Published on February 25, 2019

Women: Beware of a sore legWomen: Beware of a sore leg

Tennis sensation Serena Williams, talk show host Regis Philbin and screen actor Jimmy Stewart all suffered from blood clots in the legs or lungs. They are among the many Americans who have struggled with the condition, which can be deadly (as it was for Stewart).

For women, birth control pills, hormone therapy, pregnancy and a history of miscarriages put them at higher risk for developing dangerous blood clots, called deep vein thrombosis, or DVTs, typically in their legs.

When one of these clots breaks loose and travels to the lungs, it can cause severe complications, even death. Doctors call this a pulmonary embolism or PE.

“It (a PE) puts quite a strain on the heart,” said Lindsey M. Korepta, MD, a vascular surgeon with Vascular and Vein Center of Cape Cod, which has offices in Falmouth and Hyannis.

Untreated leg clots also can cause permanent damage to deep vein valves, producing a lifelong condition called post-thrombotic syndrome. According to an article in the journal Circulation, this syndrome can affect almost half of patients with DVTs. Patients experience a leg that stays swollen, because the damaged valves hamper the return of blood to the heart. Skin ulcers and wounds that don’t heal may result, Dr. Korepta said.

Both DVTs and PEs are clots in a vein, called venous thromboembolisms or VTEs. VTEs may affect as many as 900,000 people annually in the United States, and may kill 60,000 to 100,000, according to the Centers for Disease Control and Prevention. Of these, 10-30 percent die within a month of diagnosis and 25 percent of those with a PE have sudden death as their first symptom.

“For a majority of people (with a DVT), it’s a one-time thing,” Dr. Korepta said.

Risk Factors

VTEs affect both men and women. Risk factors for both sexes, according to the American Heart Association, include:

  • Smoking
  • Obesity
  • Physical inactivity
  • Surgery
  • Severe trauma
  • Fractures of the pelvis or leg bones
  • Cancer
  • Autoimmune diseases
  • Age, most occur in people 60 or older

If one leg has swelling, pain and perhaps red streaks, it should be checked out immediately, Dr. Korepta said. An examination with an ultrasound and blood test called a D-dimer may be used to diagnosis a DVT, according to the American Heart Association.

“If someone has one-sided leg swelling, they should have an ultrasound done,” Dr. Korepta said. “I think a lot of people put it off and regret it later.”

Treatments

Treatment for DVTs may include blood thinners to prevent new clots or more powerful anticoagulants to dissolve existing clots, elevating the affected leg and using compression stockings or compression pumps.

“We want everyone with a DVT in compression stockings – especially to prevent post-thrombotic syndrome,” she said. “We can get rid of superficial veins if they develop faulty valves, but this syndrome damages the deep vein valves and there is no good treatment for that outside of wearing lifelong compression and elevating your legs as much as possible.”

Risks increase for women for a variety of reasons, one being female hormones, particularly estrogen, which increases blood clotting. According to the National Women’s Health Network, studies suggest that a synthetic hormone, progestin, often used in combination with estrogen in birth control pills, patches and rings, may also raise risk.

A higher chance of clots is also associated with hormone therapy for peri- and post-menopausal women, according to a Swedish study published in the journal Menopause. Researchers found the risk was higher for use of estrogen-progesterone combinations than for estrogen alone.

Pregnancy and birth can raise the risk of DVTs because of heightened hormone levels, the weight of the baby pressing on the deep pelvic veins, increased blood volume and decreased physical activity, Dr. Korepta said. She recommended pregnant women wear compression stockings and elevate their legs as much as possible. Illnesses during pregnancy can further boost DVT risk, as can bed rest, being an older pregnant mother or pregnant with twins, according to the American Heart Association.

Dr. Korepta’s patients with DVTs are equally split between men and women, with most in their 60s and 70s. The majority are current or former smokers, and she strongly urges smokers to quit to avoid cancer, stroke, heart attack and DVTs.