Myth 2: lipedema is a lymphatic disorder
The Myth Explained
One of the most persistent misunderstandings about lipedema is the belief that it is a disease of the lymphatic system. This assumption has become common both in patient communities and among some healthcare providers, often leading to the classification of lipedema alongside lymphatic conditions such as lymphoedema.
This confusion is understandable — both conditions can involve enlarged legs, discomfort, and overlapping symptoms such as heaviness or tension. Historically, the two conditions were even taught side by side in some medical literature.
This has led to widespread use of terms such as “lymphatic lipedema” or “lipolymphoedema” — labels that are still used today despite being scientifically unsupported.
But current evidence clearly distinguishes lipedema from true lymphatic disorders.
The Facts
1. Lipedema does not result from lymphatic failure
According to the S2k Guideline on lipedema (2024), lipedema is not caused by — and does not primarily involve — any disruption of the lymphatic system. The guideline explicitly states:
“Lipedema is neither an oedema nor a disease manifestation with venous or lymphatic dysfunction.” (S2k Guideline, 2024, Section 4.3)
The condition is instead characterised by:
- Symmetrical, painful fat deposits (mainly on the lower limbs)
- Pressure sensitivity and easy fatigue
- Painful fat accumulation that is not linked to fluid retention or lymphatic drainage issues
2. Diagnostic imaging shows normal lymphatic function in lipedema
In studies using modern imaging tools — including lymphoscintigraphy and sonography — no pathological changes to the lymphatic system have been found in patients with lipedema and a normal body mass index.
Older studies that suggested lymphatic impairment in lipedema did not document body composition, especially body mass index (BMI). This means the observed findings were likely due to coexisting obesity rather than lipedema itself.
As explained by Bertsch and Erbacher in their 2018 review:
“The lymphatic system in patients with lipedema — unless they are obese — functions normally.”
(Phlebologie 2018: Lipedema – Myths and Facts, Part 1)
3. Lymphoedema and lipedema are separate things
Although some patients may have both conditions (e.g. obesity-associated lymphoedema developing later in life), lipedema itself is not a lymphatic disease and should not be treated as one.
Conflating the two conditions leads to:
- Misdiagnosis
- Inappropriate treatments (such as lymphatic drainage)
- Delay in the implementation of evidence-based lipedema care
The S2k guideline recommends careful differentiation, noting that swelling observed in individuals with lipedema should be evaluated independently and not assumed to indicate lymphatic failure.
4. Terminology such as “lipolymphoedema” should be avoided
The term “lipolymphoedema” implies that lipedema naturally evolves into lymphoedema, suggesting a progressive failure of the lymphatic system. This is not supported by clinical evidence.
Bertsch and Erbacher (2018) strongly oppose the use of this term:
“The term lipolymphoedema should therefore be deleted from the vocabulary of lymphology.” (Phlebologie 2018: Lipedema – Myths and Facts, Part 1)
Its continued use contributes to therapeutic errors and patient confusion.
Q&A for Patients
- Isn’t lipedema part of the lymphatic family of diseases?
No, lipedema is not classified as a lymphatic disease. The lymphatic system functions normally in people with lipedema, unless they also have another condition. - Why do some people get manual lymphatic drainage?
Manual lymphatic drainage is a valid therapy for lymphoedema, not lipedema. If someone has both conditions, it may be used — but for lipedema alone, it is not indicated. - Can lipedema turn into lymphoedema over time?
No — lipedema does not inherently progress into lymphatic disease. However, people with significant weight gain or advanced age may develop lymphoedema due to other factors, which must be assessed separately.
Futher Reading for Health Care Professionals
From the ILA Co-Presidents
“As ILA, we stand for providing evidence-based information to support healthcare professionals and women with lipedema in achieving the best possible diagnosis and treatment. We are committed to dispelling misinformation, and we encourage open dialogue that reflects diverse perspectives to move science forward.”
– Ad Hendrickx and Gabriele Erbacher, ILA Co-Presidents, September, 2025.