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Abstract Background Lipedema is a chronic condition characterized by disproportionate adipose tissue accumulation, pain, and sensitivity, often influenced by hormonal fluctuations. Despite its prevalence, the specific impact of exogenous hormones on the disease course remains understudied. Objective To investigate the association between hormonal contraceptive use and the presence and severity of lipedema in Brazilian women. Methods A cross-sectional study was conducted at Amato – Instituto de Medicina Avançada using a structured online questionnaire administered between August and November 2025. Brazilian women aged 18 years or older with suspected or diagnosed lipedema were included. The questionnaire assessed demographic and clinical characteristics, history of contraceptive use, lipedema symptoms, and impact on quality of life. Symptom scores (0-8 points) and quality of life impact scores (0-15 points) were calculated. Statistical analyses included Chi-square and Kruskal-Wallis tests, Spearman correlations, and logistic and linear regressions. Results A total of 637 women participated, with a mean age of 41.8 ± 8.7 years and a mean BMI of 28.9 ± 6.4 kg/m². Of the participants, 491 (77.1%) had a confirmed diagnosis of lipedema. It was observed that 58.8% of users reported symptom worsening after contraceptive use (p<0.001). Free-text analysis revealed that 15.1% of participants experienced the onset of lipedema symptoms concurrently with the start of contraceptive use. Weight gain as a side effect was strongly associated with worsening. In multivariate logistic regression, symptom score (OR=1.562, p<0.001) and age at menarche (OR=0.746, p=0.0135) were significant predictors of worsening. Regarding impact on quality of life, BMI (beta=0.364) and pain (beta=0.641) were independent predictors. Conclusions: This study demonstrates a significant association between hormonal contraceptive use and self-reported worsening of lipedema symptoms. These results have potential implications for individualized contraceptive counseling for women with lipedema and reinforce the need for prospective investigations to confirm the nature and direction of this association.