Spider veins are smaller versions of varicose veins that are close to the skin's surface. They can be red or blue and may look like spider webs.

Both varicose and spider veins tend to run in families. The incidence also increases with age and weight. Veins that enlarge during pregnancy tend to improve afterward. Among women, the hormonal changes associated with puberty, pregnancy and menopause can increase the risk of developing varicose or spider veins, as can birth control pills and other drugs containing oestrogen and progesterone. If you're fair skinned, you may develop spider veins on the face as a result of sun exposure. Patients with acne rosacea can also experience this.

The most common treatment is sclerotherapy, a clinic procedure that works for both varicose and spider veins. A saline solution injected into the vein causes its walls to stick together and seal shut. Other veins take over the blood circulation. You may need several treatments but you should be able to resume your normal activities immediately.
Most of the treatments for varicose and spider veins are very effective, although there's always a chance that new ones will develop over time. To lower your risk, wear sunscreen to protect your face, exercise regularly to improve the strength and circulation of your legs (walking is ideal), lose weight and don't cross your legs when sitting. Avoid either sitting or standing for long periods of time, and try to elevate your legs when resting. If you have to stand or sit for a long time, wear elastic support stockings. A low salt, high fibre diet can help, too (salt can cause water retention and swelling, and insufficient fibre increases the risk of constipation, which can contribute to varicose veins).

Quitting Hormone Replacement?
I'm currently on hormone replacement therapy (HRT) and have been for 10 years. I would like to get off. How do I do this? Do I just quit, or do I need to back it down? 

Answer
Conventional medical wisdom holds that since you've been on HRT for so long, it would be best to wean yourself off slowly. However, the few studies on this subject suggest that it really doesn't matter whether you go 'cold turkey' or withdraw from the hormones gradually: there seems to be no difference in the incidence of menopausal symptoms that develop as a result. One study, published in the December 2003 issue of Obstetrics and Gynecology, found that about one-quarter of the women participating were unable to discontinue hormone therapy because of the withdrawal symptoms they experienced. The women who had the most trouble quitting had begun taking oestrogen after a hysterectomy, and had been on it for 10 years or more. Of the women in the study who succeeded in withdrawing from HRT, 71 percent quit abruptly and 29 percent tapered off HRT. There was no difference in the incidence of menopausal symptoms between the two groups.

Another study, published in the May, 2004 issue of the Journal of Women's Health, also found no difference in symptoms between women who quit abruptly and those who tapered off. If you decide to wean yourself off HRT, discuss your plan with your doctor. I suggest cutting back on HRT over the course of two months. You can do this by taking decreasingly lower doses of oestrogens. You're probably taking 0.625 mg of oestrogen daily. You want to bring this down to 0.4, then 0.3 mgs daily. Either ask your physician to prescribe lower-dose oestrogen or start taking your pills every other day, instead of daily. Continue taking your full dose of progestin whenever you take oestrogen. If your HRT prescription is for a pill that combines both hormones, ask your physician for separate prescriptions so that you can slowly lower your oestrogen dose.

Once you're off the hormones, you may experience hot flashes, night sweats or mood swings, and within two or three months you're likely to notice vaginal dryness and loss of fullness of your breasts. If vaginal dryness becomes problematical speak to your physician about prescription oestrogen creams that can be applied vaginally.

If you were taking HRT to protect against osteoporosis, make sure that you're getting 1,200 mg of calcium daily from your diet and, if necessary, from supplements. Weight-bearing exercise, such as brisk walking, along with strength training can protect your bones. If a bone density test shows that you're at high risk of osteoporosis, you may want to consider taking Fosamax (r) (alendronate sodium),  Evista (r) (raloxifene) or Bon Viva (r) (ibondranate sodium), prescription medications that can help strengthen bone and available in Botswana.

Many women find relief from hot flashes, night sweats and vaginal dryness by taking 800 IUs of vitamin E daily and evening primrose oil. Two to three daily servings of whole soy foods (tofu and soy milk) will give you some safe plant oestrogen (phytoestrogens) that may help relieve symptoms. If these natural approaches don't help, talk to your physician about Effexor (r) (venlafaxine), Zoloft (r) (sertraline) or other drugs that can relieve hot flashes.