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What Is Lipedema? Symptoms, Treatment, and Its Relationship to Lymphedema and Obesity

Lipedema is a condition that causes swelling in the legs. The condition is relatively common and almost exclusively affects women. Learn about lipedema legs, the symptoms, lipedema treatment options, and key differences between lipedema and lymphedema.

Lipedema is a chronic medical condition that primarily affects women, resulting in disproportionately thick legs and thighs. The condition causes the fat stores below the surface of the skin to grow larger than usual, especially in the lower body, which can cause pain and tenderness. Since the condition mostly affects women, some health care providers and researchers believe that it’s caused by hormonal factors.

The condition may also be hereditary, and someone may be more likely to develop the condition if one of their direct family relatives has it. Other factors can influence the presence of fluid retention in the body, which can impact lipedema. 

The term lipedema means that there is an excess of fluid in your body’s fat stores. “Lipid” means fat, and “edema” refers to swelling caused by excess fluid collecting in the body’s tissues.

Lipedema is often mistaken for lymphedema or obesity. So how do you know if you have lipedema, lymphedema, or just thick legs? First of all, you can consult your health care provider. And also, let’s look at the different stages and symptoms of lipedema to figure it out.

Lipedema develops in four stages and progresses over time. Not everyone with lipedema will develop it at the same rate. The easiest way to identify what stage of lipedema you’re in is to assess the physical appearance.

  1. The first stage of lipedema appears as an increase in fat tissue below the surface of the skin. The fat slowly accumulates from the hips and buttocks, down the legs, to the knees and ankles. Smooth skin may become dimpled and uneven as fat storage cells develop.
  2. The second stage involves the development of large mounds of lipomas (fat tissue) throughout the legs.
  3. As lipedema enters its third stage, the legs will have become bulbous, with mounds of fat bulging under the skin in uneven formations along the legs. Folds of fat accumulate along the inner knees, and the thickness of the legs may increase overall.
  4. The fourth stage is called lipolymphedema. It occurs when the condition progresses to include both lipedema and lymphedema. Large folds of skin and fat tissue protrude and hang from the body, including the arms, midsection, and legs.

In addition to visible changes associated with lipedema, there are less visible symptoms such as pain, bruising, swelling, and loss of mobility. These symptoms can also change as lipedema progresses, impacting joint health and overall quality of life.

While both conditions have symptoms of swelling and typically start in puberty, lipedema swelling is caused by excess fluid in fat cells in the legs. In contrast, lymphedema is caused by a buildup of fluid due to missing, blocked, or malfunctioning lymph nodes. A person with lymphedema may be born with the disorder at birth, or it may develop following a lymph node biopsy, dissection, or other medical procedure affecting the lymph nodes, such as radiation. 

Other characteristic differences between lipedema and lymphedema include:

  • Lipedema affects women primarily, while lymphedema can affect anyone. 
  • Forty percent of lipedema cases are related to family history, compared to only 20 percent of cases of lymphedema.
  • Lymphedema usually causes swollen feet, while lipedema never causes swollen feet.
  • People with lipedema tend to have normal to thin skin; people with lymphedema tend to have thick to firm skin.
  • Pain and tenderness are more frequent for a person with lipedema than someone with lymphedema.
  • Fatty swelling with lipedema is consistent and constant, whereas fluid retention swelling can vary with lymphedema.
  • Lipedema is characteristic of someone with obesity, whereas lymphedema is not. 
  • Dieting does not affect or change the appearance or presence of fat on the legs of someone with lipedema. In contrast, dieting can result in evenly distributed weight loss for someone with lymphedema.

The most noticeable sign of lipedema is swelling in the lower extremities. The swelling typically affects both legs simultaneously, though the folds and bulges of fat may be asymmetrical from one leg to the other. In some cases, the arms may also become enlarged, while the joints at the wrist and ankles do not. This can cause a band-like or bracelet appearance because lipedema doesn’t affect the hands or feet.

Other symptoms of lipedema can include:

  • Pain, aching, or tenderness in the affected areas
  • Easy bruising 
  • Skin is cool to the touch in the affected areas
  • Doughy feel or appearance of the affected areas
  • Increased fluid retention (lymphedema)
  • Reduced mobility
  • Varicose veins
  • Psychological impacts, such as social isolation, depression, or low self-esteem

There is no one clear cause of lipedema. One possible reason is thought to be due to the hormonal influences of estrogen since lipedema can begin with puberty, pregnancy, perimenopause, or menopause.

Another possible cause of primary lipedema is genetics. Most cases — up to 64 percent of women with the condition — have a family history of lipedema. Health care providers and researchers believe that the genetic pattern for lipedema is passed down on the maternal side, but to date, there has been no specific gene identified for the condition.

Secondary lipedema is when the condition occurs as a result of other health conditions, diseases, or illnesses. Some people with Prader-Willi syndrome, Sotos syndrome, or Williams-Beuren syndrome also experience lipedema, as do people with disorders that affect the elasticity of the skin, such as pseudoxanthoma elasticum and cutis laxa type III. 

Another study has linked lipedema and joint hypermobility.

There is no cure for lipedema, but there are a few treatment options available. Treatments help address the symptoms and maintain quality of life. Speak to your health care provider about the right option for you. 

Treatment options for early-stage lipedema include: 

  • Compression therapy to prevent further edema
  • Developing or continuing to lead an active lifestyle including regular exercise such as walking
  • Strength and conditioning exercises to help maintain mobility and keep lipedema from getting worse
  • Weight loss programs to reduce the risk of developing other weight-related health complications
  • Dietary changes to help reduce inflammation and manage symptoms

If lipedema worsens, your health care provider may recommend liposuction (suction lipectomy) to help reduce the size and shape of protruding fatty tissues. While liposuction doesn’t cure lipedema, it can prevent new fat cells from forming and slow the rate of fatty tissue growth. Liposuction can also help improve mobility, increase quality of life, and reduce pain associated with lipedema. 

However, certain liposuction procedures or larger procedures such as surgical debulking might not be recommended if there is a risk for developing secondary lymphedema as a result of the procedure. 

If someone with lipedema has other health conditions, illnesses, or obesity, health care providers may recommend multiple treatment options or weight loss regimes based on individual needs.

Lipedema is a chronic medical condition that causes swelling of the fatty tissues in the lower legs. The condition mostly affects women and can develop during times of hormonal shifts such as puberty, pregnancy, and menopause.

While there is no cure for lipedema, there are conservative and surgical treatment options available to help manage the symptoms. Speak with your health care provider if you have symptoms of lipedema to discuss the right treatment option for you.