High endogenous estradiol is associated with increased venous distensibility and clinical evidence of varicose veins in menopausal women

Objective: The purpose of this study was to determine if there is an associ ation between elevated sex hormones (ie, serum estradiol, sex hormone bindi ng globulin [SHBG], testosterone) and increased venous distension and clini cal evidence of varicose veins in menopausal women. Methods: Participants were 104 healthy volunteer menopausal women, aged 48 to 65 years, who were not undergoing hormonal treatment. Of these 104, 14 w ere excluded from analyses because their estradiol levels were compatible w ith a premenopausal condition (4), because they had missing values for insu lin concentration (5), and because they did not show up at venous vessel ex amination (5). Patients underwent a physical examination to determine the p resence of varicose veins; a venous strain-gauge plethysmographic examinati on to compute instrumental measures of venous distensibility; and laborator y analyses of blood so serum testosterone, estradiol, SHBG, glucose, and in sulin could be measured. There were also prevalence ratios and odds ratios used to test the presence of an association between biochemical and instrum ental variables. Results: Serum levels of estradiol in the upper tertile of the frequency di stribution were significantly associated with clinical evidence of varicose veins (prevalence odds ratios 3.6; 95% CI 1.1-11.6) and with increased low er limb venous distensibility (prevalence odds ratios 4.4; 95% CI 1.2-15.5) . No association was found for SHBG and testosterone. Conclusions: Our finding that high serum levels of estradiol are associated with clinical evidence of varicose veins and instrumental measurements ind icating increased venous distensibility in menopausal women suggests that e ndogenous estrogens may play a role in the development of this very common venous vessel abnormalities.