Most people prone to spider veins start noticing the blue and purple webs on their legs in their late twenties. But I’m all sorts of lucky and started acquiring them when I was the tender age of thirteen because I needed more embarrassment while in the throes of puberty. Around sixty percent of the time, these smaller spider veins are due to chronic venous insufficiency (CVI) and eventually lead to the large, bulging cords known as varicose veins.
Having had spider veins from a really early age, I’ve spent a lot of time, money, and energy trying to fix them. I too would like to go to the beach and not feel self-conscious about the web of bloody tears sprawling across my otherwise decent gams. The medical community seems to have spent precious little time researching this “woman’s” problem (though doctors can prescribe a man an erection six ways from Sunday), and the road to clear legs is expensive and fraught with lifelong maintenance. But if you’re willing to put in the work, there are things you can do to make spider veins disappear and slow their inevitable return.
Spider veins are primarily caused by hereditary problems with blood flow and blood vessel integrity.
Don’t feel bad about your diet or lifestyle because you have spider veins—blame mom and dad! As far as we know, there are a lot of faulty veins running around in the human genetic pool. As blood moves upward through the body, it’s supposed to get through a valve and then the valve shuts. But in some people, the valve doesn’t close, so the blood falls back down and pools in the vein. This faulty mechanism is essentially venous insufficiency, which leads to spider veins and varicose veins.
Although some actions can make them worse if you’re already predisposed.
If you have genetically perfect veins, you’d be hard-pressed to give yourself spider or varicose veins in your younger years. But if you already inherited some faulty genes, there are factors that make these veins appear for the first time or make existing veins worse.
Obesity puts extra pressure on the veins as blood is trying to pump its way through the body. Excessive pressure can cause veins to burst, stretch out, or simply block blood flow which forces blood to pool below the blockage. Spider veins mainly occur on the legs, so abdominal fat is particularly problematic as it directly obstructs all the blood coming up from the legs.
Pregnancy’s fluctuating hormones can also initiate a spider vein cascade. Progesterone is increased during pregnancy to keep you pregnant, but it has a side effect of softening tissue around the veins. Veins then dilate and stretch out, sometimes too far, and are unable to snap back (like everything else in pregnancy) thus generating spider veins. Hormonal birth control high in progesterone can have identical effects.
Being sedentary can also weaken veins because there is no muscle movement in the legs. Leg muscles help propel blood back up to the heart, but when you’re sitting and lying down those muscles are inactive. If you work in a sedentary job, try to get up and walk around once every 15 minutes. Your coworkers may find you annoying, but your legs will thank you.
Topically applied ingredients may be more effective than oral supplements with the same ingredients.
There are many spider vein creams and gels out there, but do they really work? Certain vein-strengthening ingredients may work as well, or better, than ingesting those ingredients in a supplement. You can guarantee delivery of an ingredient to a certain spot of skin with a topical, which is something you can’t do with a supplement. But the only ingredients worth applying topically are vitamin K, horse chestnut, and butcher’s broom.
Horse chestnut: Properly extracted horse chestnut contains high amounts of aescin, which has been documented in various studies1 to help with venous insufficiency. Aescin causes veins to contract more frequently and with more force, thereby pushing blood upwards from the legs to the heart where it belongs. Aescin also decreases vein permeability. When veins are too permeable, water and other materials are able to pass through the walls of blood vessels. Excessively permeable vessels are a major contributor to venous insufficiency.
Robkastenein & Weinlaugb Gel uses horse chestnut and red vine leaves as active ingredients. While red vine leaves only appear in a few studies2, they contain vein-supporting bioflavonoids and were first used for chronic venous insufficiency by the ancient Roman doctor, Galen. Red vines are still a popular ingredient in Europe for spider veins.
Vitamin K: The protein MGP lowers vascular proliferation and mineralization. This is a good thing because we don’t want excessive creation of blood vessels, nor do we want excessive mineral deposits hardening the veins. Both proliferation and mineralization are rampant in varicose vein sufferers3. The body needs Vitamin K to active MGP and prevent venous insufficiency and varicose veins.
Reviva Labs Vitamin K Creme is one of the strongest on the market with a full 2% vitamin K. This cream is on the more affordable end and made by an established manufacturer.
Butcher’s Broom: Also known as ruscus aculeatus, this plant is primarily a circulation booster via its saponin and esculin ingredients. Butcher’s broom causes the blood vessels to constrict which helps eliminate pooled blood. Butcher’s broom supplements also work as diuretics and laxatives, and those who don’t want those side effects should use a cream.
Planetary Herbals Horse Chestnut Cream contains both horse chestnut extract (standardized to 20% asecin) and butcher’s broom extract. It’s the only cream left on the market to contain both ingredients. If you can only try one cream, try this one.
Supplements for overall vein health are a solid preventative for worsening veins down the road.
Supplements won’t make present veins disappear. A visible spider vein is already too damaged to really reap the benefits of beneficial ingredients. But supplements can stop new veins from appearing and existing veins from getting worse. An ounce of prevention, as they say, is worth a pound of cure. Some of these supplements are also used topically, so there may be a bit of repetitive information in this section.
Vitamin K: The protein MGP lowers vascular proliferation and mineralization which are both rampant in varicose vein sufferers. The body needs Vitamin K to active MGP and prevent venous insufficiency and varicose veins. When you take vitamin K orally, you need a mix of vitamin K1, vitamin K2-4, and vitamin K2-7 to get the maximum benefit.
Life Extension Super K is one of the few supplements to contain all three types of vitamin K for arterial health. I started using this after a couple scary episodes where I felt a blood clot in my leg during an airplane flight an again on a long commute. It takes about 4 months to notice the subtle positive effects on circulation.
Butcher’s Broom: Butcher’s broom contains saponins and esculin which constrict the blood vessels to increase blood flow. This supplement has the most side effects of any listed here. Besides the diuretic and laxative effects, Butcher’s broom can cause headaches as the vein constriction wears off.
Nature’s Way Butcher’s Broom contains saponins and esculin, and while it’s not a standardized extract, it contained more than enough active ingredient for me to feel the effects right away. I recommend taking one capsule a day with breakfast.
Solaray CircuLegs is one of many combined formulas on the market. If you want to try a bunch of remedies in one shot, then CircuLegs is the best combined formula out there. It contains standardized extracts of horse chestnut, butcher’s broom, gotu kola, hesperidin, and quercetin. While the last three are newcomers to spider vein treatment, they’re supposed to contain bioflavonoids beneficial to vein health.
Horse chestnut: Horse chestnut is the most studied herbal supplement for chronic venous insufficiency. Only use a standardized extract to guarantee that you get enough asecin to do the job—not every part of the horse chestnut plant has the same amount of asecin. Aescin increases vein contraction and force while decrease blood vessel permeability.
Planetary Herbals Horse Chestnut only contains the horse chestnut active and is standardized to 20% aescin. I used this shortly after sclerotherapy and it really helped maintain my results after the procedure. It also reduced leg swelling during premenstrual syndrome.
Bromelain: While not specifically indicated for spider veins, many spider vein sufferers are also disposed to blood clots and deep vein thrombosis. Bromelain is fibronolytic and can dissolve a blood clot in its tracks before it becomes a hospital emergency. If you experience acute “muscle” cramps or charley horses, it could actually be a blood clot.
NOW Quercetin with Bromelain is what I use on an as-needed basis when I feel any unusual swelling or pain in my legs. Bromelain is usually combined with quercetin because they have synergistic effects. Quercetin does have a mild antihistamine effect and shouldn’t be used if you’re currently using other antihistamines.
Superior Labs Best Bromelain provides pure and naturally sourced bromelain without any fillers, additives, or extra ingredients. Use this if you don’t want any unexpected effects from the typical quercetin/bromelain mixture.
Fish Oil: The latest benefit of fish oil is improving decibutus ulcers which can be caused by long-term venous insufficiency and a sedentary lifestyle. In one study, a patient who had gone through multiple failed treatments for two years was able to heal completely from his ulcers on 12 weeks of omega 3 derived from fish oil. It has long been known that fish oil thins the blood which makes it easier for your blood vessels to pump blood through—a benefit to anyone suffering from CVI.
NOW Ultra Omega-3 uses molecular distillation to formulate their balanced blend of EPA and DHA. Capsules are enteric coated so they have a greater chance of making it through the digestive system unscathed. This has more EPA and DHA per capsule than any other brand I’ve come across.
Kirkland Wild Alaskan Salmon Oil uses sustainably caught wild salmon and cold pressing to create a full spectrum fish oil product. Capsules are enteric coated. However the actual EPA and DHA content is quite low compared to other full spectrum fish oils.
Pure Alaska Omega Wild Alaskan Salmon Oil is the big brother to the Kirkland’s version with double the EPA and DHA per serving. Also sustainably sourced wild salmon which goes through an extra virgin cold press process into enteric coated capsules. This is the only product I’ve tried that does not have a fishy aftertaste.
Want those spider veins to go poof? The only immediate solution is minor surgery.
While I don’t want to downplay the health and preventive benefits of over-the-counter remedies, they aren’t strong enough to remove a twisty damaged spider vein. If your vein damage is extensive like mine, you’ll need to undergo a semi-surgical procedure called sclerotherapy.
Sclero-what? This involves a doctor or licensed nurse practitioner injecting your veins with a sclerosant that causes the vein to shrink and eventually collapse. Over time, the body naturally absorbs a collapsed vein. To help these veins dissolve, patients must also wear compression stockings day and night for a minimum of two weeks (though many doctors recommend twelve weeks or more!).
And that’s not all. Most doctors recommend a minimum of eight sclerotherapy treatments spaced 4-6 months apart to achieve the maximum benefit. Sclerotherapy is definitely the most effective treatment to date, but it comes at a steep cost of money, time, and convenience. There are also several different sclerosants which may be better or worse for a certain individual.
Glycerin at Utah Vein Specialists: This is the only practitioner in the Western United States offering sclerotherapy with glycerin. While an unusual choice, I found this to be the most effective for my particular veins. Glycerin is a tricky substance and it takes two people to administer this sclerosant effectively—the doctor injected me while the nurse pumped glycerin at varying rates. In addition to leg vines, I had strange veins along my ribcage that other doctors were afraid to inject. Utah Vein Specialists carefully treated that area as I watched most of those little purple monsters disappear.
Hypertonic saline at Intermountain Vein Center: Saline is the traditional choice and still used by many practitioners today. Saline requires a very skilled injector with excellent eyesight and a delicate hand. The practitioner at IVC had a shaky hand and seemed unable to handle my veins. A lot of sclerosant ended up on my skin as she fumbled around the veins. Saline is still one of the cheapest sclerosants, though, which makes it attractive to consumers. If you go this route, choose someone that performs saline injections on a regular basis. And be prepared for some very heavy bruising!
Polidocanol liquid at The Vein Institute: One major benefit of polidocanol is its anesthetic properties, which means that you will feel far less pain during each injection as polidocanol numbs the area4. The difference in pain was marked and if you’re squeamish about needles you should definitely try polidocanol first. This was the second most effective formula for my veins and bruising was minimal. All sclerotherapy at The Vein Institute is performed by a doctor rather than an assistant.
Sotradecol foam at Mountain Medical Vein Center: This was my worst sclerotherapy experience by far! Foaming sclerosants are considered the most effective, but they’re also the most expensive. Each injection gave me an active puncture bleed and I left the office with fifty cotton balls taped to my legs. This treatment session was not effective at all—once the bleeding stopped I could tell none of the spider veins had closed. I’m not sure if the poor result was caused by the practitioner or the sclerosant or both.
But those stockings are a drag.
Everyone’s least favorite part of sclerotherapy is post-care with compression stockings. And I’ve yet to meet a doctor that tells you about them beforehand. The first time I tried sclerotherapy, I was about to leave when they said, “you’ll need to wear compression stockings on your way home.” What now? “They’re required for your recovery and we have them in stock for $80.” WHAT NOW? I didn’t have that kind of money for glorified pantyhose. The doctor then told me that they wouldn’t let me leave without them. In hindsight, I know they can’t do that, but I was young and impressionable and embarrassed, so I put those awful stockings on a credit card and promptly huffed out.
Don’t make the mistake I did and walk into your sclerotherapy appointment unprepared. All you need are medical grade thigh high compression stockings and you can get them for far less than I paid. The compression thigh highs all have a weird half-open foot and I find myself tugging at them all day. If I had planned in advance, I would have bought medical grade compression pantyhose instead as they pass nicely for work wear tights.
Compression stockings really are necessary to help the veins close. The injections can’t do it all on their own. The stockings apply constant pressure to force the now-weakened vessels to collapse and die. Recommendations will vary but most doctors tell you to wear them 24/7 for as long as you can stand it.
What is your experience with spider veins?