Many affected women find it particularly frustrating that despite healthy eating, diets, and regular physical activity, no positive change is achieved. The feeling of being helplessly at the mercy of one’s own body represents a significant psychological burden – often accompanied by shame, withdrawal, and the impression of not being taken seriously.

In addition to the visual change, the main symptom of lipedema is pain:
A feeling of tension, increased sensitivity to pressure and touch, as well as a deep-seated, pulling pain in the arms and/or legs are crucial for diagnosis. These complaints occur independently of physical exertion and clearly distinguish lipedema from other fat distribution disorders.

Other typical symptoms include:

• Feeling of heaviness, especially increasing throughout the day
• Spontaneous bruising without apparent cause
• Feeling of coldness in the affected limbs
• Hands and feet are slim and not affected – which helps to distinguish it from lymphedema

Important: The severity of symptoms can vary greatly from woman to woman. It is precisely this diversity of manifestations that makes diagnosis difficult.
Many patients report years of complaints, frustrating doctor visits, and misdiagnoses before finally receiving a clear and accurate diagnosis.

Stage I

The skin surface still appears smooth and regular. The subcutaneous adipose tissue is soft, uniformly thickened, and shows a fine nodular pattern under pressure – comparable to small pearls under the skin. Many patients already experience severe pain and a distinct feeling of tension at this point, even if only minor changes are visible externally.

Stage II

The skin begins to become uneven, visible dents and waves form. The adipose tissue is significantly thickened and feels coarsely nodular when palpated. Even at rest or when sitting, the change in body contour remains noticeable. Pain, pressure sensitivity, and movement restrictions generally increase.

Stage III

The subcutaneous fat tissue is massively increased, the nodules are large and hardened. Pronounced tissue deformations occur with overhanging fat flaps – especially on the thighs, hips, upper arms, and in the knee area. This can lead to the formation of so-called dewlaps: heavily hanging, bulging fat deposits that further restrict mobility and are often accompanied by skin irritations.

The skin appears partly coarsely textured, and the affected body regions can be severely impaired in everyday life – both functionally and psychologically. At this stage, there is also an increased risk of secondary lymphatic drainage disorders.

Stage IV – Lipo-Lymphodema

In advanced stages, lipedema can overlap with secondary lymphedema. There is an additional accumulation of lymphatic fluid in the tissue – especially in the feet and hands, which were typically spared in pure lipedema. In this so-called lipo-lymphedema, in addition to the typical lipedema symptoms, swelling, feelings of tension, and thickening of the skin (fibrosis) also occur.

Treatment becomes more complex at this stage, as measures to promote lymphatic drainage are now also necessary. This makes early diagnosis all the more important to prevent the progression of the disease as much as possible.

Hormonal triggers

Lipedema occurs almost exclusively in women – and usually begins during hormonal transition phases such as puberty, pregnancy, or menopause. This suggests that female sex hormones, especially estrogens, play a central role in the development of the disease. During these life phases, initial symptoms may appear or existing complaints may significantly increase.

Genetic Predisposition

In many cases, patients report that other women in the family – mothers, aunts, or sisters – exhibit similar complaints or body changes. This indicates a hereditary component. It is presumed that there is an innate disorder in the regulation of adipose tissue that increasingly manifests itself over the course of life.

Altered Fat Distribution and Microcirculation

The adipose tissue in lipedema differs structurally from healthy adipose tissue. It grows uncontrollably, stores more fluid, and is less well-perfused. This leads to a congestion in the microcirculation, which can promote inflammatory processes, pain, and increased pressure sensitivity. Impaired lymphatic drainage may also play a role in the further course of the disease.

Not a Result of Obesity

A common misconception: Lipedema is not caused by obesity – however, it can occur in parallel or be exacerbated by additional weight gain. Important to note: Even through diets or physical activity, the pathologically altered adipose tissue cannot be specifically reduced – which is particularly frustrating for many affected women.

Anamnesis – the personal conversation

The focus is initially on a detailed discussion about:

• Onset and course of symptoms
• Pain, pressure sensitivity, and tendency to swell
• Changes during hormonal transitions (e.g., puberty, pregnancy, menopause)
• Family history of similar symptoms
• Impact on daily life, mobility, and mental health
• Previous measures such as diets, exercise, or compression

It is particularly important to record where and when pain occurs, as this is a central feature of lipedema and helps in distinguishing it from other conditions.

Physical examination

Subsequently, a targeted examination of the body is carried out, especially of the legs and arms:

• Assessment and measurement of body proportions (disproportionate fat distribution)
• Checking for pressure sensitivity and feeling of tension
• Palpation (touching) of the tissue – fine nodular, later coarse nodular
• Observation of tendency to bruise and temperature differences
• Checking the feet and hands – typically slim and unaffected in lipedema

The so-called Stemmer sign (ability to lift a skin fold over the toes or not) can also provide clues – it is typically negative in lipedema, while it can be positive in lymphedema.

Further examinations

In certain cases, additional measures may be useful – especially to differentiate from other conditions, such as venous or lymphatic disorders:

• Color-coded duplex sonography to assess venous vessels – important to rule out chronic venous insufficiency, varicose veins, or thrombosis
• Sonography (ultrasound) of the fatty and subcutaneous tissue to visualize the tissue structure
• Lymphoscintigraphy or lymph flow measurement, only if additional lymphedema is suspected
• Imaging procedures (e.g., MRI) for unclear findings or to rule out other causes
• Laboratory tests, e.g., to check for inflammation, hormone levels, or thyroid function

Important: The variety of symptoms and the often inconspicuous external appearance – especially in early stages – make diagnosis challenging. This makes it all the more important to consult an experienced specialist or specialized doctor who can reliably recognize lipedema and distinguish it from other conditions such as obesity, lymph or vein diseases.

The initial diagnosis is often made by a phlebologist, a vascular surgeon, or a dermatologist with special knowledge in this field. One of these specialties should also be chosen as the first point of contact if lipedema is suspected.

The following measures are an integral part of conservative treatment:

1. Compression therapy
Wearing flat-knitted compression stockings or pants is one of the most important basic measures. Compression promotes venous return, supports lymph drainage, and can reduce swelling and feelings of tension.
It’s important that the compression is individually adjusted and regularly renewed. Especially in everyday life – particularly when sitting or standing – compression can significantly alleviate symptoms.

2. Manual lymphatic drainage (MLD)
In case of additional lymphatic congestion or pronounced tendency to swell, regular manual lymphatic drainage can be beneficial. MLD can relieve pain, reduce tissue tension, and improve mobility.

3. Exercise therapy
Regular, joint-friendly exercise is essential – not only for general well-being but also to support the lymphatic and venous systems. Particularly recommended are swimming and aqua fitness, cycling, walking or Nordic walking, and special physiotherapy with lymphatic gymnastics.
Important: Exercise should be done regularly – but without overexertion. Many patients benefit from individually supervised training programs.

4. Skin care
Due to compression and possible skin folds in advanced cases, the skin of lipedema patients is often dry and prone to irritation. Consistent, moisturizing skin care prevents inflammation and eczema and supports the skin barrier.

5. Nutrition and weight regulation
Even though lipedema is not caused by being overweight, maintaining a healthy body weight can help avoid additional stress and reduce symptoms.
A balanced, anti-inflammatory diet (e.g., Mediterranean diet, low in sugar and highly processed foods) is recommended. Radical diets, on the other hand, often lead to frustration – and can negatively affect metabolism.

Important: Conservative measures cannot reduce the pathologically altered fatty tissue – they serve for symptom control and stabilization. A permanent volume reduction is only possible through liposuction. Nevertheless, conservative therapies form an important part of treatment before and after surgery.