How do I recognise lipedema?

Many affected women suffer from lipedema for years before a diagnosis is even made. Especially in the early stages, lipedema is often not recognised as such and is mistaken for simple being overweight or obese. Unfortunately, such a misdiagnosis can result in patients feeling misunderstood, thereby losing confidence in doctors and failing to receive early treatment.

To help you take the first step on the path to a symptom-free life, the LIPOCURA® team has developed various tests for conducting an initial self-diagnosis. Our experienced team of doctors can help you establish a well-founded diagnosis with subsequent individual treatment planning (conservative treatment or liposuction).

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Symmetrical proliferation of the subcutaneous fatty tissue

A symmetrical increase in subcutaneous fatty tissue, especially above or below the knees and in the triceps area of the arms, is typical of lipoedema. This increase in fat (“dewlap”) causes pain and tenderness, among other things.

Fat pad under the knee

A typical feature of lipoedema is the pronounced accumulation of fat on the inside of the knee. These fat pads can cause pain and visually deform the knee. The fat pads also make it difficult to bend and stretch the knee.

Riding breeches
(Suave pants phenomenon)

A typical fat distribution in lipoedema is the increased accumulation of fat in the hips and thighs. This increase in fat leads to an appearance reminiscent of saddlebags. Those affected often experience a disproportionate figure with a narrow waist and wide hips. The conspicuous waist-hip ratio characterizes the disproportion in lipoedema, in contrast to a generally increased BMI.

Swollen extremities

The legs tend to swell more in the evening as lymphatic fluid collects around the fatty tissue. This leads to an unpleasant feeling of tension and tenderness. The swelling can increase during the course of the day and is not equally pronounced in all lipoedema patients.

Disproportion

Lipoedema causes a disproportionate increase in fatty tissue, particularly on the arms and legs. The rest of the body often remains slimmer, which leads to an unbalanced body image. Those affected therefore do not gain weight over their entire body, but mainly on the extremities.

Column leg
(Muff phenomenon)

The legs look like columns due to the uniform accumulation of fat from top to bottom, hence the term “columnar leg”. The feet often remain slim, while a muff-like widening becomes visible from the joints. This accumulation of fat on the ankles of the feet and hands is also referred to as caliber jump.

Misalignment of the joints

Axial misalignment of the knee joints, also known as knock-knees or genoa valga, is a common consequence of lipoedema with a pronounced increase in volume in the thigh. This misalignment leads to increased strain on the knees and can cause skin irritation due to friction.

Mattress phenomenon

As lipoedema progresses, the swollen fatty tissue stretches the skin and connective tissue considerably. This results in visible indentations, making the skin look like a mattress. This phenomenon is visually similar to cellulite, but is caused by the particular fat distribution of lipoedema.

Tendency to bruise

Lipoedema patients tend to bruise quickly, even with light touches or bumps. This is due to the fragile capillaries, which are particularly vulnerable to increased fat and lymph retention. The bruises can be painful and slow to heal.

Hardening of the fatty tissue
(liposclerosis)

In the advanced stages of lipoedema, the fatty tissue can harden. This so-called liposclerosis is a sign of scar tissue remodeling and can lead to a further worsening of the symptoms, such as an increase in lipoedema pain.

Psychosocial factors

Mental strain such as stress or depression can exacerbate lipoedema symptoms. Some sufferers experience symptoms for the first time in times of great emotional stress, which indicates the interaction between the psyche and the body. The hormone cortisol can often play a role. If the cortisol level is elevated for a long time, temporary swelling or even a lipoedema flare-up can be caused.

Feeling cold

Some areas of the body, particularly the arms and legs, often feel colder than other areas. This is due to poorer blood circulation in the fatty tissue. Those affected report that it takes significantly longer for these areas to warm up again, which is particularly unpleasant in winter.

Pain at rest

Even without external influence or movement, many sufferers experience pain that can be felt during periods of rest. This pain at rest can be caused by the pressure of the fatty tissue on the nerves. Those affected report dull, aching pain that significantly impairs their quality of life. This pain can also be an expression of chronic inflammation in the fatty tissue.

Chronic inflammation

The fatty tissue tends to become chronically inflamed, which manifests itself as permanent pain in the connective tissue. This inflammation leads to further damage to the tissue and makes the healing process more difficult. They contribute significantly to an increase in the sensation of pain.

Hormonal imbalance

There is evidence that an imbalance of steroid hormones, particularly oestrogen and progesterone, influences lipoedema. These hormones can influence both the volume of fatty tissue and the perception of pain.

Tingling

A common symptom of lipoedema is the feeling of tingling or numbness in the affected areas of the body. This tingling can intensify over time and is often uncomfortable. It indicates impaired nerve function due to the increase in fatty tissue.

Hypermobility

The joints of lipoedema patients are often hypermobile, i.e. excessively mobile. This can lead to further problems such as joint pain and an increased susceptibility to injury.

Enlarged fat cells

The fat cells in lipoedema patients are significantly enlarged compared to healthy people with a similar BMI. These enlarged cells store more fat and contribute to the characteristic fat accumulation.

Pinching pain and tenderness

Even light pressure, such as pinching the skin, causes pain. This is characteristic of lipoedema and is often described as burning or stabbing and sometimes also unnaturally long-lasting. The pain can intensify as the lipoedema progresses.

Increased complaints due to hormonal upheaval

Lipoedema often manifests itself for the first time or worsens during periods of hormonal changes such as puberty, hormone treatments, pregnancy or the menopause. These phases intensify the increase in fat and the sensation of pain.

Pain behavior

The pain associated with lipoedema is multifaceted and varies from patient to patient. Some sufferers describe the pain as a dull ache, while others experience stabbing or burning pain. As the disease progresses, both the frequency and intensity of the pain can increase.

Tiredness/exhaustion/fatigue syndrome

Many sufferers suffer from constant tiredness and exhaustion. This chronic exhaustion, also known as fatigue, can severely restrict daily life. It is often a result of chronic inflammation in the body and constant pain.

Do these lipedema symptoms apply to me?

Lipoedema is a serious condition that can cause physical and emotional distress. Typical symptoms include tenderness, swelling and the appearance of bruising. In advanced stages, mattress phenomena, inflammation and even lymphoedema can also occur, which can severely affect quality of life and often leads to social withdrawal.

If you recognize yourself in these symptoms, you may have lipoedema. We are here to support you – talk to us and let us work together to find the best way forward for you.

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Lipedema self-test

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How can I test if I have lipedema? The pinch test

The biggest difference between lipedema and ordinary obesity is that lipedema causes pain and the distribution of fat is disproportionate and uncontrolled on the body. In addition, lipedema fat is often sensitive to pressure, promotes bruising and becomes hard and knotty in advanced stages.

A simple pinch test can often tell you whether you have lipedema. To do this, pinch the skin lightly in the areas of the body that may be affected. If you experience disproportionate pain, you may suspect lipedema. In this case, the next step is to get a medical diagnosis.

Lipedema or overweight? BMI Calculator & Waist-to-Hip Ratio

Normal or excessive weight can be calculated using the body mass index formulas.

The body mass index (BMI) is calculated by dividing the body weight in kilograms by the height in metres squared (kg/m²). The World Health Organisation (WHO) distinguishes between six categories:

  • Underweight: <18.5
  • Normal weight: 18.5 – 24.9
  • Overweight: ≥ 25
  • Preadiposity: 25 – 29.9
  • Obesity grade I: 30 – 34.9
  • Obesity grade II: 35 – 39.9
  • Obesity grade III: ≥ 40

Since lipedema does not follow the usual distribution of fat, it is usually not possible to make any meaningful measurements using the BMI. However, a calculation is often used as a supportive initial diagnosis. In lipedema patients, the quotient is often 30 or higher, which would correspond to grade I obesity. However, if only individual areas of the body (arms or legs) are affected while other areas remain slim, it is a clear sign of lipedema.

A more meaningful way to measure lipedema is to calculate the waist to hip ratio, as afflicted people often have a slim midsection and increased fatty tissue from the hips up.

The Waist to Hip Ratio (WHR) is the ratio of the waist circumference to the hip circumference in centimetres (WHR = waist circumference/hip circumference). The World Health Organisation (WHO) distinguishes between three categories:

HEALTH RISK WAIST TO HIP RATIO
Low ≤ 0.80
Medium 0.81 – 0.85
High ≥ 0.86

The decisive factor for the diagnosis of lipedema is ultimately the examination by an experienced specialist. Nevertheless, the WHR measurement gives patients a good initial indication, since the fat distribution is also calculated; therefore, it can be a meaningful indication for a pathological fat distribution disorder.

lipoedem-diagnose-sonografische-kriterien

Sonographic criteria for the diagnosis of Lipedema

An important aspect in the diagnosis of Lipedema are sonographic examinations, which make it possible to measure the thickness of the epidermis (cutis) and the underlying connective and fatty tissue (subcutis). This method offers an objective and standardized way to determine the extent of the fatty tissue proliferation and to better classify Lipedema. One approach that is often used in this context is the Marshall and Sehwahn-Schreiber classification.

The measurement is taken approximately 6 to 8 cm above the medial malleolus (inner ankle). The sonographic measurement of the thickness of the cutis and subcutis provides important information on how severe the Lipedema is.

  • 12 to 15 mm: Mild Lipedema or lipohyperplasia
  • 15 to 20 mm: Moderate Lipedema
  • 20 to 30 mm: Pronounced Lipedema
  • More than 30 mm: Severe Lipedema

These measurements not only help the treating doctor to classify Lipedema into different degrees of severity, but also to plan the appropriate individual therapy.

While the clinical diagnosis of Lipedema is in most cases based on a detailed medical history, visual inspection and palpation, sonography offers a complementary objective method. By measuring the thickness of the tissue, the extent of the fatty tissue can be precisely determined, which is particularly helpful in cases where visual inspection alone does not provide clear results.

Opinions or diagnoses made without a thorough examination can be flawed and should therefore be treated with caution.

How can I tell the difference between lipedema and lymphoedema?

Lipedema and lymphoedema are both conditions of the tissues that can cause swelling. Although they sound similar and are often confused, they have different causes and symptoms.

Lipedema and lymphoedema can also occur together, as so-called lipo-lymphoedema. Lipedema that goes untreated for a long time can result in the development of lymphoedema, which is why the earliest possible diagnosis and treatment tailored to the individual patient is necessary.

Lipedema Lymphoedema
Emergence Formation of abnormal fatty tissue that is irregularly distributed. Disorder in the lymphatic system - fluid build-up in the tissues
Symptoms Occurs symmetrically, pain, tenderness, heaviness in the legs, tendency to bruise, ... Swelling is often stronger in one part of the body, skin is tense and hard, skin changes possible in advanced stages
Time of occurrence Begins at puberty, pregnancy or menopause. Worsening over time possible. After previous illness, infection or surgery, especially if lymph nodes have been removed.
Side effects Restrictions in mobility/axial malposition and joint damage as well as inflammation of the skin flaps possible. Repeated skin infections and thickening.
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