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Cardiovascular

Lp(a) in women: pregnancy, menopause and hormone therapy

Lp(a), in full lipoprotein(a), is an LDL lipoprotein according to the Dutch guideline on inherited dyslipidaemia, a lipid particle that carries cholesterol, with a protein called apolipoprotein(a) coupled to it. According to the European Atherosclerosis Society (EAS), Lp(a), like LDL, is a particle with apoB, but far fewer of them circulate.

A high Lp(a) is causally associated with cardiovascular disease and with narrowing of the aortic valve according to the EAS, and the value is largely inherited. Only a blood test shows how much Lp(a) there is.

Unilabs measures Lp(a) in nanomoles per litre, uses < 60 nmol/l as the reference value, without distinguishing by sex, and calls 75 to 125 nmol/l a grey zone for cardiovascular disease.

Doctor's Assessment Included

Lp(a) is a fat particle whose level is largely inherited. Laboratories report it in nmol/l or mg/l, so a result can only be compared with the limit of the laboratory that measured it.

  • Star-SHL and Diagnostiek voor U use < 75 nmol/l, Unilabs < 60 nmol/l and Certe < 500 mg/l.
  • Lifestyle has little effect on the Lp(a) level.
  • A measurement can be useful with heart or vascular disease at a young age, or with heart or vascular disease in the family.

When is this value abnormal?

Decision limits per result, in g/l
Result Value (g/l)
Normal < 0,3
Borderline 0,3–0,5
Elevated ≥ 0,5

Lp(a) is largely inherited and stays almost constant throughout life. The risk rises gradually with the value; the EAS stresses that there is no biological threshold. The NHG guideline CVRM uses > 50 mg/dl (0.50 g/l, 80th percentile) as the cut-off and advises against screening the general population. Some laboratories apply a stricter upper limit (0.3 g/l), which matches the lower end of the EAS grey zone.

Source: Nederlands Huisartsen Genootschap Reference population: Adults (NHG guideline CVRM; EAS 2022)

Source: European Atherosclerosis Society Reference population: Adults (NHG guideline CVRM; EAS 2022)

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.

Lipoprotein(a): what Dutch laboratories use

The upper limit runs from 60 nmol/l at Unilabs to 75 nmol/l at Star-shl.

Reference ranges by group, in nmol/l
Star-shl · Everyone · a limit, not a range < 75 nmol/l
75
Unilabs · Everyone · a limit, not a range < 60 nmol/l
60
Unilabs · Everyone · grey zone for cardiovascular disease 75–125 nmol/l
75 125
Unilabs · Everyone · a limit, not a range · raised risk of cardiovascular disease > 125 nmol/l
125
Certe · Everyone · 18 years and older · a limit, not a range < 500 mg/L
Certe · Everyone · grey zone 300–500 mg/L
Certe · Everyone · a limit, not a range · high risk > 500 mg/L
Diagnostiek voor U · Everyone · a limit, not a range < 75 nmol/L
75
0 137.5 nmol/l

Source: Star-shl

Source: Unilabs

Source: Certe

Source: Diagnostiek voor U

Each value as the laboratory itself publishes it, retrieved in 2026.

Lipoprotein(a): what this test measures

An Lp(a) measurement gives the concentration of lipoprotein(a) in the serum, at Unilabs in nanomoles per litre. Unilabs writes that the Lp(a) concentration is mostly genetically determined and inversely related to the number of repeats of a protein domain in apo(a): fewer repeats, more Lp(a).

Lipoprotein(a): why this value matters

The risk of cardiovascular disease rises gradually with the Lp(a) value according to the EAS, also at values below the usual limits. The Dutch guideline on inherited dyslipidaemia considers that risk raised with an Lp(a) above the 80th percentile, 50 mg/dl.

Lipoprotein(a): 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.
Which test
on its own €36,-
Where
650+ draw sites run by independent laboratories across the Netherlands. Draw sites

Lipoprotein(a): when is testing worthwhile?

The 2022 EAS consensus advises measuring Lp(a) at least once in every adult; the Dutch guideline on inherited dyslipidaemia sees no justification for screening the general population. The Dutch guideline names a family history of cardiovascular disease or of raised Lp(a) as a situation in which a measurement can be considered.

Lipoprotein(a): symptoms of a high or low value

Low Levels

A low Lp(a), below 60 nmol/l at Unilabs, falls within the reference value. Hormone replacement therapy after menopause lowers Lp(a) by about 25% according to the EAS.

High Levels

According to the EAS, a high Lp(a) makes narrowing of the aortic valve and cardiovascular disease more likely. During pregnancy, Lp(a) rises to double according to the EAS.

Lipoprotein(a): causes of a low or high value

What lowers the value

  • Reduced liver function

    Lp(a) is made in the liver, so a poorly working liver can lower the level.

  • Overactive thyroid

    An overactive thyroid can lower Lp(a); after treatment the level rises by 20 to 25 percent.

  • Hormone therapy after menopause

    Hormone replacement therapy after menopause lowers Lp(a) by about 25 percent.

  • Severe acute illness

    In life-threatening conditions such as sepsis or severe burns, Lp(a) is lower.

What raises the value

  • Inherited level

    The Lp(a) level is thought to be mainly set by the genes and to barely change from adulthood.

  • Kidney disease

    Reduced kidney function can raise Lp(a), and in nephrotic syndrome the level is 3 to 5 times higher.

  • Pregnancy

    Lp(a) can double during pregnancy.

  • Underactive thyroid

    An underactive thyroid can raise Lp(a); treatment lowers it by 5 to 20 percent.

Lipoprotein(a): lifestyle and this value

With a high Lp(a), the EAS reads the result within the total risk of cardiovascular disease. According to the Dutch guideline on inherited dyslipidaemia, lowering Lp(a) with hormone replacement therapy or with nicotinic acid did not lead to less cardiovascular disease in studies.

Lipoprotein(a): frequently asked questions

Does Lp(a) rise after menopause?

The EAS consensus is not consistent about Lp(a) after menopause: its text says that in women the value tends to increase at menopause, while its table of non-genetic influences lists no or minimal effect for menopause.

Is Lp(a) different in women and men?

Yes, according to the EAS Lp(a) is generally about 5 to 10% higher in women than in men, in both Black and White people. The EAS describes the Lp(a) level of men as relatively constant.

Does the thyroid affect Lp(a)?

Yes, an underactive thyroid raises Lp(a) according to the EAS, and treatment lowers the value by 5 to 20%. An overactive thyroid lowers Lp(a), and after treatment with thyroid-suppressing medicine or radioactive iodine the value rises by 20 to 25%.

Lipoprotein(a): sources

  1. Kronenberg F, Mora S, Stroes ESG, et al. Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement. Eur Heart J 2022;43(39):3925-3946. Grijs gebied 30-50 mg/dl, per de FAQ in Atherosclerosis 2023. (retrieved 2026) doi.org
  2. NHG-Standaard Cardiovasculair risicomanagement (M84). Gepubliceerd juni 2019, laatste aanpassing september 2024. Tabel 22, Overzicht van afkapwaarden bij niet-nuchter afgenomen bloed (80e percentiel): "Lp(a) > 50 mg/dl". Geraadpleegd 14 juli 2026. (retrieved 2026) richtlijnen.nhg.org
  3. Star-shl, Labbepalingen (referentiewaarden per bepaling), star-shl.nl, geraadpleegd 2026-10-01 (retrieved 2026) star-shl.nl
  4. Unilabs, Bepalingenklapper (referentiewaarden per bepaling), bepalingenklapper.nl, geraadpleegd 2026-10-01 (retrieved 2026) bepalingenklapper.nl
  5. Certe, Bepalingenwijzer (referentiewaarden per bepaling), bepalingenwijzer.certe.nl, geraadpleegd 2026-10-01 (retrieved 2026) bepalingenwijzer.certe.nl
  6. Diagnostiek voor U, eLabgids (Referentiewaarden DvU), diagnostiek.getincontrol.eu, geraadpleegd 2026-10-01 (retrieved 2026) diagnostiek.getincontrol.eu
  7. Kronenberg F, et al. Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement. Eur Heart J 2022;43(39):3925-3946, Table 1. (retrieved 2026) pmc.ncbi.nlm.nih.gov
  8. Federatie Medisch Specialisten, Richtlijn Erfelijke dyslipidemie in de 2e en 3e lijn, module Behandeling patiënten met verhoogd Lp(a), richtlijnendatabase.nl, geraadpleegd 2026-10-03 (retrieved 2026) richtlijnendatabase.nl

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Lipoprotein(a)

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