Find out more about the causes, symptoms and treatments of lipedema to help you manage this condition more effectively and improve your day-to-day comfort.
What is lipoedema?
Lipoedema is a chronic condition that affects women almost exclusively. It manifests itself as an abnormal accumulation of hypertrophic subcutaneous adipose tissue, often in the legs and sometimes in the arms(2). The condition is still not widely recognised by healthcare professionals, which often leads to the misdiagnosis of obesity or lymphoedema(2). In reality, around 1 in 10 women could be affected by lipoedema (11%)(2). This condition causes considerable physical and psychological handicaps(2).
How do you recognise lipoedema?
Lipoedema is characterised by bilateral, symmetrical and disproportionate swelling, mainly of the lower limbs (lower abdomen, hips, buttocks, thighs and calves) and sometimes of the arms (in 70% of cases)(7). The hands and feet, but also the head, neck and trunk are not affected(1,4,5). This disease causes a remarkable disproportion between the upper and lower parts of the body(4). The skin may also have an ‘orange peel’ appearance(2).
What are the symptoms and clinical signs of lipoedema?
The main symptoms of lipoedema are :
Pain on pressure, spontaneous pain and tenderness: Lipoedema is characterised by chronic pain, often exacerbated by pressure on the affected areas. This pain is associated with increased sensitivity to touch(1).
A feeling of heaviness in the affected limbs(1). A sensation of weight or heaviness may be felt due to the increased volume and density of the fatty tissue and tension in the skin tissue(2).
Patients may also experience increased bruising due to vascular fragility(2).
Despite raising the legs and losing weight, swelling is still present(2).
Treating these symptoms as soon as possible will help you manage and live better with lipoedema.
In around 60 to 80% of cases, depending on the study, lipoedema is associated with obesity(2,8,9). It is also not uncommon for patients to report joint hypermobility (58%)(2) or orthopaedic problems (hollow foot and genu valgum) in 1/3 of cases(9).
What are the stages of lipoedema?
There are two classifications of lipoedema. There are 5 types and 4 stages. The first is based on the location of the adipose tissue(2,3).
Type 1 Involvement of the buttocks, hips and thighs.
Type 2 Lipedema extends to the knees with a fat pad on the inside of the knees.
Type 3 Affects all the lower limbs (except the feet).
Type 4 Involvement of the arms (except the hands).
Type 5 Involvement of the calves only.
The second type has 4 stages depending on the quality of the skin and how it is palpated(2,3).
What are the stages of lipoedema?
Stage 1 The skin has a smooth, supple texture with granular palpation linked to subcutaneous fibrosis (formation of small nodules).
Stage 2 The skin is irregular, dimpled and harder. The nodules are palpable, more numerous and larger (the size of a walnut).
Stage 3 Thick, indurated skin. Nodules vary in size and are clearly distinguishable from other tissues on palpation. Fat deposits cause deformity of the limbs. An ‘orange peel’ effect may appear when the skin is squeezed.
Stage 4 Lipolymphoedema: presence of both lymphoedema and lipoedema.
Causes of lipoedema
The exact cause of lipoedema is still not known or explained, but several hypotheses have been put forward concerning its pathophysiology, in particular:
Hormonal factors Lipoedema affects women almost exclusively, and often manifests itself during hormonal changes, such as puberty, pregnancy or the menopause, suggesting an influence of hormones, particularly oestrogen. These hormones appear to play a central role in the excessive accumulation of adipose tissue(3,4).
Genetic predisposition Lipedema may also have a genetic cause, as in some cases patients have a family history(3,4,6).
Inflammation Lipoedema is characterised by inflammation resulting in tissue fibrosis and pain, and in some cases tissue numbness(3,5).
Other factors could be responsible, such as alterations in adipogenesis (changes in the early stages of fat cell formation, leading to abnormal accumulation and distribution of fat in certain parts of the body), or dysfunction of the microvascular system (lymphatic and blood capillaries)(3).
What are the consequences of lipoedema?
Lipoedema has a number of physical and psychological consequences, which can vary depending on the severity of the disease.
In addition to chronic pain, lipoedema can have an impact on mobility and physical function. The extra weight and pain associated with lipoedema reduce mobility, walking ability and the ability to perform daily tasks(1,3).
The significant increase in fat in the legs can also cause complications such as knee misalignment (genu valgum), knee osteoarthritis and skin problems (irritation and maceration) due to friction between the skin folds(1).
Because of the physical deformity, pain and reduced mobility, patients often also suffer psychological distress. Lipoedema can actually lead to low self-esteem, depression and anxiety disorders, particularly when the condition is misdiagnosed or confused with obesity(1,4).
The consequences of lipedema are therefore considerable, in terms of both physical and psychological quality of life, requiring multidisciplinary management to mitigate its effects.
FAQ about lipoedema
Our medical team answers the questions you may have.
Losing weight with lipedema can be difficult. However, certain approaches can help to manage the condition and promote weight loss. Appropriate physical activity is essential to maintain mobility and physical function. An appropriate lifestyle and diet are also important.
For further information, please contact the appropriate professionals.
Lipoedema is diagnosed on the basis of a combination of symptoms and clinical signs, as it is often confused with other conditions such as obesity or lymphoedema. It is mainly based on a clinical assessment.
If you have several of the symptoms of lipedema (abnormal accumulation of fat, symmetry, pain and tenderness, easy bruising, swelling), it is advisable to consult a healthcare professional, ideally a doctor specialising in vascular diseases, who will be able to make a diagnosis.
Diagnosis is based mainly on :
Physical examination.
Medical history.
Exclusion of other similar conditions such as obesity or lymphoedema.
Lipoedema and lymphoedema are two distinct pathologies with important differences, although they can sometimes be confused due to certain similarities in their clinical presentation. It is also possible for lipoedema to be associated with lymphoedema, a condition known as lipo-lymphoedema.
Very simply, ‘pure’ lipoedema is a disease of adipose tissue that leads to an abnormal subcutaneous accumulation of hypertrophic fatty tissue, without any accumulation of fluid. Lipoedema is painful.
Lymphoedema, on the other hand, is a condition linked to dysfunction of the lymphatic system, leading to an accumulation of fluid in the tissues (oedema).
Lipoedema is bilateral, symmetrical and generally spares the feet and hands, whereas lymphoedema can affect only one arm or leg and often includes the feet or hands.
How can the symptoms of
lipoedema be treated and relieved?
Unfortunately, there is no definitive treatment for lipedema, as it is a chronic and potentially progressive condition (if associated with obesity), but it is possible to relieve symptoms, prevent complications and improve quality of life using a variety of approaches.
Lymphatrex Revolution: Enhances the Lives of Patients with Lymphedema and Lipedema
For patients living with lymphedema or lipedema, compression garments are a critical tool to manage their pathology. However, this essential treatment often comes with a significant tradeoff, comfort. Many patients experience discomfort due to restrictive movement, skin irritation, or sensitivity exacerbated by traditional seams. Additionally, some garments can lack the expected rigidity required for patients' compliance, leading to doubts about their efficacy. These issues discourage daily use, creating obstacles to proper care.
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Forner-Cordero, I., Forner-Cordero, A., & Szolnoky, G. (2021). Update in the management of lipedema.. International angiology : a journal of the International Union of Angiology. https://doi.org/10.23736/S0392-9590.21.04604-6.
Kruppa P, Georgiou I, Biermann N, Prantl L, Klein-Weigel P, Ghods M. Lipedema-Pathogenesis, Diagnosis, and Treatment Options. Dtsch Arztebl Int. 2020 Jun 1;117(22-23):396-403. doi: 10.3238/arztebl.2020.0396. PMID: 32762835; PMCID: PMC7465366.
Forner-Cordero, I., & Forner-Cordero, A. (2021). Lipoedema – a growing problem in Spain. Phlebologie, 50(06), 376-383. https://doi.org/10.1055/a-1306-7626
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Le Lipoedème : une pathologie peu connue, Dr. Hadji.,juin 2022. Réalités en chirurgie plastique (n°47)
Aday AW, Donahue PM, Garza M, Crain VN, Patel NJ, Beasley JA, Herbst KL, Beckman JA, Taylor SL, Pridmore M, Chen SC, Donahue MJ, Crescenzi R. National survey of patient symptoms and therapies among 707 women with a lipedema phenotype in the United States. Vasc Med. 2024 Feb;29(1):36-41. doi:10.1177/1358863X231202769. Epub 2023 Oct 16. PMID: 37844030; PMCID: PMC10858625.
Bertsch T, Erbacher G, Elwell R. Lipoedema: a paradigm shift and consensus. J Wound Care. 2020 Nov 1;29(Sup11b):1-51. doi: 10.12968/jowc.2020.29.Sup11b.1. PMID: 33170068.
Forner-Cordero I, Perez-Pomares MV, Forner A, Ponce-Garrido AB, Munoz-Langa J. Prevalence of clinical manifestations and orthopedic alterations in patients with lipedema: A prospective cohort study. Lymphology. 2021;54(4):170-181. PMID: 35073621.
