Causes & risk factors
Why does lipoedema develop?
Genetics, hormones and other factors – what science knows today about how lipoedema develops.
Medically reviewed byDr. med. Martin Reifenrath, Specialist in Plastic and Aesthetic SurgeryLast reviewed:
What we know
Research is still in its early days
The exact causes of lipoedema have not yet been fully established. Current research, however, shows clear links between genetic predisposition and hormonal factors.
What we know for certain: lipoedema is not the result of a poor diet or a lack of exercise. It is a condition in its own right with complex biological causes.
Main cause
Genetic predisposition
The fact that lipoedema runs in families is the strongest indication of a genetic component.
A family history can be found in up to 60% of cases. If your mother, grandmother or sister is affected, your own risk rises considerably.
It is usually passed down the female line. Scientists believe that several genes are involved which, combined with hormonal triggers, can lead to the condition.
- Passed down the female line
- Several genes involved
- Runs in families
- Higher risk for relatives
60%
Family
history detectable
100%
Female
Only women affected
Triggers
Hormonal factors
Lipoedema almost always appears during phases of hormonal change – a clear sign that female sex hormones play a part.
Puberty
The most common time for the condition to begin. The hormonal changes of puberty can trigger lipoedema for the first time.
Pregnancy
Pregnancy can trigger lipoedema for the first time or make an existing condition considerably worse.
Menopause
During the menopause, existing lipoedema can progress or the symptoms can become more severe.
Hormonal contraception
Taking hormonal contraceptives can intensify the symptoms of lipoedema in some women.
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Other influences
Additional factors
Besides genetics and hormones, other biological processes play a role in how lipoedema develops and progresses.
Disrupted fat metabolism
In lipoedema, the metabolism of the fatty tissue is disrupted. The fat cells multiply uncontrollably and do not respond to normal metabolic signals.
Changes in the lymphatic system
Whether and how the lymphatic system is involved is still being researched. According to the current guideline, however, fluid in the tissue is not part of pure lipoedema – the feeling of swelling usually cannot be measured.
Inflammatory processes
Signs of inflammation have been observed in lipoedema tissue, such as an increased number of scavenger cells (macrophages). Whether they cause the pain has not yet been established.
An important clarification
What does not cause lipoedema
Many women have been told for years that it is their own fault. That is not true.
Not the result of eating too much
Lipoedema is not caused by excessive calorie intake. The diseased fatty tissue is due to a metabolic disorder, not to diet.
Not the result of a lack of exercise
Women who are physically active can develop lipoedema too. Exercise can neither prevent nor cure the condition.
Not a weakness of character
Lipoedema has nothing to do with a lack of discipline. It is a recognised condition with biological causes.
Not a failure at dieting
If diets don't work, it is because of the condition – not because of you. Lipoedema fat does not respond to a calorie deficit.
Since October 2025
Liposuction covered by German statutory health insurance – in all stages
In July 2025, the Federal Joint Committee (G-BA) decided: since October 2025, German statutory health insurers have covered the cost of liposuction for lipoedema – regardless of the stage (for patients insured in Germany). The complicated application procedure no longer applies.
No more application
The complicated application procedure with the health insurer no longer applies. The treating doctors check directly whether all requirements are met – we take care of this for you.
All stages
Until October 2025, cost coverage was limited to stage III. Since then, patients in stages I and II have also been covered by statutory health insurance.
In line with G-BA requirements
We carry out operations covered by statutory insurance at NATIONALKLINIK Wertheim, a hospital included in the German state hospital plan – using the tumescent technique, as the G-BA requires.
What you need for statutory cover – we take care of it
6 months of conservative therapy, a BMI of no more than 35, the two-doctor principle (diagnosis and the decision to operate made by different doctors) – sounds complicated? It doesn't have to be. At Lipo Doctors, we coordinate every step: from diagnosis and conservative therapy to surgery and aftercare. You don't have to worry about a thing.
Risk factors at a glance
Who is particularly at risk?
Certain factors increase the risk of developing lipoedema. If several of them apply to you, you should pay particular attention to the first symptoms.
- Being female
- Lipoedema in your mother, grandmother or sister
- Phases of hormonal change
- Taking hormonal contraceptives
- First symptoms already in adolescence
Research & the future
What scientists are researching
Lipoedema research is making progress. Current studies are looking at a range of approaches.
Genetic markers
Researchers are looking for specific genes responsible for lipoedema. The aim is earlier diagnosis and targeted prevention.
Hormonal links
The exact influence of female hormones on fatty tissue is being studied intensively in order to develop new treatment approaches.
Inflammatory mechanisms
The role of chronic inflammation in lipoedema tissue is being researched in order to improve anti-inflammatory treatments.
Frequently asked questions
FAQ on causes & risk factors
Is lipoedema hereditary?
Yes, there is a strong genetic component. A family history can be found in up to 60% of cases. It is usually passed down the female line. If your mother, grandmother or sister is affected, you should pay particular attention to the first symptoms.
Can I prevent lipoedema through my lifestyle?
No. Because lipoedema is genetic and triggered by hormonal factors, you cannot prevent it through your behaviour. A healthy lifestyle with a balanced diet and regular exercise is still important – it can have a positive effect on the course of the condition and ease the symptoms.
Why does lipoedema appear during puberty?
Puberty is a phase of intense hormonal change. In women with a genetic predisposition, the rise in female sex hormones (oestrogen, progesterone) appears to trigger lipoedema. That is why puberty is the most common time for the condition to begin.
Can pregnancy make lipoedema worse?
Yes, pregnancy can make existing lipoedema considerably worse or trigger it for the first time in women with a predisposition. The hormonal changes during pregnancy and the weight gain can intensify the symptoms. After giving birth, these changes usually do not reverse completely.
Does the contraceptive pill play a role in lipoedema?
Hormonal contraceptives can intensify the symptoms of lipoedema in some women. The effect varies greatly from person to person. If you have lipoedema and use hormonal contraception, you should discuss possible alternatives with your doctor.
Does health insurance cover the cost of lipoedema surgery?
For patients insured in Germany: yes, since October 2025. The Federal Joint Committee (G-BA) decided that liposuction for lipoedema is covered by German statutory health insurance in all stages (I, II and III). The complicated application procedure no longer applies. The requirements are: a BMI of no more than 35, 6 months of conservative therapy and the two-doctor principle (diagnosis and the decision to operate made by different doctors). With a BMI between 32 and 35, the waist-to-height ratio (WHtR) must also be appropriate for your age. We carry out operations covered by statutory insurance at our NATIONALKLINIK Wertheim – preparation and aftercare remain at the location near you. At Lipo Doctors, we coordinate every step for you.
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