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Where does lipedema come from? This question has ultimately not yet been answered. In many cases it seems certain that there is a genetic predisposition. For example, if your mother or grandmother has lipedema, she may have inherited the disease. Lipedema is not caused by being overweight. The number of fat cells is fixed until the age of 20, after that they can only get bigger. Lipedema is not only a simple enlargement of the fat cells, for example in the case of overweight, but also a change in the structure of the fatty tissue. It is therefore a disease in which the fatty tissue itself changes. For this reason, the disease cannot be influenced by weight loss – because the altered structure still remains.

How does lipedema develop?

The structure of the fatty tissue in the subcutis changes when lipedema occurs. On the one hand, the lymph vessels are unable to remove water properly, which eventually leads to chronic lymphedema. On the other hand, fibrosis (increase in connective tissue) and scarring of the subcutaneous adipose tissue occur. These scars can then be felt under the skin.

Background knowledge: Function of the lymph vessels in the body

The task of the lymphatic system is to collect lymph fluids from all parts of the body. It consists of the finest capillaries that converge into thicker vessels and, unlike the blood vessel system, is not a circulatory system.

The lymph vessels complement the body’s blood vessel system and transport body fluids, blood cells and nutrients (fats) that are secreted by the cells. The fine lymph capillary tissue water (so-called lymph) is absorbed and passes into the larger lymphatic vessels and finally into the blood vessel system of the upper vena cava. The lymphatic system thus forms a drainage system for the human tissue. The lymph vessels have valves that transport the lymph fluid through the body with their own muscle power. The lymph fluid is produced by pressing blood fluid from the arteries as interstitial fluid into the tissue and supplying the cells there with nutrients. This fluid is then removed via the lymph vessel system. If necessary, the lymph vessels can work faster and absorb and transport more fluid.

In lipedema patients, the permeability of the blood vessel capillaries is disturbed, resulting in increased fluid release into the connective tissue. The fat cells of the subcutis absorb this fluid and exert increased pressure on the vascular system, creating a vicious circle and releasing even more fluid from the blood vessels. The lymph vessels are compressed and can therefore transport less fluid away. This results in water accumulation in the tissue, a so-called edema.

Summary of the function of the lymphatic system:

  1. Arteries release fluid into the tissue to supply cells with nutrients
  2. Part of this liquid is absorbed and transported by the lymph capillaries
  3. The lymph system removes body fluids, blood cells and lipids and serves as a drainage system
  4. The lymph system returns the lymph fluid to the bloodstream

Microangiopathy in lipedema

Lipedema also affects the smallest blood vessels (microangiopathy) and as a result they become more permeable. Due to this, blood can more easily escape into the surrounding fatty tissue and be absorbed there, leading to bruises. Not only blood, but also water escapes into the tissue and causes edemas, which can strongly tension the tissue. This accumulation of water finally causes pressure pain – a leading symptom of lipedema.

Good to know: Lipedema usually develops or can worsen when there are hormonal changes, such as during puberty, pregnancy or the menopause.

If lipedema remains untreated for years, it disrupts the lymphatic drainage and increasingly strains the lymphatic vessels. This can lead to lymphedema in addition to lipedema.

Hormonal causes: Lipoedema expert Dr. Katrin Lossagk answers the most frequently asked questions.

How is the development or outbreak of lipedema related to the birth control pill?

A connection has not yet been scientifically proven. However, some patients attribute a worsening or the onset of the disease to taking the pill. These cases are not evidence-based.

Is there a connection between lipedema and thyroid insufficiency?

Here, too, there is no correlation that can be proven. Nevertheless, we have been able to detect frequent hypothyroidism (a lack of thyroid hormones triiodothyronine and thyroxine in the body) and hashimoto (thyroid inflammation) in lipedema patients for years.

Is there a connection between lipedema and progesterone/progesterone deficiency?

Progesterone deficiency causes a tendency to edema, so an additional deficiency of progesterone can lead to a worsening of lipedema.