as haemorrhoids. Graduated compression stockings, put on before getting out of bed, elevation and movement are what help; standing or sitting still is what makes it worse. Most improve markedly after birth. Pain in one calf that is constant, with warmth, redness or swelling, is a clot — same-day call.
Why it happens
Veins in the legs move blood upward against gravity using one-way valves and the squeezing action of the calf muscles. Pregnancy attacks that system from three directions at once: total blood volume increases by roughly half, progesterone relaxes the muscular wall of the veins so they dilate, and the enlarging uterus presses on the inferior vena cava and the iliac veins, raising the pressure everywhere downstream.
Under sustained pressure the valves stop meeting properly, blood pools, and the vein distends visibly. The same mechanism produces vulval varicosities, where the veins draining the pelvis are affected directly, and haemorrhoids, which are the same process in the veins around the anus. Family history matters — the tendency is inherited — and it is more likely with each subsequent pregnancy.
What is normal
| Varicose veins | Possible clot — ring today | |
|---|---|---|
| Appearance | Blue or purple bulging veins, visible | Whole calf swollen, sometimes red or discoloured |
| Sensation | Aching heaviness, worse by evening | Constant pain, tender to touch, warm |
| Sides | Both legs, or one more than the other | One leg only, clearly different from the other |
| Elevation | Eases it | Makes no difference |
| Vein itself | Soft, compressible | Hard, hot, exquisitely tender along its length |
Call the same day if one calf is painful, swollen, warm, red or tender, or if a vein becomes hard, hot and very painful. Call emergency services if you also have sudden breathlessness, chest pain worse on breathing in, or you cough up blood.
Also ring if a varicose vein bleeds. Lie down, elevate the leg high and press firmly on the point until it stops — bleeding from a varicose vein can be brisk and stops readily with elevation and pressure.
What helps
🦵 In order of effect
- Graduated compression stockings, fitted properly, and put on before getting out of bed. This is the intervention with the best evidence, and the timing is the part people get wrong.
- Elevate your legs above hip level several times a day, and prop the foot of the bed at night if it is bad.
- Walk daily and move often. The calf muscle is the pump; standing still or sitting still both disable it.
- Lie on your left side, which takes the uterus off the vena cava.
- For vulval varicosities, ask about a support garment made for the purpose. They exist, they help, and asking is the hard part.
- Do not cross your legs for long periods, and avoid tight bands at the knee or groin.
- Defer treatment until after birth — several months after, so natural improvement has happened first.
Varicose veins in pregnancy — at a glance
Blood volume rises by around half, progesterone relaxes the muscular wall of the veins, and the uterus compresses the inferior vena cava and iliac veins — so pressure rises, the one-way valves in leg veins stop meeting, and blood pools. The same process produces vulval varicosities, which are common in pregnancy, rarely mentioned anywhere, and cause a great deal of unnecessary alarm; a purpose-made support garment exists and helps. It also produces haemorrhoids. Graduated compression stockings fitted to measurement and put on before getting out of bed are the most reliably effective measure, alongside elevation above hip level several times a day, daily walking, left-side lying and avoiding long periods standing or sitting still. Most improve substantially within months of birth and vulval ones usually resolve completely; treatment is generally deferred several months so that improvement can happen first. A varicose vein that bleeds is controlled by lying down, elevating and pressing. Constant pain in one calf with swelling, warmth or redness is a DVT and needs a same-day call.
Inside Baby Novum: the swelling tracker records by body zone and compares photos over time, which is how a difference between one leg and the other stops being a thing you squint at and becomes something you can show someone. Encrypted on the device, no account, no server copy.
Frequently Asked Questions
Why do varicose veins appear in pregnancy?
Three things together. Blood volume rises by around half. Progesterone relaxes the smooth muscle in vein walls so they distend more easily. And the uterus compresses the large pelvic veins, raising the pressure in everything draining into them. The valves inside leg veins that normally stop blood flowing backwards become incompetent under that pressure, and the vein bulges.
Can you get varicose veins in the vulva?
Yes — vulval varicosities are common in pregnancy and are barely mentioned anywhere, which leaves people who have them assuming something is badly wrong. They feel like heaviness, aching, swelling or visible bulging veins in the labia, worse on standing and late in the day. They almost always resolve after birth. A support garment designed for this exists and helps; ask your midwife rather than searching in silence.
Do compression stockings actually work?
Yes, and they are the intervention with the most reliable effect. They need to be graduated compression, fitted to your measurements rather than bought by shoe size, and put on before you get out of bed in the morning, when the legs are least swollen. Wearing them from mid-morning after a couple of hours on your feet is why some people conclude they do not work.
Will varicose veins go away after the birth?
They usually improve substantially within a few months as blood volume and pelvic pressure normalise, and vulval ones typically resolve completely. Leg veins may not disappear entirely, particularly after more than one pregnancy. Treatments exist and are generally deferred until at least several months after birth, so that improvement has had time to happen first.
How do I know it is not a blood clot?
A varicose vein is a visible bulging vein with an aching heaviness, in both legs or the more affected one, and it eases when you elevate. A DVT is pain in one calf that is constant, with swelling, warmth, redness or tenderness, and it does not ease with elevation. Pregnancy substantially raises clot risk, so that pattern is a same-day call. Sudden breathlessness or chest pain with it is an emergency.