Lipedema is a chronic disease that mainly affects women, characterised by the abnormal accumulation of fatty tissue in the limbs, especially in the legs and, to a lesser extent, the arms. Despite its high prevalence and the impact it has on quality of life, its exact causes are still being studied. Understanding what causes lipedema is essential not only to initiate appropriate treatment, but also to achieve an early and accurate diagnosis of lipedema, avoiding confusion with other pathologies. Throughout this article, we will explore the most relevant factors that contribute to its onset, from hormonal changes to genetic predisposition.
The development of lipedema cannot be attributed to a single cause. Various studies indicate that it is a multifactorial disease involving endocrine, hereditary and environmental components. Its onset often coincides with times of significant hormonal changes in a woman’s life, such as puberty, pregnancy, or menopause. In addition, there is a clear familial predisposition, suggesting a strong genetic component. These factors, combined with a general lack of knowledge about the disease, contribute to late diagnosis and inadequate treatment in the early stages.
One of the most consistent factors in the onset of lipedema is the hormonal component. Most cases diagnosed in women are associated with periods of intense hormonal transition, suggesting a strong relationship between endocrine fluctuations and the development of this condition. This hormonal influence not only affects the distribution of adipose tissue, but also the response of the lymphatic and vascular systems, thus contributing to the inflammation and pain characteristic of lipedema. This is why it commonly appears during puberty, worsens during pregnancy and menopause, and can be aggravated by the use of oral contraceptives or infertility treatments.
Numerous clinical studies agree that the phases of greatest risk for the development or worsening of lipedema are puberty, pregnancy, and menopause. These stages involve drastic hormonal changes that often coincide with the appearance of the first symptoms of lipedema (such as increased volume in the legs and pain when touched), especially related to oestrogen and progesterone levels, which can alter the metabolism of adipocytes and promote their disproportionate accumulation in the legs and arms. For this reason, many patients report that their lipedema began or worsened at one of these times in their lives.
In addition to natural physiological changes, some women with lipedema have endocrine disorders such as thyroid dysfunction or polycystic ovary syndrome (PCOS), reinforcing the hypothesis of an underlying hormonal cause. These alterations can affect overall hormonal balance, leading to increased susceptibility to localised fat accumulation. Although further research is still needed, the link between the endocrine system and lipedema is becoming increasingly evident and should be considered in the diagnosis and comprehensive treatment of the disease.
Genetic inheritance is one of the strongest hypotheses when attempting to explain what causes lipedema. It is estimated that between 60% and 80% of patients with a confirmed diagnosis have a direct family history with compatible signs, although they may not always have received a formal diagnosis, and it is more closely related to paternal inheritance. This observation supports the idea that the cause of lipedema could be partly encoded in DNA, which would explain its early onset and resistance to conventional diets or exercise.
Everything seems to indicate that it is. Although no specific gene responsible has yet been identified, various clinical studies have found repetitive family patterns that point to a hereditary transmission of lipedema, probably of the autosomal dominant type with variable expression. This means that a person can inherit a predisposition to developing lipedema, but the manifestation of the disease will also depend on other factors, such as hormonal changes, a sedentary lifestyle, or diet.
Recent research, such as the study “The Advanced Care Study” co-authored by Dr. Carballeira in 2023, has provided valuable data on the familial prevalence of lipedema in more than 1,000 Spanish patients. Although genetic studies are still in the preliminary stages, variants have been identified in genes related to lipid metabolism and connective tissue structure that could be involved in the origin of the disease. These findings reinforce the need for a multidisciplinary approach that considers the genetic basis as part of the diagnostic evaluation.
One of the most common mistakes is to confuse lipedema with obesity. Unlike obesity, lipedema cannot be resolved through diet or exercise and disproportionately affects the legs and arms, while sparing the hands, feet and torso. Although both conditions can coexist, their causes are different: obesity is mainly due to a sustained energy imbalance, while lipedema has a structural, hormonal and possibly genetic origin. Understanding this difference is key to avoiding misdiagnosis and applying the appropriate treatment.
A sedentary lifestyle, an unbalanced diet or prolonged exposure to chronic stress do not cause lipedema on their own, but they can contribute to its progression in genetically predisposed patients. In addition, these factors can worsen symptoms such as heaviness, swelling, and pain in the legs. Although Lipedema is not caused by poor diet or excess weight, a healthy lifestyle can help control systemic inflammation and improve the quality of life for those who suffer from it.
Although hormonal and genetic factors are the most widely studied, the development of lipedema may also be influenced by environmental and lifestyle factors. While these variables are not considered direct causes of lipedema, they could act as triggers or aggravating factors in predisposed individuals. Therefore, understanding these elements helps to provide a more complete picture of what causes lipedema and how it manifests in each patient.
The legs are the area most commonly affected by lipoedema, and in many cases this is where the first signs appear. This characteristic distribution is not coincidental: the accumulation of subcutaneous fatty tissue in the lower extremities seems to be related to an alteration in the response of the lymphatic and microcirculatory systems, which are particularly sensitive to hormonal variations. The causes of lipedema in the legs do not differ substantially from the general causes, but anatomical morphology, gravitational pressure and local metabolic changes can accelerate its progression.
In the early stages, the increase in volume may be slight and confused with cellulite or fluid retention. Over time, the fat becomes more fibrous, painful and resistant to conventional treatment, which highlights the importance of early diagnosis.
The total percentage of patients with lipoedema who present vascular alterations, considering both venous alterations (such as varicose veins or chronic venous disease) and lymphatic alterations, is estimated to be over 90%. According to a recent study, the prevalence of chronic venous disease was 86.2%, while subclinical lymphatic alterations detected by lymphoscintigraphy were observed in 76.5% of cases. Given that there is overlap between the two groups, the most recent studies report that the combined range of vascular disorders (venous and/or lymphatic) in patients with lipedema is between 90% and 95%. Early diagnosis and treatment are therefore important.
If you notice that your legs are disproportionately swollen, accompanied by pain, heaviness or easy bruising, it is essential to see a lipedema specialist. The diagnosis must be clinical and made by an experienced professional, as lipedema can go unnoticed in general consultations or be confused with other conditions such as lymphedema or obesity.
At Lipedema Advanced Care, we offer a comprehensive assessment that includes medical diagnosis, analysis of the stage of the disease, and a tailored treatment plan. The sooner the diagnosis is confirmed, the greater the chances of controlling the progression of the disease and improving the patient’s quality of life.
If you still have questions about the origin and progression of this disease, we recommend consulting our frequently asked questions section on lipedema, where we address the most common concerns with reliable medical information. Although there is no single cause, hormonal factors, genetic predisposition, and certain environmental triggers act together to promote its onset and development. The key is a rigorous, individualised, and multidisciplinary medical approach.
At Lipedema Advanced Care, under the direction of Dr Alexo Carballeira, we treat each case with the seriousness it deserves, combining advanced surgery with nutritional, physiotherapeutic and psychological support. Because knowledge is power, and understanding the causes of lipedema can make the difference between living with pain and regaining your well-being.
