“I haven’t changed how I eat, so why has my cholesterol suddenly gone up?”
This is something many women notice during their forties and fifties. A cholesterol result that was previously within range may begin to rise, even though your weight, diet and lifestyle have not changed all that much.
It does not necessarily mean you have done anything wrong. The hormonal changes of perimenopause can affect how the liver processes fats, and how cholesterol is transported and cleared from the blood.
So, rather than blaming yourself or panicking over one result, it can be helpful to take a wider look at your hormones, metabolic health, family history and overall cardiovascular risk.
What does oestrogen have to do with cholesterol?
Oestrogen does much more than regulate the menstrual cycle. It also has a role in:
- How the liver processes cholesterol
- How readily LDL particles are cleared from the blood
- How the body responds to insulin
- Where body fat is stored
- The health and flexibility of the blood vessels
During perimenopause, oestrogen does not simply decline in a smooth, predictable way. Levels can rise and fall quite a bit before becoming consistently lower after menopause.
Around this time, some women may see increases in:
- Total cholesterol
- LDL cholesterol
- Non-HDL cholesterol
- Apolipoprotein B, or ApoB
- Triglycerides
Research following women through the menopause transition has found rises in LDL cholesterol, ApoB and several measures of LDL particles.
Ageing plays a part too, of course, but it does not explain every cholesterol change that can happen around the time of the final menstrual period.
Cholesterol is not the enemy
Cholesterol is an important substance. Your body needs it to:
- Build cell membranes
- Produce steroid hormones
- Make vitamin D
- Produce the bile acids needed for digestion
So the aim is not to get rid of cholesterol altogether.
The more useful question is whether the number and pattern of cholesterol-carrying particles are increasing the likelihood of cholesterol entering the artery walls over time.
This is why a total-cholesterol result on its own cannot tell us the full story.
Understanding your cholesterol results
Total cholesterol
This is the combined amount of cholesterol carried in several types of lipoprotein particles. It is useful, but it is quite a broad number and is best understood alongside the rest of your results.
LDL cholesterol
LDL cholesterol measures the amount of cholesterol carried mainly inside LDL particles. Higher levels are generally linked with greater cardiovascular risk, but the LDL result does not tell us exactly how many particles are carrying that cholesterol.
HDL cholesterol
HDL is often called “good cholesterol”. However, a higher HDL result does not automatically cancel out a high LDL or ApoB result.
As with most things in health, it is the overall picture that matters.
Triglycerides
Triglycerides are a type of fat used by the body for energy. Raised levels can be linked with insulin resistance, diabetes, alcohol intake, some medicines and other metabolic factors.
Non-HDL cholesterol
Non-HDL cholesterol is your total cholesterol minus your HDL cholesterol. It gives us an idea of the cholesterol being carried inside all the potentially artery-damaging particles.
What is ApoB?
ApoB stands for apolipoprotein B. It is a protein found on the cholesterol-containing particles that can enter the artery walls and contribute to plaque formation.
One simple way to think about the difference between LDL cholesterol and ApoB is to imagine the particles as delivery vans:
- LDL cholesterol tells us how much cargo is inside the vans.
- ApoB gives us an idea of how many vans are travelling on the road.
Two women could have a similar LDL cholesterol result but a different number of particles carrying that cholesterol.
The woman with more particles, or more “vans on the road”, may have a higher cardiovascular risk.
This is why ApoB can sometimes give us a clearer picture than LDL cholesterol alone, particularly when triglycerides are raised or when insulin resistance, metabolic syndrome or type 2 diabetes is part of the picture.
Is ApoB available in Ireland and Europe?
Yes. ApoB testing is available in Ireland, the United Kingdom and throughout Europe. It is not an American-only test.
That said, it is not usually included in a standard cholesterol panel.
Your doctor may request it when a more detailed cardiovascular assessment would be helpful. Access can vary between laboratories and health services. Some public laboratories may reserve it for particular clinical indications or specialist lipid clinics, while private laboratories may also offer the test.
A useful question to ask your doctor might be:
“Would an ApoB test add useful information in my case, particularly as my cholesterol has changed during perimenopause?”
What else might be worth looking at?
A fuller assessment may include:
- LDL, HDL, triglycerides and non-HDL cholesterol
- ApoB
- Lipoprotein(a), or Lp(a)
- Blood pressure
- Fasting glucose or HbA1c
- Thyroid function
- Kidney and liver health, where appropriate
- Smoking, alcohol, medicines and movement
- Waist measurement and changes in body composition
- Personal and family cardiovascular history
You do not necessarily need every test at once. The most useful next step will depend on your results, symptoms, medical history and family history.
What is lipoprotein(a)?
Lipoprotein(a), written as Lp(a), is another cholesterol-carrying particle.
Your level is largely inherited and usually stays fairly stable throughout your life. A raised level can increase cardiovascular risk, even when an ordinary cholesterol panel looks reasonably reassuring.
Many guidelines now support measuring Lp(a) at least once in adulthood, particularly if there is a family history of heart disease or stroke at a younger age.
It is worth remembering that Lp(a) is mostly genetic. It is not a reflection of whether you have been “good” or “bad” with your diet.
Is it only about oestrogen?
No. Hormonal change can be an important part of the story, but cholesterol may also be influenced by:
- Genetics or familial hypercholesterolaemia
- An underactive thyroid
- Insulin resistance or diabetes
- Increasing abdominal or visceral fat
- Reduced muscle mass
- Poor sleep or obstructive sleep apnoea
- Smoking
- Alcohol intake
- Some medicines
- Kidney or liver conditions
- Dietary patterns
- Reduced physical activity
This is why it is important to look at the whole person rather than assuming every change is simply “the menopause”.
Sometimes the cholesterol change is mainly hormonal. Sometimes it is a combination of several small changes that have gathered momentum over time. And sometimes it points to something else that is worth investigating.
A naturopathic, whole-person approach
A naturopathic approach asks what may be contributing to the change, while still taking your cholesterol results and wider cardiovascular health seriously.
The next step is not to chase one perfect number or to feel that you have failed in some way. It is to understand your individual results, look at the factors that may be contributing and build appropriate nutrition and lifestyle support around your health, your needs and your medical care.
And, as always, if your cholesterol is significantly raised or your overall cardiovascular risk is high, it is important to discuss this with your doctor. Lifestyle support can sit alongside medical care; it does not have to be one or the other.
Food and everyday support for cholesterol
There are practical ways to support your cholesterol and metabolic health during perimenopause. The most useful plan takes account of your results, digestion, food preferences and the rest of your health.
Bring back cholesterol-lowering fibre
Soluble fibre is particularly useful. It helps carry some bile acids out through the bowel, and the liver uses cholesterol to make more bile acids. Food sources include oats, barley, beans, lentils, chickpeas, ground flaxseed, chia seeds, apples, pears, berries and vegetables.
That might mean porridge at breakfast, lentils added to a soup, or a little ground flaxseed stirred into yoghurt. Increase fibre gradually and drink enough water. If beans or seeds cause significant bloating, the type and amount need to suit your digestion. Constipation is worth addressing in its own right.
Choose cholesterol-lowering fats
Use extra virgin olive oil more often, and include suitable nuts, seeds, avocado and oily fish if you eat them. Replacing some butter, cream, coconut oil, fatty or processed meat with these foods can help lower LDL cholesterol for some people. You do not need an extremely low fat diet, but it is worth looking at the amounts and patterns in your own meals.
Support blood sugar balance
Insulin resistance may go alongside raised triglycerides, changes in HDL and more abdominal fat. Build meals around adequate protein, fibre-rich carbohydrates and vegetables. Regular meals, a walk after eating and fewer sugary drinks or frequently eaten refined snacks can be helpful starting points.
Protect and build muscle
Muscle helps the body handle glucose. Strength exercises adapted to your abilities are especially valuable during perimenopause. Walking, dancing or another form of movement you enjoy supports your heart too; the aim is a routine you can actually keep up.
Address sleep and stress
Night sweats, broken sleep and a stressful week can make food choices and movement much harder. Sleep also matters for blood pressure and insulin sensitivity. Look at what is disturbing your sleep and where you need support, rather than treating a cholesterol result as a question of food alone.
Supplements need individual guidance. Fibre products, plant sterols, omega-3 products and metabolic herbs are not suitable for everybody and may interact with medicines. Do not start one or change prescribed treatment without advice from a suitably qualified practitioner.
Would you like more individual support?
I offer a comprehensive, individualised programme shaped around your needs and circumstances. We can explore food, lifestyle, supplements and herbs, and I can recommend testing when appropriate. Email lisa@evolvefemalewellness.com to enquire about working together.