HRT and Lipedema | Can Hormone Therapy Help Lipedema?

In my previous blog about Lipedema and menopause, I touched briefly on hormone replacement therapy (HRT) and how it might affect women with Lipedema. Since then, I’ve had so many questions from readers wanting to know more – should I take HRT? Will it make my Lipedema worse? What type is safest? These are the questions many women in our community are asking, and unfortunately, there aren’t always clear answers.

The relationship between HRT and Lipedema is very complicated. Lipedema is an oestrogen-sensitive condition, which means hormones play a significant role in how it develops and progresses. At the same time, menopause brings its own set of challenges that HRT can help address. So how do we balance the benefits of HRT against potential concerns about our Lipedema?

In this blog post, I want to explore what we currently know about HRT and Lipedema, the different types of HRT available, and the key considerations for making an informed decision with your healthcare provider.

A Quick Recap: Why Hormones Matter in Lipedema

Before we dive into HRT specifically, let’s remind ourselves why hormones are so important for Lipedema sufferers. Lipedema almost exclusively affects women, and it typically develops or worsens during times of hormonal change – puberty, pregnancy, taking hormonal contraceptives, and menopause.

I believe my own Lipedema journey began when I started taking the contraceptive pill at 15. Many women in the community share similar stories, noticing their Lipedema symptoms appearing or getting worse during these hormonal transitions.

Research now suggests that Lipedema is what scientists call an ‘oestrogen-sensitive adipose tissue disorder.’ This means that oestrogen plays a key role in how Lipedema fat behaves, affecting inflammation, fat cell growth, fibrosis (tissue hardening), and even lymphatic function.

What makes this particularly complex is that oestrogen works through different receptors in the body (called ERα and ERβ), and the balance between these receptors appears to be disrupted in Lipedema tissue. This is why hormonal changes can trigger such significant responses in our bodies.

What is Hormone Replacement Therapy?

Hormone replacement therapy is a treatment used to relieve the symptoms of menopause by replacing the hormones (primarily oestrogen) that decline as your ovaries stop producing them. HRT can be incredibly effective at managing symptoms like:

• Hot flushes and night sweats

• Mood swings and anxiety

• Vaginal dryness and discomfort

• Sleep disturbances

• Brain fog and concentration issues

• Reduced bone density (osteoporosis prevention)

For many women, HRT can be life-changing, significantly improving quality of life during the menopause. The NHS and the British Menopause Society both recognise HRT as a safe and effective treatment option for most women when started at the appropriate time.

Types of HRT: Understanding Your Options

Not all HRT is the same, and the type you choose can matter, particularly if you have Lipedema. Here’s an overview of the main options:

By Hormone Composition

Oestrogen-only HRT: This is prescribed for women who have had a hysterectomy (removal of the womb). Without a uterus, you don’t need progestogen to protect the uterine lining.

Combined HRT (oestrogen + progestogen): This is for women who still have their womb. The progestogen component is essential to prevent the oestrogen from causing overgrowth of the uterine lining, which could lead to endometrial cancer. Combined HRT can be taken continuously or cyclically.

By Delivery Method

Oral HRT (tablets): These are taken daily by mouth. While convenient, oral oestrogen passes through the liver first, which can affect how it’s metabolised and may increase the risk of blood clots compared to other methods.

Transdermal HRT (patches, gels, sprays): These deliver oestrogen through the skin directly into the bloodstream, bypassing the liver. This route is generally considered to have a lower risk of blood clots and may be preferable for women with certain risk factors.

Vaginal oestrogen: This is applied locally to treat vaginal dryness and urinary symptoms. Because very little is absorbed into the bloodstream, it’s often considered safe even for women who can’t take systemic HRT.

HRT and Lipedema: What Does the Research Say?

There’s currently no definitive research specifically studying the effects of HRT on Lipedema. This is really frustrating, but it’s a reflection of how under-researched Lipedema is as a whole.

What we do have is:

Conflicting anecdotal reports: Some women with Lipedema report that HRT made their symptoms worse. Others report no change. And some have found that HRT actually helped stabilise their condition. This variation likely reflects individual differences in oestrogen sensitivity and the type/dose of HRT used.

Emerging scientific understanding: Recent research published in 2025 proposes that menopause itself acts as a ‘critical turning point’ in Lipedema progression. The theory suggests that the drop in oestrogen during menopause disrupts the balance of oestrogen receptors in fat tissue, potentially worsening inflammation, fibrosis, and fat accumulation. This research actually suggests that appropriately timed HRT could be protective…but this hasn’t been proven in clinical trials yet.

Expert recommendations: Most Lipedema specialists suggest avoiding high-dose HRT and recommend using the lowest effective dose. The general principle is “as little hormone as possible, delivered in the safest way possible.”

Key Considerations for Women with Lipedema

If you’re approaching or going through menopause and considering HRT, here are some important things to discuss with your healthcare provider:

1. Transdermal May Be Preferable

For women with Lipedema, transdermal HRT (patches, gels, or sprays) may be the better choice over oral tablets. Transdermal delivery bypasses the liver, resulting in a more ‘natural’ hormone profile with lower oestrone levels (similar to premenopausal levels). Research also shows transdermal HRT has a lower risk of blood clots compared to oral forms – an important consideration since Lipedema can affect circulation.

2. Where You Apply Matters

Emerging research suggests that where you apply transdermal HRT could be relevant for Lipedema. Since Lipedema tissue already has dysregulated oestrogen production locally, some experts recommend applying patches or gels to areas not affected by Lipedema, such as the back, shoulder blades, or inner arms (if unaffected). This aims to avoid further stimulating the abnormal hormone processes in Lipedema tissue.

3. Low Dose is Generally Recommended

The general advice for women with Lipedema is to use the lowest dose of HRT that effectively manages your symptoms. High-dose HRT is typically not recommended. Your doctor can help you find the right balance.

4. Timing May Matter

The ‘timing hypothesis’ suggests that starting HRT during the menopausal transition or within the first few years after menopause may offer more benefits than starting later. For Lipedema, early intervention might help prevent the oestrogen receptor imbalance that occurs with declining hormones, though this is based on theory rather than proven evidence specific to Lipedema.

5. The Type of Progestogen Matters

If you need combined HRT (oestrogen plus progestogen), the type of progestogen may be relevant. Some research suggests that certain progestins, particularly drospirenone, may have beneficial effects on inflammation and fluid retention due to its anti-mineralocorticoid properties. Natural micronised progesterone is another option that’s often well-tolerated. The Mirena coil (LNG-IUS) is another way to deliver progestogen directly to the uterus while minimising systemic effects.

HRT Options Overview

What If HRT Seems to Have Triggered or Worsened My Lipedema?

If you’ve started HRT and noticed your Lipedema symptoms worsening, it’s important to speak with your doctor rather than stopping abruptly. Some options to discuss include:

• Switching to a different type of oestrogen (some women are more sensitive to certain types)

• Lowering the dose

• Changing the delivery method (e.g. from tablets to patches)

• Trying a different progestogen component

• Using vaginal oestrogen only if your main concerns are urogenital symptoms

Remember that some changes during menopause may be due to the menopausal transition itself rather than the HRT. It can be difficult to separate these effects, which is why close monitoring and open communication with your GP is so vital.

Questions to Ask Your Doctor

When discussing HRT with your GP or menopause specialist, consider asking:

• What type and dose of HRT would you recommend for someone with Lipedema?

• Would transdermal HRT be safer for me than tablets?

• Where should I apply patches or gel given that my legs/arms are affected by Lipedema?

• How will we monitor whether HRT is affecting my Lipedema?

• What are the signs I should watch for that might indicate I need to adjust my treatment?

• Are there any progestogens that might be better for someone with fluid retention or inflammation?

It’s worth remembering that many GPs may not be familiar with Lipedema, so you might need to advocate for yourself and potentially ask for a referral to a menopause specialist who can work alongside a Lipedema specialist.

Supporting Your Body Through Menopause (With or Without HRT)

Whether or not you decide to take HRT, there are ways to support your Lipedema during the menopausal transition:

Maintain your conservative measures: Continue wearing your Lipedema compression garments, following your anti-inflammatory diet, staying active with gentle exercise, and booking regular MLD (lymphatic drainage massage). These are even more important during times of hormonal change.

Monitor your symptoms: Keep a diary of your Lipedema symptoms, pain levels, swelling, heaviness, so you can identify any changes over time. This is really useful if you’re starting or adjusting HRT.

Support your overall health: Focus on reducing inflammation through diet, managing stress, getting enough sleep, and avoiding known triggers. These lifestyle factors can influence both menopausal symptoms and Lipedema.

Stay connected: The Lipedema community and organisations like Lipoedema UK and Lipedema Foundation can be valuable sources of support and shared experience.

My Conclusion on HRT and Lipedema

The decision to take HRT is a personal one that depends on many factors, such as the severity of your menopausal symptoms, your overall health, your risk factors, and yes of course, your Lipedema. Unfortunately, there’s no one-size-fits-all answer.

This blog proves that HRT isn’t automatically off the table for women with Lipedema. With careful consideration of the type, dose, and delivery method, many women can benefit from HRT while managing their Lipedema symptoms. The key is working with knowledgeable healthcare providers who understand both conditions and can help you make an informed choice.

As always, we desperately need more research in this area. Until then, we’re navigating with the best information we have – I hope this blog has helped you gain some clarity on this topic.

If you’ve taken HRT and have Lipedema, I’d love to hear about your experience in the comments. Did it improve or worsen your symptoms? Let me know.

Disclaimer: My blogs talk about Lipedema, diet, surgery and much more. I’m talking from my point of view to help women, and remind them they are not alone. I am not a medical professional, so the content above is from my own perspective with research I have done into the topic. It’s not meant as medical advice, you should always consult your doctor or a specialist for both your diagnosis, and a treatment plan.

You may also be interested in:

• Lipedema and Menopause
• Lipedema and Contraception
• Lipedema and Pregnancy