{"id":1228,"date":"2026-10-22T09:00:00","date_gmt":"2026-10-22T09:00:00","guid":{"rendered":"https:\/\/clinicanering.com\/blog\/?p=1228"},"modified":"2026-10-19T19:45:44","modified_gmt":"2026-10-19T19:45:44","slug":"lipedema-menopause","status":"publish","type":"post","link":"https:\/\/clinicanering.com\/blog\/en\/weight-loss\/lipedema-menopause\/","title":{"rendered":"Lipedema at Menopause: Why It Can Get Worse and What to Do"},"content":{"rendered":"<blockquote>\n<p><strong>Main points<\/strong><\/p>\n<ul>\n<li>Hormonal changes, such as puberty, pregnancy and menopause, can trigger or worsen lipedema.<\/li>\n<li>Menopause is not the most common trigger: in studies, lipedema starts or gets worse more often at puberty.<\/li>\n<li>At menopause, fat tends to move to the belly, while lipedema stays in the legs and sometimes the arms.<\/li>\n<li>The idea that menopause is a turning point in lipedema is still a hypothesis.<\/li>\n<li>There is no proof that menopausal hormone therapy improves or worsens lipedema, and whether to use it depends on the usual reasons for treating menopause.<\/li>\n<\/ul>\n<\/blockquote>\n<p>This is the third post in the series on lipedema, and this time the topic is lipedema at menopause. In the first, I explained <a href=\"https:\/\/clinicanering.com\/blog\/en\/weight-loss\/lipedema-what-it-is-how-to-tell-it-apart\/\">what lipedema is and how to tell it apart from ordinary fat<\/a>. In the second, I talked about <a href=\"https:\/\/clinicanering.com\/blog\/en\/nutrition\/lipedema-treatment-diet-exercise-compression-surgery\/\">lipedema treatment<\/a>, with diet, exercise, compression stockings and surgery.<\/p>\n<p>Did your legs get worse when your periods started to skip? Menopause may have something to do with it, and in some women lipedema only appears after it. But a lot is still being studied, so it helps to separate what we know from what is still a hypothesis.<\/p>\n<h2>What hormones have to do with lipedema<\/h2>\n<p>The worldwide consensus on lipedema, published in 2026, states that several findings suggest hormones play a part in the disease. Lipedema affects almost only women, and the few cases in men usually come with hormonal changes.<\/p>\n<p>The experts also agree that hormonal changes can trigger or worsen lipedema. But they add a warning of their own: the mechanism linking hormones to lipedema has not been worked out yet.<\/p>\n<p>When we look at the moment lipedema appears or gets worse, puberty comes first. A 2026 review gathered the numbers from different studies:<\/p>\n<figure class=\"nering-chart\">\n<img decoding=\"async\" src=\"\/blog\/wp-content\/uploads\/lipedema-quando-comeca-en.svg\" alt=\"Chart with the range of study results on when lipedema starts or gets worse: puberty from 15.7% to 67.3% of women with lipedema, pregnancy and breastfeeding from 9.5% to 63.1%, menopause from 1.9% to 21% and contraceptive use from 1.2% to 3.8%\" width=\"640\" height=\"400\" loading=\"lazy\"><br \/>\n<\/figure>\n<p>The ranges are wide because each study asked the question in its own way and followed different groups. Even so, menopause shows lower numbers than puberty and pregnancy.<\/p>\n<h2>What menopause changes in the body<\/h2>\n<p>Menopause is the last menstrual period, and it is only confirmed after 12 months without a period. The time around it, when cycles become irregular, is called perimenopause. During this transition, the ovaries make less and less estrogen.<\/p>\n<p>The 2025 European menopause guideline describes what happens to the body from the end of perimenopause onward. Total fat goes up, including the fat inside the belly, around the organs. Lean mass goes down, and the body starts to <a href=\"https:\/\/clinicanering.com\/blog\/en\/body-composition\/metabolism-calories-burned-at-rest\/\">burn less energy<\/a>. Along with this, insulin starts to work less well, which raises the risk of type 2 diabetes. According to the guideline, about 1 in 4 women have menopause symptoms that get in the way of daily life quite a lot, such as hot flashes and poor sleep.<\/p>\n<p>This shift of fat toward the belly can happen even without much weight gain, and the scale stays put while the waist grows.<\/p>\n<h2>Why lipedema can get worse at menopause<\/h2>\n<p>In 2025, a group of Brazilian researchers proposed a model to explain why menopause may be a turning point in lipedema. The idea is interesting, and I&#8217;ll simplify it a lot.<\/p>\n<p>Estrogen acts on cells through two receptors, called alpha and beta, which work like different locks for the same key. According to the model, alpha protects fat: it helps insulin work and keeps inflammation in check. Beta does almost the opposite. In menopause and in lipedema, the balance would tip toward beta, which would favor inflammation and hardening of the fat.<\/p>\n<p>There&#8217;s another curious point. Fat itself can make estrogen. According to the authors, this local production would be higher in lipedema tissue, and estrogen would stay active for longer. So even as estrogen in the blood falls at menopause, the fat in the legs would keep getting stimulated.<\/p>\n<p>The authors compare lipedema with other estrogen-sensitive diseases, such as endometriosis and fibroids. Those usually improve after menopause. Lipedema, according to them, seems to keep going or even get worse.<\/p>\n<p>The explanation makes sense, but it is a model built from lab studies, observational studies and other diseases. The authors themselves write that clinical studies in women with lipedema are still needed to confirm what they propose.<\/p>\n<h3>Lipedema that appears after menopause<\/h3>\n<p>The same 2025 group describes cases in which lipedema only appears after menopause, often in more severe forms that respond less well to treatment. This comes from clinical observation, with no studies measuring how many women go through it.<\/p>\n<p>For this reason, lipedema can&#8217;t be ruled out just because a woman is past 50 and never had the problem before. At the same time, legs that swell or thicken for the first time at this age call for an assessment to rule out other causes, such as vein problems, lymphedema, heart, kidney or thyroid disease, and side effects of medicines.<\/p>\n<h2>Menopause fat or lipedema?<\/h2>\n<p>At this stage, it&#8217;s easy to confuse the two. Menopause moves fat to the belly, and lipedema builds up fat in the legs. They can happen at the same time, and one doesn&#8217;t rule out the other. You&#8217;ll find the other signs in the post on <a href=\"https:\/\/clinicanering.com\/blog\/en\/weight-loss\/lipedema-what-it-is-how-to-tell-it-apart\/\">how to tell lipedema apart from ordinary fat<\/a>.<\/p>\n<table>\n<colgroup>\n<col style=\"width: 33%\" \/>\n<col style=\"width: 33%\" \/>\n<col style=\"width: 33%\" \/>\n<\/colgroup>\n<thead>\n<tr>\n<th>Feature<\/th>\n<th>Menopause fat<\/th>\n<th>Lipedema<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td>Where it builds up<\/td>\n<td>Belly and waist<\/td>\n<td>Hips, thighs, legs and sometimes arms, on both sides<\/td>\n<\/tr>\n<tr>\n<td>Pain when pressed<\/td>\n<td>Usually not<\/td>\n<td>Usually yes, with easy bruising<\/td>\n<\/tr>\n<tr>\n<td>Ankles and feet<\/td>\n<td>No typical change<\/td>\n<td>Fat stops at the ankle and the foot is left untouched<\/td>\n<\/tr>\n<tr>\n<td>With diet and exercise<\/td>\n<td>The belly usually responds<\/td>\n<td>The legs change little<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>To assess excess weight in people with lipedema, the consensus suggests the waist-to-height ratio rather than weight or BMI alone. The waist reflects belly fat, which is the fat that grows most at menopause and the one that counts most for heart and diabetes risk.<\/p>\n<h2>What about hormone therapy?<\/h2>\n<p>It&#8217;s a natural question: if estrogen drops and lipedema gets worse, would replacing estrogen fix it?<\/p>\n<p>The worldwide consensus answers with caution: the effect of menopausal hormone therapy and of contraceptives on lipedema is still uncertain. Studies that have measured this in women with lipedema are lacking.<\/p>\n<p>What we do have is plenty of information on hormone therapy at menopause in general. The European guideline recommends it for bothersome symptoms, such as hot flashes, starting within the first 10 years after the last period or before age 60. It also shows effects on the body: less fat inside the belly and a fat distribution less concentrated on the trunk, but no gain in lean mass.<\/p>\n<p>A 2025 review pooled 17 studies in which women without diabetes were randomly assigned to hormone therapy or placebo, more than 5,000 women in all, and found that hormone therapy improves how insulin works.<\/p>\n<p>On the other hand, the guideline asks that every woman starting hormone therapy be told about the higher risk of breast cancer. Situations in which it is generally not recommended include breast cancer, thrombosis and active liver disease, and women who have a uterus also need a progestogen, to protect the endometrium. The decision weighs each woman&#8217;s own history.<\/p>\n<p>The Brazilian group proposes hormone therapy with estradiol as a centerpiece for lipedema at menopause. The proposal comes from their model and has not yet been tested in women with lipedema.<\/p>\n<p>As I see it, there is currently no proof that hormone therapy improves or worsens lipedema. So the decision follows the usual reasons for treating menopause, such as symptoms, bone protection and each woman&#8217;s risks, and lipedema comes into the conversation as one more piece of information.<\/p>\n<h2>What about weight-loss injections?<\/h2>\n<p>The 2025 model also mentions tirzepatide, one of the weight-loss injections, as a promising option at this stage. Again, the basis is the mechanism, with no clinical trial in women with lipedema. In the <a href=\"https:\/\/clinicanering.com\/blog\/en\/weight-loss\/which-weight-loss-injection-works-best\/\">post on which weight-loss injection works best<\/a>, I compare the options.<\/p>\n<h2>What helps lipedema at menopause<\/h2>\n<p>The basis of treatment stays the same as I explained in the <a href=\"https:\/\/clinicanering.com\/blog\/en\/nutrition\/lipedema-treatment-diet-exercise-compression-surgery\/\">post on lipedema treatment<\/a>: a tailored diet, exercise and compression stockings. Menopause just adds a few extra precautions.<\/p>\n<p>Start with weight. The 2026 review makes two practical points. When a woman with lipedema also carries excess weight that needs treatment, treating obesity early may help keep the disease from reaching more limiting stages. And large swings in weight during times of hormonal change, such as menopause, should be avoided, because they can make symptoms worse. That&#8217;s why a plan you can stick to is worth more than a strict diet dropped within a few weeks.<\/p>\n<p>Next comes muscle. Since lean mass drops at menopause, strength training matters even more, and strengthening the legs and calves helps push lymph along. If you have pain or are overweight, you can start in the water or on a bike and build up little by little.<\/p>\n<p>And look beyond the legs too: menopause raises the risk of heart disease and diabetes, and that deserves its own follow-up, with tests and waist measurements.<\/p>\n<h2>Conclusion<\/h2>\n<p>Hormonal changes can trigger or worsen lipedema, and menopause is one of them, although puberty is the most common trigger. At menopause, fat tends to move to the belly and muscle decreases, which can add to lipedema in the legs. The idea that menopause is a turning point in the disease is still a hypothesis, and there is no proof that menopausal hormone therapy improves or worsens lipedema. At this stage, the usual care still applies, with extra attention to keeping your weight stable, to strength training and to heart health.<\/p>\n<p>Until next time, everyone!<\/p>\n<hr \/>\n<p><strong>Responsible physician:<\/strong> <a href=\"https:\/\/clinicanering.com\/sobre\/\">Dr. Gilberto Nering Junior<\/a>, <a href=\"https:\/\/clinicanering.com\/medicina-do-esporte\/\">sports medicine physician<\/a>, CRM-SP 160822, RQE 142486 (Sports Medicine, Brazil).<\/p>\n<p><small>This text was not sponsored, is for information only and does not replace an individual assessment. Questions about the content: <a href=\"https:\/\/clinicanering.com\/contato\/\">contact the clinic<\/a>.<\/small><\/p>\n<p>Cover photo: <a href=\"https:\/\/unsplash.com\/photos\/a-woman-is-walking-down-a-path-in-the-woods-Zv0Bkn2Fl2g\">Giorgio Trovato<\/a> on Unsplash.<\/p>\n<div class=\"nering-faq\">\n<h2>Frequently asked questions about lipedema at menopause<\/h2>\n<h3>Does lipedema get worse at menopause?<\/h3>\n<p>It can. The worldwide consensus says hormonal changes, such as menopause, can trigger or worsen lipedema, although the mechanism is still unclear. In studies, puberty is the most common trigger.<\/p>\n<h3>Can lipedema start after menopause?<\/h3>\n<p>Yes, it can. A group of Brazilian researchers described, in 2025, cases that only appear after menopause, often more severe ones. This comes from clinical observation, and how often it happens is still unknown.<\/p>\n<h3>Does hormone therapy treat lipedema?<\/h3>\n<p>There&#8217;s no proof that it does. The worldwide consensus says the effect of hormone therapy on lipedema is uncertain. Hormone therapy has its own indications, such as menopause symptoms, and the decision follows those criteria.<\/p>\n<h3>How can I tell menopause fat from lipedema?<\/h3>\n<p>Menopause fat goes mainly to the belly. Lipedema sits on the hips, thighs and legs, on both sides, usually hurts when pressed and bruises easily, and stops at the ankle. The two can exist together, and a medical assessment helps tell them apart.<\/p>\n<h3>Does exercise help lipedema at menopause?<\/h3>\n<p>Yes. Adapted exercise is part of lipedema treatment, and strength training becomes more important at menopause, when lean mass decreases. Water exercise and cycling are good ways to get started if you have pain.<\/p>\n<\/div>\n<h2>References<\/h2>\n<ol type=\"1\">\n<li>Faria AM, Valerio CM, Barcellos CR, et al.\u00a0Unraveling lipedema: comprehensive insights and the path to future discoveries. <em>NPJ Metab Health Dis<\/em>. 2026;4(1):3. <a href=\"https:\/\/doi.org\/10.1038\/s44324-025-00093-y\">doi:10.1038\/s44324-025-00093-y<\/a><\/li>\n<li>Kruppa P, Crescenzi R, Faerber G, et al.\u00a0Lipedema World Alliance Delphi Consensus-Based Position Paper on the Definition and Management of Lipedema: Results from the 2023 Lipedema World Congress in Potsdam. <em>Nat Commun<\/em>. 2026;17(1):427. <a href=\"https:\/\/doi.org\/10.1038\/s41467-025-68232-z\">doi:10.1038\/s41467-025-68232-z<\/a><\/li>\n<li>Li T, Jiang NS, Kaskey J, et al.\u00a0Hormone therapy and insulin resistance in non-diabetic postmenopausal women: a systematic review and meta-analysis. <em>Climacteric<\/em>. 2025;28(6):673-681. <a href=\"https:\/\/doi.org\/10.1080\/13697137.2025.2509844\">doi:10.1080\/13697137.2025.2509844<\/a><\/li>\n<li>Lumsden MA, Dekkers OM, Faubion SS, et al.\u00a0European society of endocrinology clinical practice guideline for evaluation and management of menopause and the perimenopause. <em>Eur J Endocrinol<\/em>. 2025;193(4):G49-G81. <a href=\"https:\/\/doi.org\/10.1093\/ejendo\/lvaf206\">doi:10.1093\/ejendo\/lvaf206<\/a><\/li>\n<li>Pinto da Costa Viana D, Caseri C\u00e2mara L, Borges Palau R. Menopause as a Critical Turning Point in Lipedema: The Estrogen Receptor Imbalance, Intracrine Estrogen, and Adipose Tissue Dysfunction Model. <em>Int J Mol Sci<\/em>. 2025;26(15):7074. <a href=\"https:\/\/doi.org\/10.3390\/ijms26157074\">doi:10.3390\/ijms26157074<\/a><\/li>\n<\/ol>\n<p><script type=\"application\/ld+json\">{\"@context\": \"https:\/\/schema.org\", \"@type\": \"FAQPage\", \"inLanguage\": \"en\", \"mainEntity\": [{\"@type\": \"Question\", \"name\": \"Does lipedema get worse at menopause?\", \"acceptedAnswer\": {\"@type\": \"Answer\", \"text\": \"It can. The worldwide consensus says hormonal changes, such as menopause, can trigger or worsen lipedema, although the mechanism is still unclear. In studies, puberty is the most common trigger.\"}}, {\"@type\": \"Question\", \"name\": \"Can lipedema start after menopause?\", \"acceptedAnswer\": {\"@type\": \"Answer\", \"text\": \"Yes, it can. 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What hormones have to do with it, what is still a hypothesis, what we know about hormone therapy and what helps.<\/p>\n","protected":false},"author":1,"featured_media":1149,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[74],"tags":[],"class_list":["post-1228","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-weight-loss","entry entry-center"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.7 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Lipedema at Menopause: Why It Can Get Worse and What to Do<\/title>\n<meta name=\"description\" content=\"Can lipedema get worse at menopause? 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