In 2002, a woman we will call Ellen sat across from her doctor and was told that her migraines — the ones where she lost pieces of her vision, where darkness crept in from the edges — were caused by hormones, and that the fix was more estrogen. She was forty-four. She had bulging, twisted veins running down both legs. A close relative had had breast cancer. She didn’t know that her DNA contained a variation in a gene that controlled how much estrogen her body was making and holding onto. Her doctor didn’t know either. The prescription took eleven minutes to write. Six weeks later, Ellen had a migraine so severe she couldn’t see anything in front of her for a full hour. No one looked at what had changed. No one thought to.
What’s happening in a varicose vein
You’ve probably seen varicose veins — those dark, swollen, twisted veins that bulge under the skin, usually on legs. They look like a plumbing problem, and in a way they are. But there’s something happening inside them that goes beyond plumbing, and almost no one talks about it.
Scientists have found that in varicose vein tissue, the receptors for estrogen and progesterone — think of receptors as tiny docking areas on the surface of the cells, waiting to receive incoming hormone molecules — are present in unusually high numbers, and the tissue can accommodate far more estrogen molecules than normal. At the same time, the docking areas for androgens — the hormones we usually associate with men, but which women have too, and need — are reduced. The counterweight is missing.
Why does this matter? Because these receptors don’t just receive messages. They act on them. When estrogen docks, it triggers certain chains of events inside the cell that change how the cell behaves, how fast the cell grows, what it does. A tissue packed with estrogen receptors is a tissue being heavily driven by estrogen chain of events. And a tissue that has lost its androgen receptors has lost a specific stabilizing function — because androgens, at sufficient levels, actually suppress a gene called c-MYC that drives uncontrolled cell growth.
The varicose vein tissue is not just damaged. It is telling us something about what drove the damage. The body, in the place where it is most visibly damaged, is flooded with one chain of events and starved of another. That pattern has a cause. Finding the cause is what the rest of this piece is about.