After menopause, many women see their LDL cholesterol rise, often by around 10 to 15%. That is linked to the loss of oestrogen, which helped protect your cardiovascular system (Santoro, 2016). An unfavourable cholesterol profile gives no complaints, but raises your long-term risk of cardiovascular disease. A lipid panel shows where you stand.
This article belongs to our postmenopause series. I notice that many women mainly associate cardiovascular disease with men, while it is the leading cause of death in women. Below you will read why your risk shifts after menopause, which values give insight and what you can do yourself.
Why does your cholesterol change after menopause?
Your cholesterol changes after menopause mainly because oestrogen falls. Oestrogen helped keep your LDL cholesterol (the unfavourable one) lower and your HDL cholesterol (the favourable one) up to level. When that influence falls away, your profile often shifts the wrong way.
This happens gradually and without you feeling it.
In the years around menopause you often see a rise in total cholesterol and LDL, and sometimes a fall in HDL. Triglycerides can rise too. As a result your cardiovascular risk can gradually increase, even if your lifestyle does not change.
How big is the cardiovascular risk for women?
Cardiovascular disease is a major cause of death in women, and the risk rises after menopause. Before menopause, women on average carry less risk than men of the same age. That difference narrows after menopause.
The symptoms of a heart problem can differ in women from the classic picture. Alongside chest pain, complaints like fatigue, shortness of breath or pain between the shoulder blades can occur.
So it makes sense to map your risk factors, precisely when you feel well. Cholesterol is one of them. The NHG guideline on cardiovascular risk management (CardioVasculair Risicomanagement) describes how doctors in the Netherlands weigh that risk, based on several factors together.
Which cholesterol values give insight?
One cholesterol number says little, it is about the whole profile. A lipid panel looks at several values together, so you see how they relate to one another. The table below explains what each value shows.
| Value | What it shows |
|---|---|
| Total cholesterol | The total amount of cholesterol in your blood |
| LDL cholesterol | The unfavourable part, which can build up in the vessel wall |
| HDL cholesterol | The favourable part, which carries cholesterol back |
| Triglycerides | Fats in your blood, which also influence your risk |
No single value says on its own whether your risk is high. Doctors look at the combination, together with your age, blood pressure, smoking and family history. A raised LDL with a low HDL is usually less favourable than a single raised number.
Want your profile measured? The Lipids test looks at total cholesterol, LDL, HDL and triglycerides in one draw. You then discuss an abnormal result with your GP.
What can you do yourself for your heart?
You can influence a large part of your cardiovascular risk yourself through lifestyle. Nutrition, exercise and not smoking together have a lot of effect. They do not replace medical treatment, but they do support your heart.
What guidelines suggest can help:
- Food with more vegetables, fruit, fibre and unsaturated fats
- Less saturated fat, salt and fast sugars
- Regular exercise, ideally at least 150 minutes of moderate intensity a week
- Stopping smoking, which brings one of the biggest gains
Lifestyle lowers your risk, but gives no guarantee. With a strongly raised cholesterol or a high overall risk, medication can be useful. What suits you is something you decide together with your GP.
Want the wider picture of what changes after menopause? Then read our article on what happens after menopause. Alongside your heart, your bone health also changes, which you can read about in our pillar on bone loss after menopause.
Testing cholesterol through Lunara: how it works
You do not need a GP referral for a lipid panel. You order online, book a slot at a draw location near you and have blood taken in the morning. You receive your result digitally, usually within a few working days.
Every result gets context from a BIG-registered doctor, per value. So you know not only what your LDL or HDL is, but what it can mean in your situation and whether a conversation with your GP makes sense.
Frequently asked questions
Do I need to fast before a cholesterol test?
For total cholesterol, LDL and HDL, fasting is often not strictly needed. For a reliable triglyceride value, fasting is sometimes advised. Follow the advice you receive with your test.
Is a high cholesterol after menopause normal?
A rise in LDL after menopause is common and is linked to the falling oestrogen. Common does not mean unimportant. Whether your value needs attention depends on your overall risk profile.
Does hormone therapy lower my cholesterol?
Hormone therapy can influence your cholesterol profile, but it is not prescribed to lower cholesterol. Whether it suits you depends on many factors. Always discuss this with your GP or specialist.
References
- Santoro N. Perimenopause: From Research to Practice. J Womens Health (Larchmt). 2016;25(4):332-339.
- NHG Guideline Cardiovascular Risk Management (CardioVasculair Risicomanagement). Dutch College of General Practitioners. Available via nhg.org.
- Gezondheidsraad (Health Council of the Netherlands). Dutch dietary guidelines (Richtlijnen goede voeding). The Hague.
- Thuisarts.nl. I have a raised cholesterol. Available via thuisarts.nl.
Every blood test result through Lunara includes a professional assessment by a BIG-registered doctor. For treatment decisions, discuss your results with your GP.
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