Chronic Venous Insufficiency in Women: Hormonal and Gender Differences

Abstract Chronic venous insufficiency (CVI) represents a significant global health burden with marked gender disparities in prevalence, presentation, and pathophysiology. This comprehensive review examines the multifaceted impact of hormonal and gender-specific factors on CVI development and progression in women. Epidemiological studies consistently demonstrate higher prevalence of superficial venous disease in women, with estimates reaching 73% compared with 56% in men. Hormonal influences—particularly estrogen and progesterone fluctuations during menstruation, pregnancy, and menopause—critically modulate venous structure and function through receptor-mediated pathways. Women exhibit distinct anatomical patterns with increased prevalence of anterior accessory saphenous vein reflux and ascending venous incompetence, contrasting with men's predominant great saphenous vein involvement and descending reflux mechanisms. Pregnancy represents a significant risk factor, with multiparous women showing an 82% increased likelihood of developing varicose veins. Beyond physiological factors, women report greater symptom burden and quality of life impairment, with aesthetic concerns affecting 58% of female patients compared with 39% of male patients. While early-stage CVI (C1–C3) remains more common in women, recent studies indicate that advanced CVI stages (C4–C6) show comparable prevalence between genders, with socioeconomic factors playing an increasingly significant role. Management approaches should acknowledge these gender-specific considerations, with early intervention potentially beneficial for women with hormone-related venous insufficiency. This review highlights the essential need for gender sensitive approaches to CVI diagnosis, prevention, and treatment, particularly focusing on women's unique venous physiology and hormonal influences.