Lipoedema: what it is, symptoms, causes and treatments

Lipoedema is a chronic fat tissue disease that mainly affects women: fat builds up disproportionately and symmetrically in the buttocks, thighs and legs, and sometimes the arms, and is often accompanied by pain, heaviness and easy bruising. It is frequently mistaken for obesity or lymphoedema, which delays diagnosis. There is no known cure, but there are measures and treatments that relieve the symptoms.

What is lipoedema?

According to the UK National Health Service (NHS), lipoedema is an abnormal build-up of fat in the legs and, sometimes, the arms. It affects both sides of the body equally and is more common in women. It can make the buttocks, thighs and lower legs look out of proportion with the rest of the body, while the feet and hands are not usually affected.

It is a little-recognised condition. According to the review by Kruppa and colleagues published in 2020, lipoedema is estimated to affect around 10 % of women and is often not identified or is wrongly diagnosed. This is an estimate, not a fixed figure.

What are the symptoms of lipoedema?

The NHS describes the following signs of lipoedema:

• Bulkier legs, with a narrow waist and a smaller upper body, especially in the early stages.
• Soft skin that feels cold to the touch and sometimes has an orange-peel texture.
• Pain, tenderness or a feeling of heaviness in the affected areas.
• A tendency to bruise easily.

Everyone experiences it differently. Some people have mild symptoms that barely affect their daily lives, while others find it limits their movement and has a significant emotional impact. Both are compatible with lipoedema.

If a leg swells up, turns red, hot and painful and you also have a fever or flu-like symptoms, do not put it down to lipoedema: the NHS advises seeking urgent medical attention, because it could be a skin infection.

What causes lipoedema?

The exact cause is not clear. Kruppa and colleagues put forward as hypotheses an alteration in the formation of fat cells, damage to small vessels and impaired lymphatic circulation, although no specific blood marker has been found. What is known is that:

• Hormones seem to play a part. The NHS links it to hormonal changes such as puberty, pregnancy, the menopause or taking oral contraceptives.
• There is a family component. According to the NHS, it sometimes occurs in several members of the same family.
• It is not caused by being overweight. You can have a healthy weight and still have lipoedema.

The fact that it does not depend on what you eat has a practical consequence: it is not a failure of discipline. Diet and exercise remain advisable for your health, but on their own they may not be enough to reduce the fat typical of lipoedema.

What are the stages of lipoedema?

Kruppa and colleagues describe three clinical stages, according to how the skin surface changes and what can be felt underneath:

• Stage I: smooth skin, with small nodules and swelling that can go down.
• Stage II: an uneven or wavy surface, with nodules the size of a walnut and swelling that may or may not be reversible.
• Stage III: very thickened and hardened skin, with bulky, deforming fat deposits and, often, associated lymphoedema.

Symptoms and discomfort do not always match the stage: an early stage can also hurt and affect daily life.

How do you tell lipoedema from obesity and lymphoedema?

They are confused because in all three there are larger legs, but they are different conditions:

• Lipoedema: symmetrical fat build-up in the legs and sometimes the arms, with pain and bruising, and without affecting the feet or hands.
• Obesity: increased fat throughout the body, including the trunk, which usually reduces when weight is lost.
• Lymphoedema: swelling from fluid build-up when the lymphatic system is not working properly. According to the NHS, it can appear anywhere on the body, although it is usually in the arms or legs, and it shows as swelling of a whole limb or part of one.

All three can coexist, which is why the diagnosis needs to be assessed by a professional.

How is lipoedema diagnosed?

There is no blood test or imaging scan that confirms it. Kruppa and colleagues explain that diagnosis is currently made on clinical criteria alone: the history, the examination and the appearance of the limbs. Complementary tests are used only to rule out other diagnoses.

These criteria include symmetrical involvement of the limbs that spares the hands and feet, a feeling of heaviness and tension, pain on pressure or touch, a tendency to bruise, a leg contour that does not shrink even if you lose weight and symptoms that get worse through the day.

If you suspect you have lipoedema, the NHS advises starting with your GP, who can refer you to a specialist.

What treatments are there for lipoedema?

Conservative measures

These are the starting point. The NHS mentions healthy eating, more exercise and keeping to a suitable weight, compression stockings or bandages to reduce pain and discomfort, skin care with moisturisers and psychological support if lipoedema affects your mood.

A systematic review published in 2026 by Vazirnia and colleagues, which selected 61 of 339 articles, places some eating patterns, compression therapy and exercise in water among the measures associated with less pain and swelling. Most of the studies were observational, and randomised trials were scarce.

On diet, Kruppa and colleagues warn that no diet has solid evidence for lipoedema, because no randomised trials have been published. Even so, normalising weight can improve symptoms, and since many patients also have an eating disorder, they recommend that dietary changes be made, whenever possible, with the support of a psychologist. Exercise, according to the same review, is adapted to each person and their stage: walking, which activates the calf muscle pump without punishing the tissue, and exercise in water, such as swimming or aqua aerobics, which also puts less load on the joints.

In aesthetic medicine, pressotherapy applies intermittent compression to the legs and is used as a complement to these measures. It does not change the fat tissue.

Liposuction in lipoedema

When symptoms are significant and conservative measures are not enough, liposuction can be considered. The NHS includes it among the options for the most severe cases and warns that more than one operation may be needed. Kruppa and colleagues report that, in observational studies, liposuction relieves symptoms markedly with few complications, but warn that the quality of the evidence for any treatment is low.

The 2026 Vazirnia review agrees that tumescent liposuction has the strongest evidence for maintaining improvement in symptoms, mobility and quality of life. In lipoedema, techniques such as tumescent or water-assisted liposuction are used, which aim to preserve the lymphatic vessels. It is not a cosmetic operation and does not cure the disease: it is considered to relieve pain and improve mobility, and the surgeon tells you at the consultation whether it is suitable for you, which areas would be treated and how many sessions might be needed.

If you are looking for information on the technique, it is on the liposuction page and, for the legs, on the one for thigh liposuction. It is surgery and, as such, has risks: the surgeon details them before you decide.

What can you do if you think you have lipoedema?

• Note when your legs hurt and whether they get worse at certain times of the month or day.
• Write down your family history, because lipoedema can run in families.
• Do not settle for the idea that it is just being overweight. If you have dieted and exercised and the fat in your legs does not change, it is worth asking.
• Ask for an in-person assessment. Take these notes with you: they help distinguish lipoedema from other causes.

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