Introduction

Lipedema is the abnormal accumulation of fat in the lower body, typically in the legs, buttocks, thighs, and calves. It can sometimes occur in the arms, but it doesn’t affect the hands or feet. Other symptoms of this condition include:

• Swelling 
• Pain ranging from mild to severe and from continuous to only with pressure
• Bumps inside the fat that feel like there is something under the skin 
• Heavy feelings in the legs
• Easily-bruised skin
• Fatigue

Lipedema is classified as genetically heritable, as 20% to 60% of cases are seen in families. Although being overweight is not a cause, more than half of the people affected by lipedema have a body mass index (BMI) higher than 35. It happens most often in people assigned females at birth (AFAB), reportedly about 11%, but it's rarely reported in people assigned males at birth (AMAB). Significant hormonal changes such as puberty, consumption of contraceptive pills, pregnancy, and menopause can trigger the onset and development of lipedema.

Types of lipedema

There are different types of lipedema, namely:

1. Type I – fat is between your belly button and your hips
2. Type II – fat is between your pelvis and your knee
3. Type III – fat is between your pelvis and your ankles
4. Type IV – fat is between your shoulders and your wrists
5. Type V – fat is between your knees and your ankles

Lipedema and pregnancy

Hormonal shifts

As lipedema mostly begins or aggravates during times of hormonal changes, it is proposed that estrogen and estrogen signalling contribute to the development of lipedema by affecting the adipocytes and immune cells, directly and/or indirectly influencing brain control centres. Studies have shown that estrogen promotes adipose tissue buildup in the lower body areas. During pregnancy and lactation, there is also an increased level of prolactin receptors in the adipose tissues, which regulate adipogenesis and inhibit lipolysis. In early pregnancy, the heightened levels of oestrogen, progesterone, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) and insulin also promote fat deposition and inhibit lipolysis.^2,3

Potential progression 

During pregnancy, the preferred storage sites become intensified with increased fat storage and resistance to lipolysis. Additionally, the innate reduction in insulin sensitivity, particularly  from the second trimester onwards,, facilitates fat deposition and hinders lipolysis. Notably, fat cells in the gluteal-femoral regions are less responsive to catecholamines during pregnancy.³

Management strategies

There are numerous treatment options that pregnant birth parents can utilise for lipedema. These include:

• Compression therapy

This helps to increase blood circulation and flow in the lower extremities, which is beneficial for pain and swelling. Products and devices used include compression stockings, bandages, wraps and inflatables.

• Manual lymphatic drainage (MLD)

Lymphatic drainage massage is a therapy to alleviate swelling and inflammation associated with lymphedema.

• Exercise and anti-inflammatory nutrition

Eating healthy and exercising regularly helps to maintain a healthy weight, as well as reduce swelling, reduce joint stress and improve mobility.

• Skin moisturiser

Using emollients or moisturising creams to help the skin from drying out can be useful.  

Lipedema and menopause

Hormonal decline

In the menopausal transition, the levels of estrogen and progesterone gradually decrease while follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels increase. Due to this hormonal shift, fat distribution is altered and adipose tissue changes to control steroidogenesis, which contributes to the onset of lipedema.^2,3

Symptoms and progression

Approximately 20% of lipedema cases in persons assigned female at birth (AFAB) are discovered during menopause. Furthermore, a large portion of these persons with lipedema experience worsening symptoms when transitioning into menopause. Menopause can also change sensitivity to pain or pain tolerance.^2,3,4

Management approaches

The previously mentioned options, as well as the ones listed below, are treatment choices:

• Hormone replacement therapy (HRT)

Hormone replacement therapy (HRT) involves the use of hormones like estrogen and progesterone to replace those that are at low levels during menopause.

• Physical therapy, manual lymphatic drainage (MLD), and consistent movement
• Counselling or cognitive behavioural therapy (CBT) 

This may help people to cope with their symptoms and any extreme feelings

• Liposuction

This surgery removes fat to improve pain and mobility. Bariatric surgery may be suggested if lipedema is accompanied by a BMI higher than 35.

Differential diagnosis

There are multiple conditions with similar features to lipedema, which can lead to misdiagnosis. The most common condition that lipedema is mistaken for is lymphedema. 

The others include: 

• Lipohypertrophy in obesity 
• Phlebedema
• Dercum disease 
• Panniculitis
• Cushing’s syndrome
• Hypothyroidism
• Familial multiple lipomatosis
• Adipose tissue tumours
• Neurofibromatosis type I 
• Multiple symmetric lipomatosis (Madelung disease/ Lanois-Bensaude syndrome) 
• Fibromyalgia 
• Chronic polyarthritis 
• Depression with obesity 
• Angiolipomatosis³

Summary

Lipedema is a chronic fat disorder characterised by the abnormal accumulation of fat, primarily in the lower body, often leading to pain, swelling, and a heavy sensation in the limbs. It primarily affects people assigned female at birth and is strongly influenced by hormonal changes. The condition is often inherited and is not caused by obesity, though many affected individuals have a high BMI. Hormonal shifts, especially during puberty, pregnancy, and menopause, are key triggers for the onset and progression of lipedema.

During pregnancy, increased levels of hormones such as estrogen, progesterone, and prolactin contribute to fat storage, particularly in the lower body, and reduce the body’s ability to break down fat. This hormonal environment can worsen lipedema symptoms and fat distribution. Management during pregnancy focuses on non-invasive strategies, including compression therapy, manual lymphatic drainage (MLD), gentle exercise, anti-inflammatory diets, and proper skin care.

In menopause, the decline in estrogen and progesterone and the rise in FSH and LH alter fat metabolism and distribution, which can either trigger the onset or worsen existing lipedema. Many report increased symptoms and pain during this transition. In addition to conservative treatments like those used during pregnancy, hormone replacement therapy (HRT), psychological support through cognitive behavioural therapy (CBT), and surgical options like liposuction may also be considered.

Because lipedema shares characteristics with several other conditions, such as lymphedema and obesity-related disorders, accurate diagnosis is critical. Early recognition and tailored interventions during key hormonal life stages can help manage symptoms and slow disease progression.