She was off to get her veins stripped. “I’m doing weight-training and my legs always feel heavy and sore afterwards for a few days. They also ache and get restless at night,” she mentioned to me.
I knew she loved her exercise and had done so for decades, so I raised my eyebrows and said, “I hope that you aren’t doing heavy power-lifting and holding your breath during the lift, as this can make your varicose veins worse.” Her reaction confirmed to me that she had no idea what I was talking about.
In exercise physiology this is known as the Valsalva Manoeuvre – holding your breath and straining as you try to move those very heavy weights through the movement. It doesn’t have to be weights either – some of you are in physical jobs whereby you are lifting heavy loads too. If you hold your breath as you do the movement however, there is greater pressure on your cardiovascular system and your intra-thoracic (chest) pressure, including your blood vessels.
This can cause blood-flow to the heart to decrease during the lifting movement. As such, blood pressure and strain on your ageing blood vessels occurs. But it’s not just this additional strain on exertion that is the problem, it’s the additional blood pressure changes that occur when the effort and exertion is completed.
Immediately following the exertion, your systolic blood pressure (the top figure) begins to fall. However, the average pressure in your arteries remains higher above baseline, due to the forces of breath-holding. If you have ever held your breath to lift a heavy object, put it down and felt faint and dizzy, then that’s the effect of the Valsalva Manoeuvre.
Whether you are an experienced power-lifter as Dr Catherine Walter is in the image below, or you lift heavy loads during your normal working day, then hopefully you are getting your blood pressure checked regularly – especially if you already have varicose veins.
For women with existing vascular or blood vessel inflammation and varicosities, or for women who have naturally high oestrogen levels and are overweight or obese, then frequent heavy power-lifting may actually increase your blood pressure. This puts women at more risk of having higher blood pressure with age (Nascimento, da Silva et al, 2018) … or needing your varicose veins seen to by a vascular surgeon.
The Connection between Oestrogen Levels and Varicose Veins:
One of the most frequent problems affecting women as they age is their aching lower legs and changes to the venous system (veins) in the lower limbs. If you’ve been kicking your feet out of the bedding at night and you’ve had hot feet or you find that your legs are aching for longer after exercise, then you will know what I’m talking about. During menopause, it’s known as ‘restless leg syndrome.’
That’s why I was pleased to find that researchers in Italy (Ciardullo, Panico, Bellati et al, 2000) have found a curious connection between higher oestrogen levels in menopausal and post-menopausal women and the incidence of varicose veins.
While this sounds confusing because we lose oestrogen as we move through menopause, if you are someone who is oestrogen dominant (and puts on body-fat easily), then you may have higher oestrogen levels, even during menopause.
Fat cells love to store excess oestrogen (which we also absorb from certains food, plastics, medications and environmental chemicals), so with these excess storage levels, some of you who are struggling with weight gain, may indeed have higher levels of oestrogen stored in your body – even in post-menopause.
Varicose veins are veins that are inflamed and have valves that don’t close properly.
Hence, fluid shifts in and out of tissues can become disrupted, causing some blood to pool in the veins. They can become engorged and unsightly. I didn’t know that oestrogens were involved in this process, until the article arrived in my in-box.
I’m now a lot more cautious about weight training, excess oestrogens (read more HERE) and looking after my blood pressure, now that I better understand the effect of excess circulating oestrogens on the veins.
“Our findings that high serum levels of estradiol (also spelled oestradiol) are associated with clinical evidence of varicose veins and measurements suggest that increased venous distension in menopausal women suggest that endogenous oestrogens may play a role in the development of these very common venous vessel abnormalities.” (Ciardullo et al, 2000).
Oestradiol is an oestrogen steroid hormone and as we all know, it is the major female steroid hormone that is involved in the regulation of our hormonal cycle.
In menopause, the amount of oestradiol declines, but unbeknownst to many women, it is always present, even in post-menopause. And some women produce more oestradiol naturally than others. It’s genetic.
Reduce the Effect of Varicose Veins:
(1) Change your diet. Don’t get fooled by diets that aren’t designed with our ageing blood vessels in mind. All of the women who come into the MyMT™ programmes learn how important it is to follow a Mediterranean influenced, anti-inflammatory diet which is evidenced for helping our heart health – and yes, grains are important too.
2) Add beetroot/beets to your diet. There is always a flurry of activity in my coaching groups when someone announces that they have added some beetroot juice to their diet. I recommend it to them all (unless they have low BP) and I especially mention it to women who are exercising or training daily and those with vascular problems. Beetroot (or Beet) has compounds (nitrates) which help blood vessels to dilate. Dietary inorganic nitrate from vegetables such as beetroot is absorbed rapidly and completely in the small intestine with 100% bioavailability.
So many women get put on anti-hypertensives in mid-life, but I wonder how many know to have their beetroot as well? But it’s not just beetroot that’s important – there are other vegies too. The vegetables with the highest nitrate contents (>250 mg/ 100 g fresh weight) are celery, cress, chervil, lettuce, red beetroot, spinach and rocket. Add these to your diet as well.
(3) Be cautious about heavy resistance training if you have varicose veins. I’ve noticed in the fitness industry here in New Zealand, that there is a move to encouraging women in menopause to do heavy resistance weights. This includes adding more and more weight to the barbell in BodyPump classes.
However, studies from the prestigious Cooper Aerobic Institute in America, report that the more muscle mass used during a resistance training exercise, the greater the blood pressure response. Hence, performing exercises like leg press, leg extensions or chest press using both legs or arms together will increase blood pressure more than single leg/arm exercises.
If you’re a middle aged woman and haven’t had your Blood Pressure checked and you are starting an exercise programme, then be aware that the more weight you lift, the greater the blood pressure response. Avoid maximal or near maximal lifts if you can.
An initial resistance of 30-40% of 1 RM which is the total amount of weight you can lift in one movement) for upper body and 50-60% of 1 RM for lower body exercises is an appropriate place to start.
As women go into their menopause transition, their risk for not exercising is as high as it’s ever been. This is because there hasn’t been a lot of understanding about how to look after ourselves during this life stage. Staying active is a fundamental part of our healthy ageing and with the right information, women can remain active as they age and this includes doing the right exercise to support our ageing blood vessels too.
The decline in oestrogen over our menopause transition, causes constriction of our blood vessels and this further increases the risk of high blood pressure and worsening varicose veins. This also limits the flow of oxygen-rich blood to your organs and other parts of your body.
If your blood pressure has increased now that you are in your menopause or post-menopause years then yes, losing weight helps, as does changing your diet and of course, watching the type of exercise that you do, and turning around your sleep and stress levels. If we get this right during our menopause transition, then it will help to set us up to be able to enjoy a healthier future. I so want you to be able to achieve this.
P.S. If you haven’t listened to my Masterclass on Menopause yet, then have a listen to the video below when you can, as I explain what’s in it.
Ciardullo, A., Panico, S., Bellati, C. et al. (2000). High endogenous estradiol is associated with increased venous distensibility and clinical evidence of varicose veins in menopausal women, Journal of Vascular Surgery, 32(3), 544-549.
Jani B, Rajkumar C. (2006). Ageing and vascular ageing. Postgrad Med J. 82(968):357-62. doi: 10.1136/pgmj.2005.036053.
Nascimento, D., da Silva, C. R., Valduga, R., Saraiva, B., de Sousa Neto, I. V., Vieira, A., Funghetto, S. S., Silva, A. O., Oliveira, S., Pereira, G. B., Willardson, J. M., & Prestes, J. (2018). Blood pressure response to resistance training in hypertensive and normotensive older women. Clinical interventions in aging, 13, 541–553.
Porth C., Bamrah V., Tristani F., Smith J. (1984). The Valsalva Maneuver: Mechanisms and clinical implications. Heart Lung. Sep;13(5):507-18.