Surgeon: Why women over 40 with a ‘heavy leg’ feeling need to stop ignoring it immediately

For women entering their 40s and 50s, conversations about health tend to revolve around hormones, wrinkles, weight gain and slowing metabolisms.

But according to one vascular surgeon, there’s another major bodily change happening beneath the surface that rarely gets a mention.

She warns it could be the reason your legs suddenly feel heavier, achier and more tired than they used to.

Dr Rema Malik, a board-certified vascular surgeon based in Houston, Texas, said she sees it every day in her clinic.

The specialist, who regularly shares advice about vein health and circulation with her 116,000 Instagram followers, recently revealed the three vascular changes she believes every woman at a certain age should understand.

‘When you hit your 40s… nobody tells you what is happening to your circulation.’

According to Dr Malik, her waiting room is filled with women who are frustrated by symptoms that seem to appear out of nowhere with legs that feel heavy, tired, or achy.

While many assume these symptoms are simply part of getting older, Dr Malik added there are often specific changes happening within the veins themselves.

The first vascular truth is what Dr Malik calls the ‘pregnancy tax’ – the delayed impact pregnancy can have on vein health decades later. 

‘If you carried babies in your 20s or 30s, your blood volume doubled, putting immense stretching pressure on the valves in your leg veins.’

During pregnancy, a woman’s circulatory system works significantly harder to support both mother and baby.

Blood volume increases dramatically and veins are placed under extra pressure, particularly in the legs, where blood must travel back upwards against gravity.

For many women, the body compensates successfully for years. However, Dr Malik warned the effects can emerge decades later.

‘Your body compensated back then, but as you hit your 40s, gravity finally catches up. Those stretched valves start to leak. The heaviness you feel now is the ‘tax’ from decades ago.’

When the tiny valves inside the veins weaken or stop closing properly, blood can begin pooling in the lower legs instead of efficiently returning to the heart.

Over time, this can contribute to symptoms such as swelling, aching, heaviness and visible varicose veins.

The second change, she said, is linked to one of the most significant transitions in a woman’s life – perimenopause.

‘The perimenopause ‘stiffening’,’ she wrote.

‘Oestrogen is a vascular protector. It keeps your vein walls flexible, smooth, and relaxed.’

Many women are familiar with the role oestrogen plays in regulating menstrual cycles and reproductive health, but fewer realise it also influences blood vessels throughout the body.

As hormone levels begin to fluctuate and decline during perimenopause, Dr Malik said veins can lose some of that natural support.

‘As you enter your 40s and perimenopause begins, your oestrogen levels drop.

‘Without that protection, your veins become physically stiffer, making it much harder for them to pump blood back up to your heart.’

The result can be increased feelings of fatigue in the legs, swelling and worsening vein function at a time when many women are already dealing with a host of other hormonal changes.

The third warning sign is one many people dismiss as purely cosmetic.

‘Spider veins are your body’s ‘check engine’ light,’ she added.

Tiny purple, blue or red veins that appear around the ankles, calves or behind the knees are often brushed off as a harmless aesthetic concern. But Dr Malik said they can sometimes indicate a deeper issue.

‘Stop letting med-spas tell you spider veins are just a ‘cosmetic issue’.’

‘If you have a sudden cluster of purple veins near your ankles or behind your knees, it is almost always a sign of Venous Insufficiency.’

Venous insufficiency occurs when damaged or weakened veins struggle to return blood efficiently to the heart, allowing pressure to build within the circulatory system.

According to Dr Malik, those visible spider veins may be the body’s way of signalling a hidden problem.

‘The large, hidden vein deep inside your leg is leaking pressure to the surface.’

The condition becomes increasingly common with age and can be influenced by pregnancy, hormonal changes, genetics, prolonged sitting and extended periods of standing.

Australian health experts have similarly warned that chronic venous disease often develops gradually, with symptoms such as aching, swelling, throbbing and leg fatigue frequently dismissed until they begin interfering with everyday life.

For women navigating midlife changes, Dr Malik said the key message is that discomfort shouldn’t automatically be accepted as the new normal.

‘Your body is changing, but living with leg pain or hiding your legs behind long pants doesn’t have to be your new normal.’