Lipoedema vs lymphoedema: how they differ, how they overlap and how they are treated

Both conditions can leave a person with larger-looking legs, and both are often mistaken for weight gain. The underlying problem is different. Lipoedema is a disorder of fat distribution. Lymphoedema is a disorder of fluid drainage. That difference shapes the pattern of swelling, how the skin feels, what tests are used and which treatments help.

The NHS lipoedema page describes an abnormal build-up of fat in the legs and sometimes the arms that can be painful and affect daily life. The NHS lymphoedema page describes a long-term condition that causes swelling in the body's tissues, usually in the arms or legs, and says it develops when the lymphatic system does not work properly. The lymphatic system is the network of channels and glands that helps fight infection and drain excess fluid.

According to the NHS, lipoedema is more common in women and usually affects both sides of the body equally. It can make the bottom, thighs and lower legs, and sometimes the arms, look out of proportion with the rest of the body. In early-stage lipoedema a person may have bigger legs, a narrow waist and a much smaller upper body.

The affected skin feels soft and cool and may be dimpled with an orange-peel texture. People may also have pain, tenderness or heaviness in the affected limbs and may bruise easily. The NHS notes that lipoedema affects people differently: some have mild symptoms that do not affect their life, while others struggle with physical problems and with mental health, sometimes blaming themselves for changes in their body.

The exact cause is not clear. The NHS says it may be linked to hormone changes during puberty, pregnancy, the menopause or while taking the contraceptive pill, and that lipoedema sometimes runs in families.

The main symptom of lymphoedema, according to the NHS, is swelling in all or part of a limb or another part of the body. Clothes can become difficult to fit, and jewellery and watches can feel tight. At first the swelling may be soft and easy to push in, leaving a dent, and it may come and go, worse during the day and better overnight. Without treatment it will usually become more severe and persistent.

Other symptoms can include an aching, heavy feeling, difficulty with movement, repeated skin infections, hard or thickened skin folds, wart-like growths and fluid leaking through the skin. Signs in the head and neck can include swelling or heaviness in the face, mouth or throat and problems with swallowing and speech.

The NHS describes two main types. Primary lymphoedema is caused by faulty genes affecting the development of the lymphatic system and usually starts in infancy, adolescence or early adulthood. Secondary lymphoedema is caused by damage to the lymphatic system or by problems with the movement and drainage of fluid, for example after cancer treatment, an infection, an injury, inflammation of the limb or a lack of limb movement. The NHS says lymphoedema is thought to affect more than 200,000 people in the UK, that primary lymphoedema is rare and that secondary lymphoedema is much more common.

The NHS lipoedema page itself points out that other conditions can cause large or swollen legs, and that if there is swelling in a limb it could be lymphoedema. Persistent swelling of the feet and ankles can also be oedema from other causes. A useful rule of thumb from the NHS wording is that in lipoedema the feet are not usually affected, so swelling that reaches the foot points the clinician towards fluid rather than fat.

The two can also sit alongside each other. The NHS lymphoedema treatment page notes that fat accumulation is a significant feature of lymphoedema swelling, which is one reason the same procedures, such as liposuction, appear in discussions of both. This is why the assessment is done by a clinician who is used to looking at swollen limbs, and why a label should not be self-assigned from photographs.

Neither condition is the same as general obesity. The NHS states plainly that lipoedema is not caused by being overweight. At the same time, the NHS lists healthy eating, regular exercise and keeping to a healthy weight among the main measures for lipoedema, and lymphoedema teams help people lose weight if they are overweight. Weight management supports comfort and mobility; it does not remove the lipoedema fat itself.

For both conditions the first step is a GP appointment. The NHS advises seeing a GP if you have symptoms of lipoedema, or if you have swollen legs, ankles or feet that have not improved after a few days. For lymphoedema it advises seeing a GP for symptoms such as swelling in the arms and legs.

The NHS says lymphoedema can often be diagnosed by asking about symptoms and medical history, examining the affected limb and measuring the distance around it to see if it is enlarged. A GP may refer to a specialist lymphoedema treatment centre. Further tests are not usually needed, but may include limb volume measurement (tape measure, water displacement or perometry), bioimpedance testing and imaging such as lymphoscintigram, MRI, ultrasound or CT, used when the diagnosis is uncertain or to rule out other causes of swelling.

For lipoedema the NHS says that if the GP thinks you have it they may refer you to a specialist for treatment. The diagnosis rests mainly on the pattern of the body shape, the feel of the skin and the history.

The NHS lists the main treatments for lipoedema as healthy eating, more exercise and a healthy weight; compression stockings or bandages to reduce pain and discomfort and make walking easier; skin care, including regular moisturiser; counselling or CBT if coping is difficult; and, if symptoms are particularly severe, a procedure to remove the fat (liposuction). It adds that more than one operation may be needed and that liposuction may not be available on the NHS.

For lymphoedema the NHS describes decongestive lymphatic therapy as the recommended treatment. It has four parts: compression bandages or garments, skin care, exercise and specialised massage known as manual lymphatic drainage. There is an intensive phase, which may mean daily treatment for several weeks, followed by a maintenance phase in which you take over your own care with self-massage, compression garments, exercise and skin care, with reviews every few months. Compression may not be suitable for some people, for example those with arterial problems in their legs.

Surgery for lymphoedema is used in a small number of cases and is only available in some specialist centres. The NHS names liposuction and procedures that restore fluid flow, such as lymphaticovenular anastomosis. After liposuction a compression garment has to be worn for the rest of life to help keep the swelling down.

• Compression: used in both conditions, but fitted and chosen by a trained clinician.

• Skin care: important in both; broken or dry skin raises the risk of infection, especially in lymphoedema.

• Movement: muscles drive lymph flow, so regular activity helps lymphoedema; exercise also supports weight, comfort and mobility in lipoedema.

• Manual lymphatic drainage: a core part of lymphoedema therapy, taught as self-massage for the maintenance phase.

• Psychological support: recognised by the NHS for both conditions.

Cellulitis is the most common complication of lymphoedema, according to the NHS, because fluid in the tissues makes infection more likely. Symptoms include redness and a feeling of heat (which may be harder to see on brown and black skin), pain and increased swelling, and a high temperature or feeling hot, cold or shivery. Oral antibiotics usually treat it, but severe cases may need hospital treatment with antibiotics into a vein.

The NHS lipoedema page gives the same warning in its urgent advice: ask for an urgent GP appointment or get help from NHS 111 if a leg or legs become swollen, red, hot and painful and you have flu-like symptoms, because this may be cellulitis. The same urgent advice applies to anyone with either condition.

Living with either diagnosis can affect mood and confidence. The NHS notes that lymphoedema can have a significant psychological impact and that effective treatments for depression are available. Lipoedema UK and Talk Lipoedema are named by the NHS as sources of help and advice, and the Lymphoedema Support Network is named for lymphoedema.

On the NHS the route for both conditions starts with a GP, who may refer to a specialist lymphoedema service or a specialist for lipoedema. Access to specialist services, compression garments and surgical options varies by area, and the NHS says liposuction for lipoedema may not be available. Some people choose to see a private consultant or buy compression privately; if so, it is sensible to ask the clinician which condition they have diagnosed, what the evidence is for the suggested treatment and what follow-up is included.