Lipoedema is a painful and progressive condition that primarily affects women. It causes a disproportionate build-up of fat, usually around the legs, hips, buttocks and sometimes arms, often accompanied by swelling, easy bruising and tenderness. Unlike standard weight gain, lipoedema fat does not respond to dieting or exercise in the same way.
Most people with lipoedema can link it’s onset or development to a time of hormonal change. Many women notice the first signs at puberty, with further worsening during pregnancy or during perimenopause. This suggests that oestrogen and progesterone play a central role in how the condition develops and progresses. Standard hormone blood tests provide only a snapshot and cannot give us any real onset in lipoedema. They do not reveal how hormones are being metabolised or whether there are imbalances between production, breakdown and clearance.
This is where the DUTCH Complete test is useful. By using dried urine samples, it offers a comprehensive profile of sex hormones, adrenal hormones and their metabolites. For women living with lipoedema, the insights can directly inform diet, lifestyle, supplement strategies to help manage lipoedema and prevent progression.
Oestrogen Metabolism and Inflammation
Many women with lipoedema experience signs of oestrogen dominance, where oestrogen activity is strong compared to progesterone. The DUTCH Complete measures total oestrogen but also shows how the body is processing it. Oestrogen can follow three main metabolic routes:
- 2-OH pathway, which is protective and anti-proliferative.
- 4-OH pathway, which is potentially DNA-damaging and pro-inflammatory.
- 16-OH pathway which is associated with tissue growth, fluid retention, and higher oestrogenic activity.
If the DUTCH results show a bias towards the 4-OH or 16-OH pathways, it highlights a need for liver and gut support to encourage safer oestrogen clearance. There are actionable steps that can reduce inflammatory burden and lessen the hormonal drive that worsens lipoedema.
Progesterone Balance and Fluid Retention
Low progesterone in relation to oestrogen often correlates with fluid retention, breast tenderness and mood changes and an aggravation of lipoedema symptoms. The DUTCH Complete measures progesterone metabolites to confirm whether this is a factor. If progesterone is low, interventions may include supporting levels through nutrition and stress management, or discussing strategies to manage oestrogen dominance or prevent the progesterone steal which keeps levels low.
Cortisol Patterns and Pain Sensitivity
Chronic pain and fatigue in lipoedema put pressure on the adrenal glands. The DUTCH test maps cortisol patterns throughout the day. A flat or reversed cortisol rhythm often explains why women feel wired at night but exhausted in the morning. Addressing this might involve nutritional adjustments to stabilise blood sugar and reduce stress on the HPA axis as well as identifying other physical stressors. By matching interventions to the cortisol pattern, energy and pain resilience can be improved.
Androgens, Muscle Mass and Body Composition
DHEA and testosterone influence how easily women maintain lean muscle mass and strength. In lipoedema, lower androgens can contribute to poor muscle tone and fatigue, while higher levels may lead to skin breakouts or hair changes. DUTCH results in this area can guide tailored recommendations.
Sleep, Melatonin and Tissue Repair
Sleep disruption is common in lipoedema, and poor sleep drives inflammation. The DUTCH Complete measures melatonin, the hormone that regulates circadian rhythm and supports tissue repair. Better sleep directly improves lymphatic drainage, pain perception and overall energy.
Methylation and Detoxification Capacity
A super important piece of the puzzle is methylation. The DUTCH Complete indicates whether a woman is efficiently methylating oestrogen metabolites. Poor methylation increases the risk of harmful oestrogen build-up. This is especially important in people with MTHFR genetic deviations. This is common in the lipoedema community and may explain why hormonal upheaval causes such chronic and distressing symptoms.
Turning Insights into Personalised Care
The strength of the DUTCH Complete is that it translates hormone data into personalised, actionable strategies. For someone with lipoedema this may mean:
- Nutrition that actively improves hormone clearance rather than generic healthy eating advice.
- Supplements tailored to metabolic bottlenecks.
- Lifestyle changes prioritised according to test findings, whether that’s stress management for a flattened cortisol curve, sleep support for low melatonin or liver detoxification support for poor oestrogen clearance.
- Collaboration with doctors to refine or monitor HRT, ensuring it supports rather than worsens lipoedema progression.
By uncovering how hormones are actually working beneath the surface, the DUTCH Complete provides a roadmap for interventions that target the underlying mechanisms of lipoedema, not just the symptoms.
Lipoedema is hormonally influenced and worsened by inflammatory and stress-related pathways. The DUTCH Complete test allows practitioners and patients to see the hidden patterns of hormone production, metabolism and clearance that shape the condition. With this knowledge, a personalised plan can be created, one that supports hormone balance, reduces inflammation and ultimately helps women with lipoedema feel more in control of their health.
