Vulvar varicosities during pregnancy

By trimester

Weeks 1–13

1st trimester

Vulvar varicosities are uncommon this early and usually show up later as blood volume and uterine pressure build, so new swelling in the first trimester is worth a routine mention rather than alarm.

Weeks 14–27

2nd trimester

In the second trimester, as pelvic blood flow and uterine size increase, vulvar varicosities are more likely to appear or become noticeable, especially in a second or later pregnancy.

Weeks 28–birth

3rd trimester

By the third trimester, discomfort from vulvar varicosities is usually at its peak. Compression garments and side-lying rest can help, and it's worth discussing delivery planning with your provider if they're large.

What does the evidence show for vulvar varicose veins?

• Vulvar varicosities occur in about 4 percent of pregnancies, driven by pelvic venous congestion, compression of the inferior vena cava and iliac veins by the growing uterus, and hormone-related changes in vein-wall strength. 1
• Pregnancy hormones, especially estrogen, progesterone, and relaxin, are thought to weaken vein walls, and the ovarian vein's vascular capacity can rise as much as 60-fold during pregnancy, adding to the venous pooling behind these varicosities. 2
• Vulvar varicosities usually go down within about 30 to 40 days after delivery regardless of delivery method, and in one reviewed case series, most cesarean deliveries performed partly because of vulvar varicosities lacked a separate medical reason for the surgery. 3
• Risk factors include advancing maternal age, prolonged standing, a genetic predisposition, and the elevated hormone levels of pregnancy, and providers usually identify them through a physical exam, sometimes confirmed with an ultrasound. 4
• Management typically favors compression garments and, when planning delivery, avoiding operative vaginal techniques like forceps or vacuum extraction that could raise the risk of bleeding from these fragile veins. 1

When should I call my provider about vulvar varicose veins?

A vulvar varicosity that suddenly grows larger, becomes hard, hot, or red, or starts bleeding needs prompt medical attention rather than waiting it out. Significant pain, especially if it's new or one-sided, is also worth a same-day call to rule out a blood clot. Bring up any vulvar varicosities with your delivery team well before your due date so they can plan a delivery approach that lowers bleeding risk. Trust your read on your own body. If something feels off beyond the list above, please consult your healthcare provider rather than waiting it out.