What Is Lipedema?

First…Let's Explain what Lipedema is NOT!!

LIPEDEMA IS NOT OBESITY. Biopsies of lipedema prove that lipedema cells are fibrotic, inflamed and surrounded by an abnormal extracellular matrix, unlike the hypertrophic but metabolically active fat cells seen in obesity. Lipedema is a disorder of connective tissue and lymphatic function, and a distinct pathological entity, not simply excess calorie storage (Prelinger, E. 2021)

LIPEDEMA IS NOT CELLULITE!! Cellulite consists of fibrous septae which are collagen-rich bands running perpendicular to the skin, anchoring, or tethering, the dermis down to the fascia below, allowing fat globules to bulge upward between these tethers. This creates the dimpled appearance.

LIPEDEMA fat accumulates deeper with horizontal fibrosis, no tethering to the fascia. There is painful, nodular formations, often enclosed in compartments, and inflammation (cytokines, macrophages) (Fonder, 2010).

Imagine gaining weight in your legs, hips, and arms—no matter how well you eat or how hard you exercise, it does not go away. And it is painful. Now imagine being told it's just obesity, that it is your fault. You need to eat right, move more. This is the real story of millions of women that are living with lipedema—A condition that is real, biological, and tragically misdiagnosed.

Lipedema is a chronic connective tissue disorder, often associated with Ehlers Danlos Syndrome, that affects the lymphatic tissues, as well. It causes symmetrical fat accumulation, most often in the legs, hips, and arms, sparing the hands and feet. The fat is fibrotic, painful, bruise-prone, and highly resistant to calorie restriction or exercise. And it’s not rare—it’s just under recognized and under diagnosed. Most patients are gas-lighted and told to 'just move move, exercise more, diet more'.

What Causes Lipedema?

It is well known that LIPEDEMA occurs at times of stress, hormonal shifts—puberty, pregnancy, perimenopause, and even pre menopause (times of progesterone decline) menopause use of synthetic contraception. These are all times when estrogen surges, especially in women who may lack enough progesterone or testosterone to keep estrogen’s proliferative effects in check.

The Estrogen Metabolism Pathway

But it’s not just the amount of estrogen—it’s how the body metabolizes it. When it comes to Hormones, we have to USE THEM, AND LOSE THEM! Estrogen is broken down into different metabolites. Progesterone ,and even Testosterone, are protective. In puberty, when hormones are rushing out the gate, bombarding the young girl's body at sometimes very high levels, the body may not be able to effectively metabolize and dispose of the metabolites properly. In pre- peri- and post- menopause, when both of those have declined and Estrogen and its metabolites are left, weight gain can occur as ESTROGEN DOMINANCE gets worse. if genetically pre-disposed, this can be LIPEDEMA.

There are genetic variants like COMT, MTHFR, and CYP1B1, which impair estrogen detoxification and clearance. There are others that affect the way we store and burn fat.

The DUTCH test gives us a clear picture of the hormones and the metabolites. We can form a personalized plan for you!

The Role of Stress and Synthetic Hormones

Add in chronic stress, and the picture becomes even clearer. Cortisol, the primary stress hormone, increases insulin , cortisol, insulin resistance, drives inflammation, and further disrupts hormonal balance. Stress also aromatizes testosterone Ito more estrogen. High Cortisol = Weight Gain. With high cortisol, GLP1s might not even work.

Synthetic birth control ) (Medrosyprogestins, Medrosyprogesterones, Prempro, provera)—while often prescribed to help—can actually worsen the issue by introducing non-bioidentical hormones that suppress natural rhythms and burden the liver’s detox pathways. The enzymes of the body that break down hormones were not made to break down these synthetic chemicals. As far as hormones go, we are supposed to USE THEM AND LOOSE THEM. We cannot loose these efficiently.

Biological Behavior of Lipedema Fat: INFLAMMAITON!

At the tissue level, lipedema fat is biologically active. It’s hypoxic, fibrotic, and resistant to breakdown. These fibrotic bands of collagen enclose the fibrosed adipocytes (nodules) and the extracellular matrix (ECM) that invites macrophages, inflammatory cytokines. Aromatase from the fat cells cause more estrogen and more fat into this Compartment Syndrome. It is a vicious cycle that has to be broken! It doesn’t just sit there—it causes pain, heaviness, swelling, and can have emotional and psychological impact.