Varicose veins during pregnancy are mostly managed with conservative measures like compression stockings, leg elevation, and regular movement. Medical procedures such as sclerotherapy are generally avoided until after delivery, since most pregnancy-related varicose veins fade on their own within about 12 weeks of giving birth.
Why Pregnancy Causes Varicose Veins
Three things happen simultaneously during pregnancy that put your leg veins under strain. First, your blood volume increases significantly, putting veins under higher pressure than usual. Second, rising progesterone levels relax the muscular walls of your blood vessels, making it harder for veins to push blood upward against gravity. Third, your growing uterus presses directly on the pelvic veins and the inferior vena cava, the large vein that returns blood from your lower body to your heart. This combination slows blood flow in the legs and can cause vein walls to stretch and valves to fail, letting blood pool and creating those visible, bulging veins.
There are also hormone receptors on the veins in your legs that may directly trigger dilation and valve problems during pregnancy. This helps explain why varicose veins can appear as early as the first trimester, before the uterus is large enough to cause mechanical pressure on its own.
Compression Stockings: The Most Effective Option
Graduated compression stockings are the first-line treatment for varicose veins during pregnancy. They work by applying the most pressure at the ankle and gradually less as they go up, helping push blood back toward the heart. Two compression levels are commonly used:
- 15 to 20 mmHg: Suitable for mild swelling, leg fatigue, and preventing varicose veins from worsening. This is the most common choice for pregnant women and is available over the counter.
- 20 to 30 mmHg: Better for moderate swelling, existing varicose veins, or blood clot prevention. This is medical-grade compression and is often prescribed by a provider.
Put them on first thing in the morning before getting out of bed, when swelling is at its lowest. You don’t need to sleep in them. Proper sizing matters: stockings that are too tight can restrict circulation, and ones that are too loose won’t do much. If you notice numbness, tingling, skin irritation, or increased pain while wearing them, take them off.
You can start wearing compression stockings as early as the first trimester, and continuing for four to six weeks after delivery is a good idea since the risk of blood clots stays elevated in the postpartum period.
Movement and Positioning
Your calf muscles act as a pump for your veins, squeezing blood upward with each step. Walking is the simplest way to keep this pump working. Even short walks throughout the day are more helpful than one long session followed by hours of sitting. Swimming and prenatal yoga also promote circulation without putting stress on your joints.
When you’re sitting or lying down, elevate your legs above the level of your heart when possible. This lets gravity do the work your veins are struggling with. If you have a desk job, take breaks every 30 to 60 minutes to stand up and walk around, and try flexing your feet up and down (ankle pumps) while seated to keep blood moving. Avoid crossing your legs, which adds extra pressure on your veins.
Sleeping on your left side takes pressure off the inferior vena cava, which runs along the right side of your spine. This improves blood return from your legs and pelvis. A pillow between your knees or under your calves can make this position more comfortable.
Vulvar Varicosities
Varicose veins don’t only appear on the legs. Some women develop them on the vulva, which can cause a heavy, aching sensation and visible swelling. According to the Mayo Clinic, the main strategies for relief include wearing a support garment specifically designed for vulvar varicosities (your provider can help you find one), changing positions frequently, elevating your legs, and applying cold compresses to the area. These veins almost always resolve after delivery.
Procedures Are Usually Postponed
Sclerotherapy, the most common procedure for treating varicose veins outside of pregnancy, involves injecting a solution that closes off the vein. Pregnancy is listed as a contraindication for this procedure. While case reports of accidental sclerotherapy during undetected pregnancies have not shown increased risk to the mother or baby, the procedure is avoided because there’s limited safety data and a high likelihood the veins will shrink on their own after delivery.
The same applies to laser treatments and other vein procedures. The general approach is to use conservative measures during pregnancy and reassess several months postpartum. In rare cases, such as painful genital varicosities that don’t respond to other measures, a provider may consider sclerotherapy during pregnancy on a case-by-case basis.
What to Expect After Delivery
Varicose veins that developed during pregnancy typically fade or disappear within about 12 weeks of giving birth, as blood volume drops and hormone levels normalize. Most women see significant improvement well before their baby’s first birthday.
That said, some factors make it less likely your veins will fully resolve: having varicose veins before pregnancy, multiple pregnancies, a family history of varicose veins, carrying extra weight, or spending long hours on your feet. If your veins haven’t improved by three to six months postpartum, that’s a reasonable time to discuss treatment options like sclerotherapy or other procedures with a vein specialist.
When Varicose Veins Signal Something Serious
Ordinary varicose veins are uncomfortable but not dangerous. Deep vein thrombosis (a blood clot in a deep vein) is a separate and more serious condition, and pregnancy increases your risk for it. The warning signs to watch for are pain, swelling, and tenderness in one leg, particularly in the calf. The skin may feel warm and look red, especially at the back of the leg below the knee. The pain often gets worse when you walk.
Swelling and discomfort in your legs are common during pregnancy and don’t automatically signal a problem. The key distinction is that DVT symptoms are usually one-sided and involve warmth, redness, or a heavy ache that feels different from typical pregnancy leg fatigue. If you notice these signs, contact your midwife or provider right away.