It’s completely valid that progression is the top concern for most people living with lipedema. Because most patients discover the condition through online research, they are immediately met with images of advanced stages, which can create a lot of fear. But just because progression is possible does not mean it is inevitable. Currently, evidence has not established that lipedema progresses in everyone.[1]
Though lipedema is generally considered progressive, the course can vary significantly. Periods of stability are also relatively common. [2,3] Lipedema is an incredibly heterogenous condition, and part of that is because it doesn’t happen in a vacuum. Many variables can play into the risks of lipedema exacerbation, and some we don’t yet understand.
The largest factors influencing progression are typically hormonal changes (primarily menopause), age, BMI and comorbidities (co-existing conditions). [3,4] Some of these comorbidities are considered more likely to be secondary to lipedema while others may be having a greater influence on progression. Chronic venous insufficiency, obesity/elevated BMI, mental health conditions such as depression and anxiety, hypothyroidism, hypermobility, and migraines are all seen at higher rates in advanced disease stages.
Chronic venous insufficiency is the most prevalent, affecting 86.2% of patients with lipedema in one large study.[5] Both the venous and lymphatic system are critical elements in lipedema pathophysiology, as they are both necessary for fluid return from the legs. When the venous system isn’t working properly, lymphatic compensation can be triggered which then can become overwhelmed. In later lipedema stages we can see more lymphatic dysfunction (lipolymphedema).[6-8] Some people may have lymphedema through other avenues entirely, like primary lymphedema or pelvic surgery, but ultimately impacts their lipedema.
The progression of any individual’s lipedema is difficult to predict as it can be influenced by all these factors and some unknown. Currently, evidence supports foundational treatments such as compression, lymphatic massage, exercise, nutrition therapy, and in some cases surgery, to help prevent progression. [2,9] Identifying conditions that influence drivers of lipedema such as those that affect the lymphatic and vascular systems, connective tissue, hormones such as thyroid and estrogen, mitochondrial function, and those that affect inflammation and weight like insulin resistance and metabolic inflammation are logical targets to identify and address. By doing this we may be able to reduce progression, modifying the variables we know we can.
Sources
- Lipedema World Alliance Delphi Consensus-Based Position Paper on the Definition and Management of Lipedema: Results From the 2023 Lipedema World Congress in Potsdam. Nature Communications. 2026. Kruppa P, Crescenzi R, Faerber G, et al.
- S1 Guidelines: Lipedema. Journal Der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG. 2017. Reich-Schupke S, Schmeller W, Brauer WJ, et al.
- .Lipedema and Adipose Tissue: Current Understanding, Controversies, and Future Directions. Frontiers in Cell and Developmental Biology. 2025. Rabiee A.
- Clinical Characteristics, Comorbidities, and Correlation With Advanced Lipedema Stages: A Retrospective Study From a Swiss Referral Centre. PloS One. 2024. Luta X, Buso G, Porceddu E, et al.
- Clinical Characteristics, Comorbidities, and Correlation With Advanced Lipedema Stages: A Retrospective Study From a Swiss Referral Centre. PloS One. 2024. Luta X, Buso G, Porceddu E, et al.
- The American Venous Forum, American Vein and Lymphatic Society and the Society for Vascular Medicine Expert Opinion Consensus on Lymphedema Diagnosis and Treatment. Phlebology. 2022. Lurie F, Malgor RD, Carman T, et al.
- Lymphatic Function and Anatomy in Early Stages of Lipedema. Obesity. 2022. Rasmussen JC, Aldrich MB, Fife CE, Herbst KL, Sevick-Muraca EM.
- Lymphoscintigraphic Alterations in Lower Limbs in Women With Lipedema in Comparison to Women With Overweight/Obesity. Frontiers in Physiology. 2023. Chachaj A, Dudka I, Jeziorek M, et al.
- Lipedema Diagnosis, Clinical Manifestations, and Therapeutics: A Systematic Review. International Journal of Dermatology. 2026. Vazirnia A, Smart DR, Mohseni Y, Amron DM.
