What is lipedema?
Lipoedema is a chronic, degenerative disease affecting fatty tissue. It is characterized by abnormalities in the physiology, volume and distribution of these tissues. It frequently leads to significant pain, reduced mobility and body deformities, and can have a strong impact on patients' mental health.
Lipedema mainly affects the legs, hips and, in a third of cases, the arms. Lipoedema is often painful, can interfere with activity and generate spontaneous bruising. It is resistant to dieting.
It's a little-known pathology that affects 11% of adult women. Left unchecked and untreated, it can lead to obesity, venous and lymphatic problems (oedema, varicose veins)...It's a condition that's often misunderstood and under-diagnosed.
This disease is rare, but it is also currently under-diagnosed, and often confused with other conditions such as obesity and lymphedema.
What can help you recognize lipedema?
- Sore legs (often since puberty, pregnancy or hormonal changes) with a "pole" appearance
- Spontaneous bruises
- Disproportion between a slim waist and "big legs".
- Symmetry in affected limbs (unlike lymphedema)
- A scalloped, hard appearance that becomes more pronounced over time and is not to be confused with being overweight.
- Diets that only make you lose weight on your upper body and have no effect on your legs or arms.
Diagnosis is based on examination by a phlebologist or angiologist. The Centre Hospitalier Universitaire Vaudois (CHUV) has a special department dedicated to this pathology.
Medical imaging techniques will confirm the diagnosis.
When should you consult your doctor?
It is essential to consult a healthcare professional (angiologist or phlebologist) if lipedema is suspected, as early diagnosis can help to manage the condition more effectively and improve quality of life. Consultations with specialists (angiologists, surgeons, etc.) and medical examinations (echo-Doppler, fluoroscopy) are normally covered by basic health insurance. However, if the insured is a family doctor, he or she must obtain a delegation voucher for the specialist in question (who can then prescribe the necessary examinations).
Hospitals with a phlebology department (HUG) or lymphology department (CHUV) can also help you make a reliable diagnosis using medical imaging.
At Clinique Naturelle, you can also have a drainage test.
Why do we suffer from lipedema?
Today, the exact cause has yet to be determined. Hereditary and hormonal genetic factors may play a role. Lymphatic vessels are often more tortuous and of smaller caliber, which slows flow and favors water retention. Lipoedema is still all too often equated with weight gain, making people feel guilty for not being able to "melt" those legs despite numerous diets that only reinforce the natural evolution of lipoedema with the yo-yo effect of dieting.
A team of Australian researchers has identified a particular gene (Bub1) that causes the pathological proliferation of fat cells: in other words, under the action of this gene, not only do fat cells multiply, which they shouldn't, but the multiplied cells are also abnormal. Hormonal factors may explain why the disease mainly affects women, and why it is often triggered or aggravated during periods of hormonal change, such as puberty, pregnancy, menopause or when taking or stopping hormonal contraceptives.
What natural treatments are there for lipedema?
Conservative" therapy
In Switzerland, there is no compulsory universal coverage for lipoedema treatments. Nevertheless, a certain number of benefits are currently covered, and coverage is tending to improve, particularly now that cover for surgery can be accepted on a case-by-case basis.
Treatment generally consists of relieving symptoms and slowing the progression of lipoedema through conservative therapy:
- Adapted lymphatic drainage, deeper than conventional drainage
- Reduce swelling with a compression bandage over a few days to deflate the swelling before wearing compression garments over the long term.
- Made-to-measure support with the help of an orthopedist and a doctor's prescription,
- Appropriate exercise (water sports, walking, cycling, etc.) helps control weight gain and ease pain. Aquagym, fitness, sports and nutrition may be reimbursed by certain complementary health insurance plans.
- Good quality pressotherapy boots can provide relief between drainage sessions.
- Control your calorie intake to avoid weight gain.
In certain cases, surgery (liposuction) could be reimbursed by the LAMAL, but only for patients who suffer from pain, and for whom the intensive conservative therapy mentioned above is insufficient after at least 12 months.
However, it is important that this is carried out by a surgeon experienced in the treatment of this pathology. In some cases, the operation may be reimbursed by the LAMAL if the insurance company and hospital prove that other measures are no longer sufficient. In this case, the patient must be monitored by the hospital, which will first ask him or her to follow a healthy lifestyle as outlined above.
To begin the 12 months of conservative therapy, you need a diagnosis, usually by an angiologist, and prescriptions for compression garments and manual lymphatic drainage. The 12 months begin when the compression garments are ordered and the drainage begins. It is not necessary to be treated by the angiology department of the CHUV or the HUG to start intensive conservative therapy: most angiologists can prescribe it.
After this period, two doctors from disciplines related to the disease (angiology, dermatology, plastic surgery, etc.) must recommend the operation for it to be covered, and the operation must be performed by a specialist. The request cannot, in principle, be made by the patient or her GP.
At present, patients receive both refusals and approvals from insurance companies, but it seems that approvals are becoming more regular, and insurance companies are responding more quickly. In the event of an insurance refusal, it is possible to appeal. If you have legal protection, you can call on it (beware of coverage for this type of problem, depending on the contract, and of waiting periods). It can therefore be very useful for patients to take out this type of insurance before starting any steps to obtain reimbursement for an operation, or even before the diagnosis or as soon as it has been made.
How does lipoedema evolve in the absence of conservative therapy?
- Stage I: soft tissue, relatively smooth skin.
- Stage II: the skin shows irregularities, indentations and nodules the size of peas.
- Stage III: the skin shows greater irregularities, with tissues forming folds or even lobes (particularly around the knees and hips).
- Stage IV: lipo-lymphoedema: development of lymphedema on top of lipoedema (note that all stages can present more or less severe lymphatic insufficiency).
It is also important to note that the pain or impact of the disease is not necessarily related to stage. Some stage I or II patients may suffer disabling pain or significant limitations to their mobility. Mobility impairments are sometimes linked directly to pain (a feeling that the legs are going to explode in a squatting position, for example, or of extreme heaviness in a prolonged standing position), but also to the distribution of fatty tissue. For example, even relatively small accumulations of fat on the inside of the knees can alter posture and gait, and generate joint pain in the hips and knees.
Source: https://lipoedeme.ch/diagnostic-examens-du-lipoedeme/#types-et-stades
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