Managing Pain, Hypermobility, Lipoedema, Arthritis, and Mast Cell Activation
- Purity Carr
- Sep 4
- 4 min read
This blog explains how mast cells, connective tissue conditions such as hypermobility and lipoedema, and hormones can contribute to pain. It also outlines treatment options available in Australia.
Why Mast Cells Matter
Mast cells are part of the immune system. When overactive, they release chemicals such as histamine, prostaglandins, and leukotrienes. These can cause inflammation, pain, flushing, gut symptoms, and worsen joint or connective tissue problems.
In people with hypermobility, arthritis, or connective tissue disorders, mast cells may play a central role in pain, bursitis, stiffness, and inflammatory flares.
Prostaglandins and Pain
One of the key mast-cell chemicals, prostaglandin D2 (PGD2), contributes to:
Arthritis-type pain and stiffness in joints
Vascular changes (flushing, dizziness)
Sleep disturbances
Because prostaglandins amplify inflammation in joints, they may worsen arthritis or arthritis-like pain, particularly in menopause or MCAS.
Reducing prostaglandins can help with both arthritis-type and connective tissue pain. This is why some people respond to:
Low-dose aspirin (75 - 100 mg daily) if tolerated
Omega-3 fatty acids or curcumin as natural anti-inflammatories
Low-dose naltrexone (LDN), which reduces mast cell cytokines and neuroinflammation
Lipoedema and Pain
Lipoedema is a chronic connective tissue and fat disorder, usually affecting women. It is characterised by:
Lobular, nodular fat on hips, thighs, buttocks, and sometimes arms
Painful, heavy, or tender fat that does not improve with diet or exercise
Feet and hands are typically spared, unlike lymphoedema
Easy bruising
Worsening with hormonal changes (puberty, pregnancy, menopause)
Mast cells are present in fat tissue. In lipoedema, mast cell activation may worsen:
Pain and tenderness through histamine and prostaglandins
Bruising and vascular changes through increased vessel permeability
Inflammation and fibrosis via cytokines and tryptase
This overlap means that lipoedema pain may respond to mast cell–directed therapy, not just physical measures like compression or surgery.
Treatment Options
Treatment usually involves a combination of approaches to calm mast cells, block their chemicals, and support joint and connective tissue health.
1. Mast Cell Stabilisers
Natural options: quercetin, luteolin, and vitamin D can help stabilise mast cells.
2. Blocking Mast Cell Chemicals
Antihistamines:
H1 blockers (cetirizine, loratadine, fexofenadine) help with skin, flushing, and allergy-type symptoms.
H2 blockers (famotidine) help with acid reflux, stomach pain, and gut-related symptoms.
Montelukast: blocks leukotrienes (chemicals that cause airway and gut inflammation).
Typical dose: 10 mg once daily (usually at night).
Also has an upstream mast cell stabilising effect, which can reduce release of histamine and prostaglandins, helping to calm multiple symptoms.
Aspirin (low-dose, if tolerated and recommended by your doctor): reduces prostaglandins that drive arthritis-type pain and inflammation.
Typical dose: 75 - 100 mg once daily.
Note: Not suitable for everyone. Should only be used under medical guidance due to bleeding and stomach risks.
Omega-3 fatty acids: gentler option for reducing prostaglandins.
3. Pain and Inflammation Support
Low-dose naltrexone (LDN): immune-modulating, reduces inflammation and nerve-related pain, useful in hypermobility, arthritis-type pain, and lipoedema overlap.
Starting dose: 0.5 - 1.5 mg at night.
Titration: Increase gradually every 1 - 2 weeks as tolerated.
Common range: 1.5 - 4.5 mg nightly.
Formulation: Compounded capsules or liquid (standard tablets are too strong).
Onset of benefit: Can take 4 - 8 weeks to notice full effect.
Magnesium and vitamin D: support muscle and bone health.
Physiotherapy: strengthens muscles to stabilise hypermobile joints.
Compression/supportive therapy: may help with heaviness in lipoedema.
4. Lifestyle Approaches
Low-histamine, anti-inflammatory diet.
DAO enzyme or gut binders (e.g., Toxaprevent) to reduce histamine from food.
Regular gentle activity and pacing to avoid flare-ups.
Position in the Treatment Ladder (AU Context)
Because cromolyn sodium and ketotifen are not available in Australia, the most practical stepwise approach is:
Core therapies: H1/H2 antihistamines (H2 especially useful for acid symptoms), montelukast (10 mg daily), LDN (0.5 - 4.5 mg nightly).
Nutraceutical supports: quercetin, luteolin, omega-3s.
DAO enzyme: helps break down food-derived histamine.
Toxaprevent: a next-level add-on for patients with persistent gut-driven triggers despite the above.
Low-dose aspirin: 75 - 100 mg daily (if suitable), as an additional option for prostaglandin-driven arthritis-type pain.
Key Points
Arthritis pain can be worsened by mast cell - derived prostaglandins.
Lipoedema is a fat/connective tissue condition, often painful, and can be worsened by mast cell activation.
Cromolyn sodium and ketotifen are not available in Australia; montelukast and LDN are the main prescription tools.
Montelukast targets leukotrienes and also helps stabilise mast cells; aspirin reduces prostaglandins; antihistamines reduce histamine.
A combination approach often works best: stabilising mast cells, blocking their chemicals, and supporting connective tissue health.
Safety Note
Always discuss new treatments with your doctor before starting. Some medicines may interact with others or may not be suitable depending on your health. Keep a symptom diary to track what helps and share this with your healthcare provider.
Dr Purity Carr
Check out our new website - The Home of NEWSTART
The 10:10 Menopause Reset is geared to a low-inflammatory, low-histamine, total body reset using the NEWSTART principle.
NEWSTART is an evidence-based lifestyle framework that stands for:
Nutrition – whole plant-based foods that reduce inflammation and support hormone balance
Exercise – regular movement to build strength, protect bones, and improve energy
Water – hydration to optimise metabolism and reduce histamine load
Sunlight – natural vitamin D to support mood, immunity, and bone health
Temperance – balance and avoidance of triggers such as alcohol, caffeine, and processed foods
Air – fresh air and deep breathing to reduce stress and support oxygenation
Rest – quality sleep to allow hormone reset, repair, and healing
Trust – building emotional resilience, stress management, and s