Quick overview:
What is lipoedema?
The leading symptom of lipoedema is always pain: pressure and touch pain, spontaneous pain and a feeling of heaviness are symptoms of lipoedema. According to the current guideline, it is a disproportionate symmetrical fat distribution disorder that only affects the extremities – both legs and/or arms, with lipoedema occurring less frequently in the upper extremities. Both hips, both thighs or both lower legs can be affected, as can both upper and lower arms. The feet and hands are unaffected.
There is no cure for lipoedema, but the symptoms can be alleviated with consistent therapeutic measures. Responsible participation in therapy (self-management) by the patient is essential.
Causes of lipoedema and risk factors: Why do legs become disproportionately thick and painful?
Lipoedema almost exclusively affects women and girls. Men, in contrast, rarely suffer from lipoedema. The timing of hormonal changes is often associated with the onset of lipoedema.
Lipoedema usually appear
- towards the end of puberty,
- during pregnancy or
- during the menopause.
Furthermore, the propensity for lipoedema could be inherited, as a familial predisposition has been observed. Overall, the causes and physical connections that lead to the development of lipoedema have not yet been sufficiently researched. There is limited meaningful data on this disease, which is why further research and studies are needed.
Can lipoedema be prevented?
There is no way to prevent lipoedema, but there are certain steps you can take to help keep lipoedema in check and to relieve symptoms. If you experience any signs of lipoedema seek medical attention. Early diagnosis and consistent treatment are important to minimize the effects of lipoedema and control symptoms.
Symptoms of lipoedema: obesity or fat distribution disorder?
The symptoms of lipoedema can vary greatly from person to person.
Typical signs are:
- Pain, for example, pressure, touch or spontaneous pain in the legs and/or arms (central symptom)
- Heaviness in the affected areas.
- Symmetrical, relatively “inexplicable” increase in volume in both legs and/or arms
- Uneven proportions between the body and legs and/or arms: a rather slender upper body with disproportionately thicker legs and/or arms (often several sizes difference)
- Column-like changes and deformities of the legs and/or arms
- Dewlap formation, especially on the inside of the thighs and / or the inside of the upper arms
Important: The external appearance of lipoedema does not allow any conclusions to be drawn about the subjective symptoms. However, patients can influence the severity of their symptoms through personal commitment and adherence to treatment.
Do I have lipoedema? This test can provide initial indications
Do you recognize the symptoms in yourself and suspect that you have lipoedema? Take the test. Please note: a self-test cannot replace a medical diagnosis, but it can provide initial indications. Only a doctor can diagnose lipoedema.
S2k guideline: Pain as the leading symptom – no staging applies
Lipoedema is a painful fat distribution disorder. This means that a disproportionate increase in adipose tissue in the legs and/or arms without corresponding pain symptoms such as pressure, touch, spontaneous pain and a feeling of heaviness is not included under the diagnosis of lipoedema – this is referred to as lipohypertrophy and is not subject to the S2k guideline.
In addition, the previously used staging of morphology is no longer used as a measure of the severity of the disease.
Furthermore, lipoedema is not considered a progressive disease in principle in the current S2k guideline, since progression depends on various factors such as self-management. Thus, the fat distribution disorder does not necessarily progress or automatically worsen.
Lipoedema images: This is what the fat distribution disorder can look like
In most cases, the fat distribution disorder occurs on the legs. Depending on the patient, only the thighs or calves may be affected, or the fat deposits may extend from the hips to the ankles, by passing the feet, which show no lipoedema symptoms.
Get an idea of how differently pronounced lipoedema can appear at those affected:
Are saddle bags a form of lipoedema?
Saddle bags are commonly referred to as the fat pads on the buttocks, hips and inner knees. If the fat pads are painful and resist every diet and regular exercise, the saddle bags can be an indication of lipoedema. However, lipoedema can also be present without pronounced fat pads in the hip and buttock area if there are corresponding pain symptoms.
Note: Not all cases of breeches are pathological and indicative of lipoedema. Seek medical evaluation and advice if you have signs of lipoedema or are considering having your breeches removed by aesthetic surgery (liposuction – see below).
Differences between lipoedema and lymphoedema
Lipoedema is different from lymphoedema, which is an accumulation of lymphatic fluid in the tissue due to a blockage in the lymphatic system. These three main characteristics help to clearly distinguish between lipoedema and lymphoedema:
Lipoedema
- Lipoedema are tender to pressure and touch.
- Lipoedema always occur symmetrically, i.e. both legs are affected.
- Backs of hands and feet are unaffected.
Lymphoedema
- Lymphoedema do not usually cause pain.
- Lymphoedema usually occur unilaterally or asymmetrically.
- The back of the hands and feet are also affected.
Lipoedema with associated obesity
This mixed form exhibits the symptoms of lipoedema plus generalized fat proliferation throughout the body.
Note: Lipoedema must not be confused with obesity. In contrast to obesity, a generalized increase in adipose tissue throughout the body, dieting or increased exercise do not lead to a sufficient reduction of the diseased adipose tissue in the case of lipoedema. In addition, pain is always at the forefront of lipoedema, in the form of pressure, touch, spontaneous pain and a feeling of heaviness.
Treatment of lipoedema: diagnosis and therapy
Until lipoedema has been clearly diagnosed, many sufferers have usually been through a long history of suffering, often accompanied by severe psychological stress. Guideline-based therapy can do a lot to alleviate the symptoms. Those affected usually only seek medical advice when exercise and dieting have failed to produce results and the psychological strain becomes too great.
The most important tools for diagnosing lipoedema are taking the patient's medical history and a subsequent physical examination. During the examination, the doctor will ask about typical symptoms of the condition, such as pain or a feeling of heaviness. They will also perform a manual palpation of the patient and look for any symmetrical increases in adipose tissue on the legs and/or arms.
Hitherto, there is no laboratory test or imaging procedure that can be used to diagnose the disease with certainty.
The primary goal of lipoedema therapy is to reduce pain and other subjective symptoms to make everyday life easier for those affected.
How is lipoedema treated? With medical compression, exercise and movement, lymph drainage and more.
Medical compression
The basic therapy for reducing pain and other subjective symptoms (not for reducing fatty tissue) is the daily wearing of medical compression stockings as part of compression therapy. This can help to reduce pain and alleviate symptoms. Depending on the severity of the lipoedema, flat-knit MCS are usually used. Medical compression stockings are usually prescribed by a doctor and, unlike support stockings, are available from medical supply stores.
Skin care
In addition, the right skin care is extremely important when wearing medical compression stockings. The skin should always be cleaned and moisturized with pH-neutral products. This increases the elasticity of the skin, reduces irritation and makes the skin look better and feel softer – this also makes it easier to put on and wear the medical compression stockings.
Important: The hygiene products should be specially designed for medical compression stockings.
Sport and movement
In principle, movement in medical compression is an important element in pain reduction and should definitely be part of the overall therapeutic concept.
Regular physical activity can improve blood circulation, strengthen muscles and help control body weight.
Psychotherapy
Psychosocial support also assumes a central role in the holistic care of people with lipoedema and helps them to cope with the disease. This is because mental disorders can have a lasting effect on the symptoms and quality of life of people with lipoedema and should be taken into account in the diagnosis and treatment of lipoedema. These include, for example, eating disorders, depression, and post-traumatic symptoms after violence and abuse.
Nutrition
A balanced diet, such as the ketogenic or mediterranean diet, can help maintain a healthy weight, promote overall health, and reduce pain and discomfort.
Important: Radical diets are strongly discouraged because they do not achieve lasting success – instead, a permanent, healthy change in diet is the only sensible way for people with lipoedema.
Manual lymph drainage
If medical compression is not applicable in individual cases or does not lead to a reduction in pain when combined with other therapeutic techniques such as exercise and nutrition, the leading symptom of pain can be treated with additional manual lymph drainage.
Liposuction for lipoedema: surgical fat removal
If conservative therapy does not improve the lipoedema, liposuction of the legs and/or arms can be considered as a surgical method. Liposuction for lipoedema does not lead to a cure, but it can provide lasting pain relief and improve the quality of life of those affected.
Complex Physical Decongestion therapy (CPD) should be used for additive oedema and after liposuction. The aim of the treatment is to reduce fluid retention in the case of oedema and to loosen tissue induration. The five pillars of CPD are manual lymph drainage (MLD), medical compression therapy, sports and exercise, skin care, and education and training for individual self-therapy (self-management). CPD is divided into a decongestive phase and a subsequent maintenance phase.
Which doctor treats lipoedema?
Do you suspect that you’re suffering from lipoedema? Please discuss your observations with your general practitioner. If necessary, he/she will refer you to a specialist, such as a phlebologist (vein specialist), vascular specialist or lymphologist.
For lipoedema: medical compression stockings from medi
Medical compression stockings from medi can support you in lipoedema therapy, for example the flat-knitted medical compression stockings mediven cosy, including innovative lateral seam as an alternative to the rear seam, mediven 550 or mediven mondi.
Benefit from the wide range of mediven colors and patterns.
Diagnosis & therapy
Product tip
Patient stories
Health personnel will make the diagnosis and can prescribe compression stockings, e.g. from medi if necessary.
Your medical retailer will fit them individually for you.
Note / sources
The content was developed in accordance with European guidelines.
Source: Faerber G et al. S2k guideline lipedema. JDDG: Journal der Deutschen Dermatologischen Gesellschaft. 2024; 22: 1303–1315.
