This randomized controlled clinical trial aims to evaluate the effectiveness of extracorporeal shockwave therapy (ESWT) when added to standard conservative treatment in women with primary lipedema. Participants will be randomly assigned to receive either standard conservative therapy alone or standard therapy combined with radial ESWT. The study will assess changes in pain intensity (VAS), limb circumference measurements, quality of life (SF-36), and patient satisfaction over an 8-week period. Evaluations will be performed at baseline, at the end of the 4-week treatment phase, and at 4-week follow-up. This trial seeks to provide evidence on whether ESWT offers additional clinical benefit in the management of primary lipedema.

Lipedema is a chronic, progressive adipose tissue disorder characterized by disproportionate subcutaneous fat accumulation, pain, tenderness, easy bruising, and functional limitations. It predominantly affects women and leads to impaired mobility and reduced quality of life. Current international guidelines recommend conservative therapies as first-line management, including manual lymphatic drainage, pneumatic compression, compression garments, targeted exercise programs, and patient education. Although these interventions improve pain and function, their impact on underlying fibrotic changes and tissue stiffness is limited, creating a need for adjunctive treatments.

Extracorporeal shockwave therapy (ESWT) has been shown to enhance microcirculation, modulate inflammation, improve lymphatic flow, and exert anti-fibrotic effects through mechanotransduction. Positive outcomes have been reported in conditions with similar tissue characteristics, such as cellulite, lymphedema, and post-liposuction fibrosis. However, no randomized controlled trials have evaluated the efficacy of ESWT specifically in primary lipedema. This trial aims to address this gap in the literature.

This prospective, randomized, evaluator-blinded, controlled clinical study will include adult women aged 18-65 years diagnosed with Stage I-II primary lipedema according to Wold criteria. Eligible participants will be recruited from the Physical Medicine and Rehabilitation outpatient clinic of Medical Point Gaziantep Hospital. Participants will be randomized in a 1:1 ratio into two groups: (1) standard conservative therapy alone, or (2) standard conservative therapy plus radial ESWT. Conservative treatment will include manual lymphatic drainage, pneumatic compression therapy, Class II compression garments, and a home-based exercise program.

The ESWT group will receive additional radial ESWT using a BTL device with the following parameters: 2.0-2.5 bar pressure, 12 Hz frequency, 1000 shocks per region, 20-mm radial applicator head. Treatment regions will include the anterolateral thigh, medial thigh, and posterolateral calf. ESWT will be administered twice weekly for 4 weeks, totaling 8 sessions. Limb circumference will be measured at predefined anatomical points (thigh +10 cm/+20 cm above the patella, calf 10 cm above the medial malleolus, and ankle at the narrowest point).

Outcome measures will include pain intensity (VAS), quality of life (SF-36), limb circumference measurements, and patient satisfaction. Assessments will be performed at baseline (T0), immediately after completion of the 4-week intervention period (T1), and 4 weeks post-treatment (T2). The primary outcome is the change in VAS pain score from baseline to week 4. Secondary outcomes include changes in limb circumference, SF-36 scores, and satisfaction ratings, as well as the monitoring of any adverse events.

The study aims to determine whether adding ESWT to standard conservative management results in superior clinical outcomes compared with standard therapy alone. Findings may contribute to the development of evidence-based therapeutic strategies for women with primary lipedema.

Inclusion Criteria:

Female patients aged 18-65 years Diagnosis of primary lipedema (Stage I-II according to Wold criteria) Stable body weight for the past 3 months Ability to comply with compression garment use Willingness to participate and ability to provide informed consent

Exclusion Criteria:

Secondary lipedema or severe venous disease (CEAP C4 or higher) Liposuction or similar procedures within the past 6 months Pregnancy or breastfeeding Active infection, inflammation, or thrombosis Use of high-dose anticoagulants Contraindications to extracorporeal shockwave therapy

Eligibility is limited to biological females because primary lipedema occurs almost exclusively in women.

Individual participant data will not be shared.

Outcome assessments, including VAS, SF-36, and circumference measurements, will be performed by an evaluator who is blinded to group allocation. Participants and treatment providers will not be blinded.