Medicines for Lipoedema

What it is

Lipoedema is a long-term condition, affecting almost exclusively women, in which there is an abnormal, disproportionate build-up of fat, usually in the legs (from the hips to the ankles) and sometimes the arms, in a characteristically symmetrical pattern. A distinctive feature is that the feet (and hands) are typically spared, so the enlargement stops at the ankles (or wrists), which can give a "bracelet" effect. The affected areas are often tender or painful, feel different (sometimes with a nodular texture under the skin), bruise easily, and can feel heavy; the fat is resistant to diet and exercise, so it does not reduce with weight loss in the way other fat does, which can be distressing and is often misunderstood. Lipoedema is frequently mistaken for simple obesity or for lymphoedema (fluid swelling), and is under-recognised, so many women go a long time without a diagnosis. It is not caused by overeating, and the disproportion and pain are key features. It often begins or worsens at times of hormonal change (such as puberty, pregnancy, or the menopause), suggesting a hormonal influence, and can run in families. Over time it can progress and, in some, lead to associated lymphoedema (fluid swelling) if the lymphatic drainage becomes affected. Although lipoedema cannot be cured, recognising it and managing it supportively can improve symptoms and quality of life, and prevent complications.

How it is treated

There is no cure for lipoedema, so management focuses on relieving symptoms, maintaining mobility and function, preventing progression and complications, and supporting wellbeing, with a combination of measures and a supportive, understanding approach (as being misdiagnosed or told to "just lose weight" is common and unhelpful). Key measures include: compression therapy (such as compression garments), which helps with the heaviness, pain and any fluid, and is a mainstay; keeping active with low-impact exercise (such as walking, swimming or cycling), which supports mobility, general health and the circulation, even though it does not reduce the lipoedema fat itself; skin care and, where there is associated fluid swelling, techniques used for lymphoedema (such as manual lymphatic drainage); and support for pain and for the emotional impact. A healthy lifestyle and managing weight are encouraged for general health and because additional (ordinary) weight gain can worsen the situation, while explaining that the lipoedema fat itself is resistant to diet. In some cases, specialist treatments, including certain types of liposuction adapted for lipoedema, are considered by specialists for selected people. Recognising and diagnosing the condition, and access to specialist lymphoedema/lipoedema services, are valuable. The reassuring message is that lipoedema is a real, recognised condition — not simply obesity or a lack of willpower — and that, although it cannot be cured, supportive management (compression, activity, skin care and support) can improve symptoms, maintain function and quality of life, and help prevent complications.