# Impact of hormones on lipedema development: a systematic literature review

## TL;DR

This review explores how hormones, especially estrogen, influence lipedema, a painful fat disorder in women, and suggests it should be reclassified as a hormonal condition.

## Contribution

The paper systematically identifies hormonal and metabolic mechanisms linking hormones to lipedema development.

## Key findings

- Lipedema is linked to hormonal imbalances, particularly estrogen-related changes.
- Metabolic factors like adipokines and PPARγ are involved in lipedema's pathophysiology.
- The condition is distinct from obesity and requires targeted research for diagnosis and treatment.

## Abstract

Lipedema is a chronic disorder that affects the subcutaneous adipose tissue of the lower and upper limbs and results in painful fat accumulations. During the reproductive life span, about 11% of women are affected; however, there are a high number of suspected undiagnosed and thus untreated cases.

The aim of this systematic review was to evaluate the association between hormones and the pathophysiological mechanisms of lipedema development. Inclusion criteria were: lipedema, lipoedema, estrogen, estrogen antagonists, female sex hormones, hormones, insulin, puberty, pregnancy, menopause, subcutaneous fat tissue, and subcutaneous adipose connective tissue.

The literature search yielded 121 hits; after deduplication, 64 records were screened. After abstract and full-text screening 15 publications were suitable for being included in the systematic review. Overall, four different pathophysiological hypotheses were postulated: (1) general hormonal imbalance, (2) changes in growth hormone balance, (3) metabolic imbalance such as changes in adipose stem cells in relation to adipokines or leptin in association with the transcription factor PPARγ, and (4) changes in estrogen metabolism as well as alterations in the function of estrogen receptors.

Lipedema appears to be a multifactorial condition primarily driven by hormonal dysregulation—especially involving estrogen—alongside metabolic and possible genetic components. The findings support the reclassification of lipedema as a hormonally influenced disorder distinct from obesity, emphasizing the need for further research into diagnostic biomarkers, targeted therapies, and the role of genetic susceptibility.

The online version contains supplementary material available at 10.1007/s00404-026-08318-1.