The Lipedema
General
What is lipoedema?
Lipoedema is a chronic condition of the subcutaneous adipose tissue that affects almost exclusively women. It is characterised by a disproportionate and symmetrical increase in the volume of the limbs, mainly in the legs and sometimes in the arms, associated with pain, tissue hypersensitivity and capillary fragility, which leads to easy bruising.
Lipedema is now considered a multifactorial condition involving the following mechanisms:
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hormonal
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genetic
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inflammatory
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microvascular
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metabolic
Contrary to earlier descriptions, lipoedema is not a ‘fluid problem’ or a lymphatic disorder. It is primarily a condition affecting adipose tissue, characterised by inflammatory and painful changes which, in some cases, may be secondarily associated with lymphatic involvement.
Lipedema should not be regarded as merely a cosmetic issue. It can have a significant impact on:
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mobility
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quality of life
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body image
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mental health
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day-to-day activities
What are the symptoms of lipoedema?
Symptoms can vary from person to person and do not always correlate with the extent of the swelling in the limbs.
The main clinical signs are:
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symmetrical increase in the volume of the legs and/or arms
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typical sparing of the feet and hands
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spontaneous pain or pain on touch
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a feeling of heaviness or tightness
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hypersensitivity of the tissues
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ease with which bruises form
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limb fatigue
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a sensation of swelling
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difficulties with mobility
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disproportion between the upper and lower body
Some patients also experience:
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orthopaedic problems
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a reduction in physical activity
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difficulties finding suitable clothing
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psychological distress related to how their body is perceived
Pathophysiology: current understanding
The exact mechanisms underlying lipoedema have not yet been fully elucidated. Recent research suggests that it is likely to be a complex condition involving several interconnected mechanisms.
Genetic factors
A family predisposition is frequently observed. Several genes involved in:
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hormonal regulation
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adipocyte differentiation
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microcirculation
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connective tissue
are currently being studied.
Lipedema therefore appears to have a genetic component.
Hormonal factors and life cycles
Hormones play a central role in the development of lipoedema.
The first symptoms frequently appear during periods of significant hormonal changes:
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puberty
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pregnancy
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postpartum
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perimenopause
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menopause
Current research suggests that oestrogens and their receptors are involved in:
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the distribution of adipose tissue
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inflammation
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vascular permeability
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pain
Menopause appears to be a particularly significant period, with some patients experiencing:
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worsening pain
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an increase in volume
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reduced mobility
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metabolic changes that promote inflammation
Inflammation and adipose tissue
The adipose tissue in lipoedema is characterised by:
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hypertrophy of the adipocytes
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increased inflammation
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capillary fragility
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progressive fibrosis of the subcutaneous tissue
These phenomena may contribute to:
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pain
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a feeling of tightness
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hypersensitivity
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functional limitations
In some advanced forms, secondary involvement of the lymphatic system may occur, leading to lipolymphoedema.
Is lipoedema necessarily progressive?
No.
Lipedema should not be regarded as an inevitably progressive condition.
Its progression is likely to depend on numerous factors:
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hormonal fluctuations
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weight gain
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associated obesity
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a sedentary lifestyle
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reduced mobility
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chronic inflammation
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comorbidities
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whether or not treatment is sought early
Appropriate and early management can help to:
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stabilise symptoms,
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maintain mobility,
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improve quality of life,
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and limit functional decline.
Lipedema and obesity
Lipedema is distinct from obesity, but the two conditions can coexist.
Areas affected by lipoedema often respond poorly to conventional diets and weight loss. However, obesity can exacerbate:
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pain
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inflammation
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functional limitations
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orthopaedic problems
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mobility difficulties
The aim of treatment is not to achieve a slimmer figure, but rather:
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to improve overall health,
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to maintain mobility,
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to reduce symptoms,
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to prevent complications
A tailored nutritional approach, free from feelings of guilt, can be beneficial as part of a holistic treatment plan.
Classification of lipoedema
Lipoedema is generally classified according to morphological criteria.
Stage 1
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smooth skin
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uniform increase in fatty tissue
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supple tissues
Stage 2
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appearance of fatty nodules
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irregular skin
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increased fibrosis
Stage 3
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significant fat deposits
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deformities of the limbs
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skin folds
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possible mechanical limitations
Lipolymphoedema
In certain situations, secondary involvement of the lymphatic system may occur, leading to associated oedema.
Diagnosis of lipoedema
The diagnosis is based primarily on:
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the clinical history
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the clinical examination
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the exclusion of other conditions
There is currently no specific laboratory test available to confirm the diagnosis.
The assessment must take into account:
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pain
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functional limitations
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mobility
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psychosocial impact
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associated comorbidities
Differential diagnosis
Diagnosing lipoedema requires ruling out other conditions that may present with similar symptoms.
The differential diagnosis includes, in particular:
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gynoid obesity
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lipohypertrophy
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lymphoedema
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phlebo-lymphoedema
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chronic venous insufficiency
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certain endocrine disorders
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chronic pain syndromes
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certain vascular or inflammatory diseases
This stage is essential in order to propose appropriate management.
A multimodal therapeutic approach
The management of lipoedema must be personalised and multidisciplinary.
The aim is not merely to reduce volume, but above all:
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to alleviate pain
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to improve mobility
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to maintain functional abilities
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to improve quality of life
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to prevent complications.
Appropriate physical activity
Physical activity plays a central role in management.
It helps to:
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improve physical fitness
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maintain mobility
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reduce pain
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reduce inflammation
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improve psychological well-being
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prevent a sedentary lifestyle
Recommended activities may include:
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walking
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swimming
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aquatic exercises
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cycling
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strength training
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trampoline exercises
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low-impact activities on the joints
The aim is to encourage an active lifestyle tailored to each person’s abilities.
Compression therapy and follow-up by a healthcare professional specialising in lymphology
You can find a healthcare professional specialising in lymphology in our directory at the following link: https://www.lymphosuisse.ch/recherche-d-un-professionnel
Compression therapy can help to:
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reduce feelings of heaviness
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improve comfort
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support the tissues
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improve mobility
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reduce oedema where there is a lymphatic component
The choice of compression therapy must be tailored to the individual based on:
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body type
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symptoms
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the presence or absence of oedema
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and the patient’s tolerance
The specialist may include:
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compression therapy
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therapeutic exercises
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therapeutic education
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self-management
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mobility advice
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functional support
Manual lymphatic drainage
Manual lymphatic drainage may be beneficial for certain patients, particularly:
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in the presence of lipolymphoedema
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in cases of significant tightness
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to help adapt compression therapy
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or when compression alone is not sufficient to control symptoms
However, manual lymphatic drainage is not necessary for all patients with pure lipoedema without an oedematous component.
Mental health and quality of life
Lipedema can have a significant impact on:
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self-esteem
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body image
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mental health
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social relationships
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quality of life
Some patients experience:
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anxiety
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depression
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eating disorders
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chronic psychological distress
Comprehensive management must take these aspects into account and, where necessary, offer appropriate psychological support.
Lipedema surgery
When conservative treatments do not provide sufficient relief of symptoms, surgical management may be considered for certain selected patients.
The most commonly used surgical procedure is specialised tumescent liposuction.
The objectives are:
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to reduce pain
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to improve mobility
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to reduce mechanical limitations
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to improve quality of life
Surgery is not a ‘miracle’ treatment and does not replace a comprehensive approach.
A specialist assessment is required to determine:
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the indications
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the expected benefits
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the risks
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the limitations of the treatment
Prior conservative treatment is essential before any surgery.
After the procedure, long-term follow-up remains important and may include:
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compression
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physiotherapy
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physical activity
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self-management
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specialist medical follow-up
Living with lipoedema
Lipedema is a chronic condition that often requires long-term management.
Early, multidisciplinary management can help to:
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maintain mobility
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alleviate symptoms
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maintain a good quality of life
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minimise complications
Every situation is unique.
Treatment goals must be tailored to the individual and developed in consultation with specialist healthcare professionals.
I suffer from lipedema, what should I do?
Contact your general practitioner.
A consultation with an angiologist may be useful in order to carry out a more complete vascular assessment. This information will help refine your diagnosis and plan your treatment.