Today’s paper is by Samantha Connolly. It’s entitled, Does lipoedema mimic pregnancy? and was published in the journal Wounds International in 2022.
(Correction: We previously reported another Samantha Connolly as the author of this article. The correct author is below.)
Samantha Connolly is a physical therapist with a clinic in the seaside village of Spiddal in the West of Ireland. She is a Neuromuscular Therapist and a Lymphatic therapist.
Frustrated by the lack of research linking lipedema with possible hormonal irregularities, Samantha spent a number of years reviewing the literature and wrote an article outlining possible hormonal influences in Lipedema.
It is her strong hope that this will spark further research in this area.
This paper examines lower body fat storage, and the strong resistance to burning this fat, during pregnancy. The author asks if the hormonal changes that occur in lipedema are similar to what women experience naturally with pregnancy.
Several people, including Catherine Seo at the Lipedema Project, asked me to review this article, and I’m glad I did. I think you will find it very interesting.
Now let’s proceed to break down this paper so we can further understand lipedema using the lens of Samantha.
Fat Storage in Pregnancy and Lipedema
Samantha first discusses lower body fat storage in girls and women. Fat storage in the lower body, and the resistance to losing that fat, is a natural part of pregnancy. This also happens to be a key feature of lipedema.
In general, girls and women have more subcutaneous fat and more fat deposits specifically to the hips and buttocks than boys and men, and this difference is usually accentuated at puberty and pregnancy. A typical pattern for fat storage and fat-burning during pregnancy is fat storage in the early and mid-course of pregnancy and fat-burning in the late stages.
We also see increased levels of estrogen, progesterone, and insulin in the early stages of pregnancy. All of these hormones function to promote fat storage and block fat burning. Other hormones of interest are catecholamines. These are hormones, such as adrenaline, that are released in response to stress and induce the body to burn fat.
An interesting fact that the author brings up is that during pregnancy, the fat cells on a woman’s hips, buttocks, and thighs are virtually unresponsive to this fat-burning hormone. This may be a protective mechanism to ensure that the mother and developing fetus will have much-needed nourishment even in the event of a famine. It turns out that fat is particularly important for fetal brain development. The stored fat on the mother’s lower body becomes a rich source of needed fat during the late stages of pregnancy and during lactation after birth.
Because past research has found enlarged fat cells in the thighs and abdomen of women with lipedema compared to healthy controls and also in women who were pregnant versus those who weren’t, Samantha suggests it would also be interesting to compare fat tissue from pregnant women with those who have lipedema.
She then proceeds to discuss different hormones that play a role in pregnancy. Let’s take a look at each one of them:
Prolactin
Prolactin is a hormone produced by fat tissue that increases during pregnancy. The primary purpose of prolactin is to cause milk production and suppress impregnation immediately after giving birth. It also promotes fat storage and insulin sensitivity.
Samantha proposes an interesting theory about prolactin. Hyperprolactinemia, or very high levels of prolactin in the blood, can be caused by extreme levels of stress completely outside of pregnancy. Hyperprolactinemia is present in at least 10% of women and can cause menstrual problems, acne, and weight gain.
Samantha describes two women with lipedema for whom this hormone may have come into play in their lipedema symptoms. One had prolactin levels at 10 times the normal level due to a benign pituitary tumor (a stress response) and the other reported that the only time she had slim legs was while breastfeeding (prolactin levels are normal during late pregnancy and when breastfeeding). The author suggests that high levels of prolactin may be partly responsible for the lipedema symptoms in these two women and encourages researchers to start testing for this.
Relaxin
Relaxin is a hormone that is produced by the ovaries and the placenta. It loosens muscles, joints, and ligaments during pregnancy and delivery. Relaxin accomplishes this by degrading or preventing the rebuilding of connective tissue. Samantha suggests that this hormone may be implicated in several symptoms experienced by women with lipedema including joint hypermobility and blood vessel anomalies. This may be another important area of inquiry for researchers.
Sex Hormones
Samantha Connolly discusses two sex hormones in this section including estrogens and progesterone. Estrogens have a great deal of impact on women’s health, including reproduction, fat accumulation, bone density and strength, and immune response. Estrogens impact emotional health, nerve development, and cognition. They can have both an anti-inflammatory and pro-inflammatory effect depending on several variables.
Estrogens have also been connected to pain perception and one key feature of lipedema is heightened sensitivity to pain. Samantha reported evidence that a woman’s sensitivity to pain tends to fluctuate with her menstrual cycle. And while the lower estrogen levels experienced in menopause can decrease some pain sensitivity, such as headaches, this time of a woman’s life may bring with it new pains, such as from arthritis and joint inflammation.
Samantha reported a recent study that may link a gene variant to lipedema that seems to result in higher progesterone and increased deposition of subcutaneous fat. She also discusses how mood disturbances, sometimes seen as associated with lipedema, may be linked to the presence of progesterone in combination with elevated estrogen.
Conclusions
The author states that most research has been performed by men on males. In order for us to be better informed about the intricate hormonal interactions that may be linked to lipedema, however, it requires a concerted effort to study females and, perhaps in particular, pregnant females. She also believes that the links between mental health disturbance, hormonal imbalance, and lipedema need to be investigated, especially the possible connections between mental health, stress, and elevated prolactin levels. This may help us begin to understand the complex interactions that may trigger the onset of lipedema.
Takeaways
This article is tremendously important for women with lipedema because it coalesces old and recent information as well as the author’s own clinical experience to form new hypotheses. She makes us think about lipedema in a different way and suggests several areas for future research.
From the title, I was expecting more about how lipedema may be an exaggerated or haywire presentation of evolutionary normal processes in a pregnant female. Here are some examples of things that I would have liked her to expand upon:
Estrogen levels increase steadily during pregnancy and reach their peak in the third trimester. How may or may not this be similar to estrogen levels in women with lipedema?
Levels of progesterone remain elevated throughout pregnancy. These elevated levels also prevent the body from producing additional eggs during pregnancy. Eventually, progesterone also helps to trigger lactation. How are progesterone levels during pregnancy similar to levels seen in women with lipedema?
Some clinicians have suggested that women with lipedema may have elevated lipoprotein lipase, an enzyme that can break up triglycerides. Are LPL levels also elevated in pregnancy and what is the role that this enzyme plays in pregnancy and lipedema?
For more updates on the latest research regarding lipedema, check out Lipedema Simplified’s Flash Briefings. It’s our daily mini-podcast where we share tips, tools, and research pertaining to Lipedema.
~ Leslyn Keith, OTD, CLT-LANA
Board President, Director of Research | The Lipedema Project