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Cardiovascular

Cholesterol/HDL ratio in women: hormones, pregnancy and the result

According to the NVKC, cholesterol is needed among other things for making certain hormones and bile acids, and for building tissues and organs. According to the NVKC, HDL cholesterol belongs to the lipoproteins, fat-proteins that transport cholesterol, and is called good cholesterol because the cholesterol in the HDL particle leaves the blood via the liver. The cholesterol/HDL ratio is the ratio between total cholesterol and that HDL cholesterol.

According to the NVKC, cholesterol can deposit in the blood vessels and narrow them, and Thuisarts writes that high cholesterol itself gives no symptoms. That is why only a blood test makes the cholesterol/HDL ratio visible.

According to the NVKC, a cholesterol/HDL ratio below 3.5 is best, and the limit lies at 5.

Doctor's Assessment Included

The cholesterol/HDL ratio is the ratio between total cholesterol and HDL cholesterol. According to the NVKC, the ratio should be below 5, and below 3.5 is best.

  • None of the laboratories Star-SHL, Unilabs and Diagnostiek voor U publishes a limit for the cholesterol/HDL ratio itself; they give limits for cholesterol and HDL cholesterol separately.
  • The NHG no longer estimates cardiovascular risk in SCORE2 with the cholesterol/HDL ratio, but with non-HDL cholesterol.
  • According to the NVKC, the assessment of the cholesterol/HDL ratio should also look at the separate results.

Reference Ranges

Female
mol/mol
Normal < 5 High

Reference ranges may vary between laboratories. When you order a test, a BIG-registered doctor assesses your personal results in context. For treatment decisions, discuss your results with your GP.

Check your own value

Cholesterol/HDL Ratio: what this test measures

The cholesterol/HDL ratio divides total cholesterol by HDL cholesterol. Star-SHL and Unilabs give separate limits for HDL cholesterol for women and men, but neither publishes a limit for the ratio.

Cholesterol/HDL Ratio: why this value matters

According to MedlinePlus, the US National Library of Medicine's health site, progestins, female hormones in some birth control pills and in hormone therapy for menopause, can lower HDL cholesterol in some people, and with the same total cholesterol the cholesterol/HDL ratio then rises.

Cholesterol/HDL Ratio: how the blood test works

Referral
No GP referral needed. After the order we arrange the referral through ZorgDomein, within one business day; orders after 17:00 or at the weekend start on the next business day. ZorgDomein emails a barcode, and that barcode is what the draw site needs.
The draw
A blood draw from a vein in the arm, at a partner laboratory's draw site. No home kit, no finger prick.
Where
650+ draw sites run by independent laboratories across the Netherlands. Draw sites

Cholesterol/HDL Ratio: when is testing worthwhile?

According to the NVKC, a cholesterol/HDL ratio is better not measured during pregnancy: in pregnancy HDL cholesterol is often higher or lower than normal, and the NVKC advises the test at least 6 weeks after the pregnancy.

Cholesterol/HDL Ratio: symptoms of a high or low value

Low Levels

A cholesterol/HDL ratio falls when HDL cholesterol rises with the same total cholesterol, and according to Thuisarts high HDL cholesterol is actually good for the blood vessels.

High Levels

A cholesterol/HDL ratio of 5 or higher does not meet the NVKC limit of below 5. According to Thuisarts, when cholesterol is too high for years the risk of heart and blood vessel disease is greater, for example a heart attack or a stroke.

Cholesterol/HDL Ratio: causes of a low or high value

What lowers the value

  • Regular exercise

    Regular exercise can raise HDL cholesterol and lower LDL cholesterol.

  • Cholesterol-lowering medicines

    Some cholesterol medicines, including certain statins, can raise HDL cholesterol as well as lowering LDL cholesterol.

What raises the value

  • High total cholesterol

    High cholesterol, the number on top of the ratio, can come from unhealthy eating, being overweight, moving little, some diseases such as a slow thyroid, or many people with very high cholesterol in the family.

  • Smoking

    Smoking and second-hand smoke can lower HDL cholesterol, the number the ratio is divided by.

  • Certain medicines

    In some people, beta blockers, anabolic steroids such as testosterone, progestins in some birth control pills and menopausal hormone therapy, and benzodiazepines can lower HDL cholesterol.

  • Diabetes

    Diabetes can lower HDL cholesterol.

Cholesterol/HDL Ratio: lifestyle and this value

See your GP with a cholesterol/HDL ratio that is too high. When someone takes one of the medicines MedlinePlus lists, such as progestins or beta blockers, and HDL cholesterol is very low, MedlinePlus advises asking the provider whether to continue it.

Cholesterol/HDL Ratio: frequently asked questions

Can the pill lower HDL cholesterol?

According to MedlinePlus, progestins, which are in some birth control pills, can lower HDL cholesterol in some people, and with it the cholesterol/HDL ratio, the ratio between total cholesterol and HDL cholesterol, changes too.

Cholesterol/HDL Ratio: sources

  1. MedlinePlus, HDL: The "Good" Cholesterol, U.S. National Library of Medicine, last updated 2026-08-03, geraadpleegd 2026-10-16 (retrieved 2026) medlineplus.gov
  2. Thuisarts.nl (NHG), Ik heb een hoog cholesterol, geraadpleegd 2026-10-16 (retrieved 2026) thuisarts.nl

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