What effect do hormones have on varicose veins?

Let's pay attention to established statistical data

The prevalence of diseases of the veins of the lower extremities among women is on average 5 times higher than among men; the annual increase of the disease is 2.6% in women and 1.9% in men; the prevalence of CVI signs in pregnant women is up to 70%; 50% of women during their first pregnancy have certain signs of impaired venous outflow from the legs. The probability of developing CVI increases by 4.5 times in the presence of venous pathology in the mother, by 3.5 times with long-term hormonal therapy, by 40% with repeated pregnancy and by 2.6 times after three pregnancies.

When the venous wall is weak, usually congenital, and the function of the valve apparatus is impaired, there is a pathological discharge of blood from the deep veins into the superficial ones, which is the main cause of varicose veins. The peculiarities of the structure of the subcutaneous tissue of the limb are of great importance in the defeat of the subcutaneous veins. In women with well-developed, loose subcutaneous tissue, subcutaneous veins are often thin-walled and tortuous. Irregular nodular expansion of fine veins occurs as a result of their compression by connective tissue bridges, which dismember the subcutaneous base into lobules. They note the possibility of inheriting the specified structure of the subcutaneous tissue, primarily from the mother and much less often from the father. Women have a genetic predisposition to the development of varicose veins, the disease is observed in them 4-5 times more often than in men. Obviously, they are carriers of the "pathological gene", and the disease will definitely manifest itself in one or another generation. This gene is recessive, female-linked, and its effects can be felt through several generations. The main pathological effect of this gene is manifested in a congenital defect in the structure of the venous wall, in particular its collagen elastic layer (the ratio of collagen and elastic fibers). Such a defect is also manifested in the structure of the entire connective tissue of the body, since collagen forms the basis - the "framework" of connective tissue, and this can further manifest itself in the development of such diseases as rheumatism, osteochondrosis, arthritis and arthrosis, vasculitis. People with varicose veins often have concomitant diseases that have the same origin: hernias, hemorrhoids, flat feet. It is also necessary to note certain features of the anatomical structure of the legs in women, less muscle mass and more fat tissue, features of the structure of the fascial sheaths of the leg, which directly affects the functional load of leg veins, their resistance to various overloads. Not the last role is played by regular fluctuations of the hormonal background.

Despite the lack of fundamental differences, veins in the male and female body are in different conditions. Hormonal secretion and its physiological changes (related to pregnancy, menstrual cycle) explain why women between the ages of 20 and 35 suffer from varicose veins 6 times more often than men. This is confirmed by the fact that in 1% of women with first-time varicose veins during pregnancy, the disease was preceded by various disorders of the menstrual cycle. The appearance of subcutaneous veins is explained by the insufficient content of estrogens in the body and the predominance of hormones of the corpus luteum, which have a relaxing effect on the vein wall. The role of hormones is indicated by the fact that before menstruation, women with varicose veins complain of pain in the legs and a feeling of heaviness, which significantly decrease after the end of menstruation. A burning sensation of the skin is sometimes noted by women who have vascular "stars" on their legs.

Estrogen and progesterone receptors are found in the venous walls of the reproductive organs - the uterus and mammary glands. However, manifestations of the interaction between veins and hormones go far beyond the direct effect on the hormonal receptors of the veins:

• Certain substances that are released under the influence of sex hormones can act on the venous wall;
• Steroid hormones can disrupt the balance in the blood clotting system.

Another factor related to the high frequency of hormone therapy (in the form of contraceptives or hormone replacement therapy) also reflects new data on the effect of sex hormones on the wall of the legs.

The risk of developing superficial and deep venous reflux (backflow of blood) is significantly increased in women who take hormonal contraceptives;

Replacement therapy during menopause reduces the risk of developing venous disorders, has a positive effect on skin and bone metabolism, and also significantly reduces the risk of thrombotic complications.

Recently, gynecologists very often refer patients who take oral contraceptives and who have signs of venous insufficiency of the legs to a consultation with a phlebologist, when they cannot adequately assess the severity and danger of venous pathology. From the point of view of a phlebologist, the selection of a contraceptive method should be considered, the specialist should be guided by the principle of "risk-benefit", and the decision should be made collegially. From the large number of available drugs for hormonal contraception, it is necessary to choose those that are safer for blood vessels.

The main effects of hormones on veins

	ESTROGENS	PROGESTERONE
Direct effect on receptors	-vasodilation -thickening of the venous wall due to the thickening of all layers due to the deposition of immune complexes	- venous stasis as a result of the relaxing effect on the smooth muscle fibers of the venous wall
Indirect effects	-regulation of glycemia (reduction of glucose tolerance) -regulation of lipids (increased synthesis of lipoproteins in the liver) -change in the ratio of blood coagulation factors -increase in the amount of fibrinogen -hyperaggregation of platelets	-an increase in the synthesis of proteins of the blood coagulation system in the liver -change in fibrinolysis processes

As for the signs and manifestations of venous insufficiency, in the presence of only certain complaints and grievances, combined oral contraceptives (COC) can be combined with a course of phlebotropic drugs. When there is a change in skin vessels (asterisks, retina) without signs of damage to superficial veins, which is confirmed by ultrasound, it will be necessary to warn the patient about the negative and direct effect of the hormones being taken on the vessels and the possible progression of the changes, but this will only be a probability. Considering the fact that such changes in blood vessels have the character of a cosmetic defect, the decision on whether to take COCs lies with the gynecologist and the patient herself. If a course of sclerotherapy has been completed, it will be mandatory to recommend adherence to a permanent, seasonal regimen of compression therapy, without correlation with hormonal therapy.

If the patient has varicose veins, then this situation is twofold. First, according to the latest research evidence, varicose veins are not a contraindication to taking COCs for various purposes. However, this fact does not negate the pronounced negative effect of hormones on veins, that is, they can stimulate the progression of the disease. Secondly, the presence of varicose veins is an indication for surgical treatment, with or without the use of COCs. Therefore, in such a situation, it is necessary to solve the primary problem - to treat varicose veins, and then you can safely take COCs. The risk assessment of COC use must necessarily include a comprehensive assessment of risk factors for the development of venous or thrombotic complications, which include age, overweight, smoking, hereditary predisposition, previous diseases, multiple (3 or more) or frequent pregnancies, gynecological status, peculiarities mode of life and work. With any surgical treatment, there is a need to stop, at least temporarily, taking hormonal drugs. In addition, it is important to take into account the age of the patient, the presence of concomitant indications for taking hormonal drugs, for example, the need for hormone replacement therapy (HRT) in the pre- and postmenopausal period, as well as the obstetric history (number of pregnancies and deliveries) and the woman's future plans for offspring.

The most serious of complications when taking contraceptives can be vascular complications in the form of thrombosis, and their formation is dose-dependent. The more estrogens the drug contains, the higher the risk of thrombosis. When taking some contraceptives, smoking is prohibited, it causes the risk of strokes and heart attacks, so it is necessary to select drugs taking into account the bad habits of a woman. A woman who is younger than 35 years old and smokes can use combined oral contraceptives. If a woman is 35 years old or older and smokes < 15 cigarettes a day, these drugs are usually not recommended for her if there are other contraceptive methods available and acceptable to her. If a woman is over 35, smokes more than 15 cigarettes a day, she should not use combined oral contraceptives, as this is dangerous to her health, mainly due to the risk of myocardial infarction and stroke.

And still, methods and modes of contraception in the presence of varicose veins should be evaluated by a gynecologist, taking into account the recommendations of a phlebologist. In such a situation, it is absolutely necessary to pass tests for sex hormones with the determination of the hormonal background, which will allow rational selection of the drug. Regular detailed examinations by a gynecologist and a thorough examination once a year will also be necessary, as well as dynamic observations by a phlebologist with control of the ultrasound picture. Preference should be given to low-dose or microdose multiphasic COCs, such as third-generation progesterones.

Medications of the new generation not only protect a woman from unplanned pregnancy, but also have a beneficial effect on the body as a whole: they cause few adverse reactions, do not disrupt lipid metabolism, do not affect body weight, do not prevent fluid retention in the body, do not increase the risk the development of cardiovascular diseases, provide adequate control of the menstrual cycle, and therefore the lowest frequency of menstrual function disorders, eliminate premenstrual symptoms and pain in the days menstruation, have a positive effect on the condition of the skin, hair growth, mood and general health of a woman.

Based on the above, it is possible to single out the following types of hormonal contraception, which are preferred for varicose veins:

1. Mini-pills are drugs that contain minidoses of hormones. It is mandatory to take it daily in a constant mode.
2. Subcutaneous implants are silicone capsules that contain hormones - progestogens. They are sewn through a small incision in the forearm. The effect lasts for 5 years.
3. Hormonal ring – for vaginal use, which contains microscopic doses of hormones. Entered once a month.
4. Injectable drugs are long-acting progestagens. The effect lasts for 3 months. Injections must be repeated every 8-12 weeks.

The use of oral contraceptives in the absence of varicose veins cannot be regarded as a risk factor for its development. Female sex hormones in themselves are not the cause of the disease. These drugs can contribute to the progression of the disease that already exists and the development of complications, and will also significantly reduce the effectiveness of the treatment that is carried out, since they act in the opposite direction to venotonics and blood thinners. Therefore, every woman should decide on the use of this method of contraception herself after consulting a specialist and determining the presence of risk factors.

If there is a hereditary predisposition, as well as other risk factors for varicose veins (for example, standing or sitting work), then it is better to refrain from taking oral hormones, especially if there is an alternative, and in cases with methods of contraception it is always available.

In the case of varicose veins, which are already present, the decision to prescribe hormonal drugs is made by the doctor. Self-prescribing oral contraceptives in such a case is strictly contraindicated, because the probability of blood clot formation in the vessels of the lower extremities or hemorrhoidal veins increases sharply.

Thus, birth control pills for varicose veins should not be used to prevent unwanted pregnancy, hormones can be used only in the treatment of gynecological pathology, if the potential threat from them exceeds the existing risks. With pronounced varicose veins, hormone treatment is usually not prescribed at all, and if it is necessary, then only "under the guise" of antiplatelet agents and anticoagulants.

Contraception is prescribed taking into account many external and internal factors, selection is primarily based on age. Undoubtedly, the selection of drugs for contraception remains the prerogative of gynecologists.

Medications for teenagers (up to 19 years old)

For teenage girls, the main ones to use are combined oral drugs that contain minimal doses of estrogens and progesterone, the so-called third-generation drugs. The best for teenage girls are "Trikvalar", "Triziston", "Tri-regol". In addition, single-phase drugs such as "Marvelon", "Sylest", "Femoden" or "Mersylon" can be used. They can perfectly regulate the course of menstruation and even out an unstable cycle.

Medications for young women

Preparations for women in the most active reproductive period from 19 to 33-35 years old can be used in a fairly wide range - they can be used with almost all known contraceptives. In addition to oral contraceptives, women of this age can use intrauterine spirals, condoms, and injectable contraceptives. In addition, it has been proven that contraceptives are usually used not only for their main effect (prevention of unplanned pregnancy), but also for the treatment of diseases such as secondary infertility, oncological pathology, inflammatory processes in the reproductive system, and they also help to balance the menstrual cycle .

Preparations with microdoses of hormones are most recommended for young women to prevent unwanted pregnancy: "Yarina", "Zhanin", or "Regulon".

Medications after 35 years

Which of the drugs are most recommended for women over 35? Most often, doctors say that women of this age should protect themselves from unwanted pregnancy with the help of intrauterine means, because there are already a large number of acquired diseases in which hormonal drugs may be contraindicated. The issue of oral contraception in case of pathologies of the cervix, endometriosis, endocrine pathology - excess weight, hyperthyroidism is very difficult. diabetes. In addition, many women smoke, which also complicates the selection of drugs. Medicines can be prescribed only in the guaranteed absence of what is at least the smallest contraindication.

At this age, preference is given to combined oral contraception of the third generation and three-phase drugs - "Tri-regol", "Femoden", "Triziston", "Triquilar", "Sylest", "Marvelon". This group of patients is also suitable for drugs with a low content of hormones, "mini-pill" drugs. Hormonal contraception is combined with the parallel therapeutic effect of modern oral contraceptives. Thus, the drug "Femulen" can be used for thrombophlebitis, previously suffered strokes and heart attacks, hypertension, migraine-like headaches and many gynecological diseases.

Medications for women after 45 years

After 45 years, many women have a second round of sexuality - then the question of pregnancy is no less acute than at a young age. Although at this age the functions of one's own ovaries gradually begin to fade, the probability of an unwanted pregnancy decreases sharply, but it is still quite possible. Many women still successfully ovulate and can get pregnant, carry and give birth, but not many dare to do so. Pregnancy at this age is associated with many health difficulties, there may already be a large enough complex of chronic pathologies in the form of diseases of the heart or blood vessels, problems with the kidneys or liver, problems in the work of reproductive organs. The same diseases can cause contraindications not only for pregnancy, but also for taking oral contraceptives. In addition, a woman's smoking or other bad habits can become an obstacle to prescribing drugs at this age. Usually, women after the age of 40-45 do not plan pregnancy and terminate it, which has an extremely negative impact on their health. Medical abortions at this age can have extremely negative consequences for a woman's health. There can be such complications as uterine fibroids, the development of oncological diseases, a difficult course of pre-climax and climax. The probability of the development of such diseases makes the issue of contraception quite acute. Contraceptives are prescribed to women not only to prevent pregnancy, but also to prevent and treat osteoporosis, uterine and ovarian cancer.

In the period after 45 years, it is considered especially correct to prescribe such drugs as low-dose oral tablets, mini-pill drugs, implants and injectable forms of hormones that act for a long time. Combined oral contraceptives are prohibited for women over 45 years of age, smokers, heart and blood vessel diseases (for example, thrombosis, heart attacks), strokes, diabetes, liver problems, and severe obesity.

We wish you good health. If you have any questions, do not hesitate to contact our specialists for advice, and they will professionally help you solve your problems.

To receive information about treatment and make an appointment, call the contact center of MM "Dobrobut"

Appointment with a phlebologist
Varicose veins during pregnancy