Lyme Disease Support Group

By Crystal Phend, Senior Staff Writer, MedPage Today

Published: March 29, 2011

Reviewed by

Zalman S. Agus, MD; Emeritus Professor

University of Pennsylvania School of Medicine and

Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

CHICAGO -- Where a woman is in her menstrual cycle may affect varicose vein diagnosis, according to a small exploratory study.

Women complaining of classic symptoms of varicose veins but no abnormalities in the long saphenous vein presented a very different picture when they returned right before their menstrual period or when symptomatic, Praveen Anchala, MD, and Scott A. Resnick, MD, both of Northwestern University in Chicago, found.

In a study of five such women, four had significant saphenous vein insufficiency on subsequent evaluation, they reported here at the Society of Interventional Radiology meeting.

Action Points

■Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

■Note that in a small study, four women were identified with significant saphenous vein insufficiency occurring in the perimenstrual period after an initially "normal" venous classification.

Long saphenous vein diameter rose 73% on average between the evaluations.

"When evaluating menorrheal patients with history indicating likely insufficiency but no objective findings on initial evaluation, it may be beneficial to reevaluate these patients in the immediate premenstrual period," Anchala told attendees at the session.

John A. Kaufman, MD, of the Oregon Health & Science University Hospital in Portland, agreed.

"This is a very interesting observation in a small number of patients that could have significant consequences with respect to the diagnosis and management of venous reflux in menstruating women," he told MedPage Today in an email.

Another implication is that "stocking use during menstruation may eliminate symptoms and avoid treating a saphenous vein that is normal most of the time," said Kaufman, who was not involved in the study.

Progesterone, which peaks in the week or so prior to menstruation, may be to blame, Anchala noted.

The hormone has been shown to dilate veins throughout the body, possibly because of effects on nitric oxide, he explained.

Older studies have supported greater venous distensibility in women relative to their menstrual cycle, Kaufman added.

He cautioned that confirmation in a larger study is needed, pointing to potentially confounding factors that were missing in the data, such as parity and use of oral contraceptives and other medications.

Changes in venous distensibility throughout the day could also account for some of the between-evaluation differences, cautioned session moderator Patricia Thorpe, MD, of Arizona Heart Hospital in Phoenix, although she called the results interesting in concept.

Anchala agreed that the menstrual cycle may be just one variable to add to the multifactorial diagnosis.

He cautioned that an even bigger problem than confounding in the small study was likely recall bias.

All five of the women with repeat testing after an initially "normal" venous classification were asked to return because they said something that made the clinician think the menstrual cycle was involved.

For example, one case Anchala presented was of a 40-year-old woman with classic varicose vein symptoms but no reflux apparent on the initial sonographic examination. She had said that her symptoms come and go during the course of the month.

She was menstruating the week she visited the first time but said her symptoms were worse the week before.

The mean age of 36 among the four women whose return evaluations revealed saphenous vein insufficiency not apparent initially contrasted with that of the one patient, age 50, who still showed no reflux on return.

Anchala reported having no conflicts of interest to disclose.

Kaufman reported being a consultant for BIO2, Crux Medical, Delcath, EV3, W.L. Gore, Guerbet, Hatch Medical, and Teneo; board membership with BIO2, Hatch, Teneo, and Delcath; speaking and teaching for Gore and Cook; and being an independent contractor or contracting for research with the NIH and Gore.

Primary source: Society of Interventional Radiology

Source reference:

Anchala P, Resnick SA "Cyclical hormone-related changes in long saphenous venous insufficiency" SIR 2011; Abstract 36.

tom hennessy - Mar 29, 2011

One theory as to the genesis of the menses is to lower the iron levels for the safe gestation of an egg.

One theory is what we have accepted to be a normal hemoglobin is actually set too high.

The theory the hemoglobin found in those "anemic" vegetarians is normal whereas anything above that is abnormal / erythrocytosis.

Varicose veins exist in those with diagnosed erythrocytosis at a higher rate than normal and since iron excess is considered to be a 'subcategory of erythrocytosis' one might wonder whether it IS increased hemoglobin underlying the varicose veins ?

"Patients often seek care with symptoms related to peptic ulcer, varicose veins, gouty arthritis, and thrombotic episodes."

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