Lowering cholesterol comes down to two things: knowing which value is too high, and tackling the lifestyle that feeds it. For most women, the gains sit in soluble fibre, less saturated fat and more movement. But one detail often gets skipped: around menopause your LDL cholesterol tends to rise on its own, regardless of how you live.
That is the honest story I think gets told too rarely. You can eat exactly the same for years and still see a higher number on your result, simply because your oestrogen is falling. In this overview you will read how cholesterol works, what healthy values look like, how you can influence them and which blood values give insight. The deeper how-to questions live in separate articles that this piece links to.
What is cholesterol and why does it matter?
Cholesterol is a fat-like substance your body makes itself and also gets from food. You need it for cell walls, hormones and vitamin D. Too much of the wrong kind in your blood is linked to a higher risk of cardiovascular disease. So it is not about wiping cholesterol out, but about balance.
Doctors rarely look at one number. They look at a few sub-values that together form a picture. The main ones are explained briefly below.
- LDL cholesterol: often called the "bad" cholesterol. A raised LDL can build up in your artery walls.
- HDL cholesterol: the "good" cholesterol, which helps carry surplus cholesterol away. A low HDL is usually a lifestyle signal, not a dial you easily turn.
- Triglycerides: a separate blood fat that reacts strongly to sugar, alcohol and excess weight.
- Total cholesterol and non-HDL: sums that summarise the whole picture.
Want to know exactly what each value means and what counts as healthy? That is in our cholesterol values table with reference ranges for women.
Why does your cholesterol change around menopause?
Around menopause, many women see their LDL cholesterol rise, even without any lifestyle change. The drop in oestrogen appears to play a role. It is one reason a value that was stable for years can suddenly read higher.
This is not a hunch. In the SWAN study, which followed thousands of women through menopause, total cholesterol, LDL and apoB rose most in the year around the final period (Matthews et al., 2009). The researchers concluded that this jump had more to do with menopause than with age alone.
What does that mean for you? Mainly this: do not panic if your number climbs in your late forties or early fifties. It may fit the phase you are in. At the same time, it is a good moment to measure once, so you have a baseline. More on the hormonal side is in our article on cholesterol and heart health after menopause.
What are the symptoms of high cholesterol?
Usually none. High cholesterol on its own rarely gives symptoms, and precisely for that reason it often stays unnoticed for a long time. In most people, a rise only shows up in a blood test, not through how they feel.
That makes cholesterol somewhat elusive. You can feel perfectly fine and still have a raised value. Only with strongly raised or hereditary forms are there sometimes visible signs, such as cholesterol deposits in the skin or tendons, but that is rare.
Because symptoms are absent, measuring is the only way to really know your values. I say this not to push you towards testing, but to clear up a misunderstanding: "I feel good, so my cholesterol must be fine" is unfortunately not a reliable assumption.
What are healthy cholesterol values?
There is no single "good" number that fits everyone. What counts as healthy depends on your whole risk profile: age, blood pressure, smoking, family history and whether you already have cardiovascular problems. The Dutch Heart Foundation (Hartstichting) therefore uses target values that differ per person. The table below gives a rough direction, not an individual verdict.
| Value | Rough direction (adults) |
|---|---|
| Total cholesterol | below about 5.0 mmol/l |
| LDL cholesterol | often below 3.0 mmol/l, lower at higher risk |
| HDL cholesterol | for women, ideally above 1.3 mmol/l |
| Triglycerides (fasting) | below about 1.7 mmol/l |
See these figures as a compass, not a final verdict. Your GP weighs them against the rest of your profile. The full explanation per value, including the cholesterol ratio, is in the cholesterol values table for women.
How do you lower your cholesterol?
For many people, cholesterol lowering is partly possible with food and lifestyle. According to the Hartstichting, an adjusted diet can lower cholesterol by roughly ten to twenty percent. What works most varies per person and per starting value.
With food
The biggest food lever is the fat choice: swapping saturated fat for unsaturated fat. Soluble fibre helps too. Oats contain beta-glucan, a fibre that can lower LDL; in a meta-analysis of 58 studies, about 3.5 grams a day did so measurably (Ho et al., 2016). Products with added plant sterols can lower LDL by roughly six to twelve percent (Ras et al., 2014).
Which products exactly, and in what amounts, we have set out in lowering cholesterol with food. In short: oats, legumes, nuts, oily fish and plant oils belong on the list.
With movement and lifestyle
Movement works mainly on your HDL and triglycerides. Regular activity can raise HDL slightly; in a meta-analysis the threshold sat around 120 minutes of exercise per week (Kodama et al., 2007). Quitting smoking and losing excess weight help too. The practical approach is in raising HDL cholesterol and, for the fat that reacts fastest, in high triglycerides.
When medication enters the picture
Sometimes lifestyle is not enough, for example with a strongly raised risk or a hereditary form. Then your GP may discuss medication such as a statin. Whether that fits you is a conversation with your doctor, not a decision you take from a blog. We give no treatment advice here; we only sketch when the topic can come up.
When is high cholesterol hereditary?
In a small share of people, high cholesterol is hereditary. Familial hypercholesterolaemia (FH) occurs in about one in 250 people according to the European specialist society, but often goes unrecognised (Nordestgaard et al., 2013). With FH the LDL is strongly raised from a young age.
Think of a hereditary cause if your LDL is strikingly high, if close family developed cardiovascular problems young, or if you already had high values early. Recognise this? Read on in hereditary high cholesterol and familial hypercholesterolaemia, and discuss it with your GP.
What is the difference between good and bad cholesterol?
The difference is in what the particles do. LDL carries cholesterol to your tissues and can build up in your artery walls, hence the "bad" nickname. HDL does the opposite: it collects surplus cholesterol and brings it back to your liver. That is why it is "good".
Still, that split is a bit too simple. Your body simply needs LDL; the problem only arises with too much relative to the rest. That is why doctors also look at non-HDL cholesterol, the sum of all non-HDL fractions. Besides LDL, that value also captures other unfavourable particles.
What helps me explain it: see LDL as delivery vans and HDL as the collection service. You need both, but if too many vans drive and too little is collected, cargo is left in the artery wall. So it is about the balance between supply and removal, not one bad number. Want to improve your HDL on purpose, read raising HDL cholesterol.
Can you lower cholesterol without statins?
With a slightly raised cholesterol and a low risk, people often try lifestyle first. Food and movement can capture part of the gain, especially if there is room in your eating pattern. Whether that is enough depends on your starting value and your overall risk.
With a strongly raised LDL, a hereditary form or a high risk, lifestyle is often not sufficient. Then a statin may come up. That is a trade-off your GP makes with you, not a choice you take from a blog. We give no treatment advice here.
Important to know: lifestyle and medication do not exclude each other. Even if you take medication, healthy eating and movement remain useful. I say this because some people see lifestyle as an "either-or", while in practice it is often a "both-and". Discuss with your GP what fits your situation.
What does high cholesterol mean for your heart?
A long-raised cholesterol, especially a high LDL, is linked to a greater chance of atherosclerosis and cardiovascular disease. It is one of several risk factors, alongside blood pressure, smoking, diabetes and family history. No single factor determines your risk on its own.
That is why your GP never looks at cholesterol alone. Someone with a slightly raised LDL but an otherwise favourable profile carries a different risk than someone with the same LDL who smokes and has high blood pressure. Your cholesterol is a puzzle piece, not a final verdict.
For women, this is extra relevant around menopause, when several risk factors can shift at once. That makes this phase a logical moment to set a baseline once and discuss with your GP what fits.
Which blood values do you test?
A lipid profile measures the values that together form your cholesterol picture. Usually that is total cholesterol, LDL, HDL, the cholesterol ratio and triglycerides. Below you see what each value tells you roughly.
| Value in the profile | What it roughly indicates |
|---|---|
| Total cholesterol | the sum of all cholesterol fractions |
| LDL cholesterol | the fraction that can build up in artery walls |
| HDL cholesterol | the fraction that helps carry cholesterol away |
| Triglycerides | blood fat that reacts to sugar, alcohol and weight |
| Cholesterol/HDL ratio | ratio that puts the fractions in context |
At Lunara you can measure these values with a lipid profile blood test. Every result is assessed by a BIG-registered doctor, so you see your numbers in context. If you only want to look at your bad cholesterol, you can check individual values such as LDL cholesterol.
A test result is a snapshot, not a diagnosis. What your values mean for your situation, you decide together with your GP. Just seen a number you do not trust? Then first test a full profile, so you have LDL, HDL and triglycerides side by side, and take that to your appointment.
Sources
- Matthews KA, Crawford SL, Chae CU, et al. Are changes in cardiovascular disease risk factors in midlife women due to chronological aging or to the menopausal transition? J Am Coll Cardiol. 2009;54(25):2366-2373. PMID 20082925.
- Ho HVT, Sievenpiper JL, Zurbau A, et al. The effect of oat beta-glucan on LDL-cholesterol, non-HDL-cholesterol and apoB for CVD risk reduction: a systematic review and meta-analysis. Br J Nutr. 2016;116(8):1369-1382. PMID 27724985.
- Ras RT, Geleijnse JM, Trautwein EA. LDL-cholesterol-lowering effect of plant sterols and stanols across different dose ranges: a meta-analysis. Br J Nutr. 2014;112(2):214-219. PMID 24780090.
- Nordestgaard BG, Chapman MJ, Humphries SE, et al. Familial hypercholesterolaemia is underdiagnosed and undertreated in the general population. Eur Heart J. 2013;34(45):3478-3490. PMID 23956253.
- Hartstichting. Cholesterol and lowering high cholesterol. Available via hartstichting.nl.
Every blood test result at Lunara includes a professional assessment by a BIG-registered doctor. For treatment decisions, discuss your results with your GP.
Author
