Why cholesterol can change around menopause

You can't feel high cholesterol

The NHS puts it simply: high cholesterol does not usually cause symptoms, and you can only find out if you have it from a blood test.

That's what makes it easy to overlook. There's no warning sign, no tiredness or ache that tells you something has shifted. The numbers can change quietly for years.

What happens at menopause

Two large studies give us a clear picture.

SWAN, a US study that followed women through the menopause transition, found that total cholesterol and LDL cholesterol rose substantially within the year either side of the final period. The change was linked to menopause itself, not just to getting older. The researchers concluded that monitoring cholesterol in perimenopausal women should help with prevention.

A UK Biobank analysis of around 273,000 women compared women before and after menopause. Postmenopausal women had, on average, LDL cholesterol about 15% higher, non-HDL cholesterol about 17% higher and triglycerides about 30% higher.

Average difference in women after menopause compared with before, UK Biobank, around 273,000 women. An observational study.

The rise sped up around the final period, and the authors estimate that falling oestradiol, the main form of oestrogen, accounts for much of the difference in LDL.

Oestradiol isn't just a reproductive hormone. It plays a part in how your body handles cholesterol, along with your bones, skin, brain and blood vessels. When it falls, your cholesterol can change even if your habits haven't.

The American Heart Association describes the menopause transition as a critical window for looking after heart health. It's a good moment to know where you stand.

The six cholesterol numbers, in plain English

A cholesterol profile usually includes six results. Here's what each one means.

• Total cholesterol: all the cholesterol in your blood.
• LDL cholesterol: carried in particles that can settle in artery walls. Often called "bad" cholesterol.
• HDL cholesterol: carried in particles that take cholesterol back to the liver. Often called "good" cholesterol.
• Non-HDL cholesterol: your total cholesterol minus HDL. It adds together all the types that can settle in artery walls.
• Total cholesterol to HDL ratio: used in heart risk calculators.
• Triglycerides: the main fat your body uses to store energy. They rise after eating and with alcohol, sugar and extra weight.

Cholesterol itself isn't the enemy. Your body needs it to make hormones and build cells. What matters is how much is travelling in the particles that can settle in your arteries, and for how long.

It's a long game

A European consensus statement concluded that LDL cholesterol causes artery disease, and that the effect depends on both the level and how many years you're exposed to it. Think of it as the level multiplied by the years.

That's why a baseline in your 30s or 40s is useful. It shows where you're starting from, so if your numbers change around menopause you can see it, rather than finding out years later.

What else can affect your cholesterol

Menopause is one factor among several:

• diet, particularly saturated fat
• weight, activity levels and smoking
• alcohol, which affects triglycerides especially
• an underactive thyroid
• PCOS
• some medicines, including some contraceptive pills and HRT
• your genes: a condition called familial hypercholesterolaemia runs in families and causes very high LDL from a young age

A recent meal mainly affects triglycerides. European guidance says fasting isn't routinely needed for a cholesterol test.

What a cholesterol test can't tell you

• Whether your arteries are affected. Cholesterol is a risk marker, not a scan.
• Your overall heart risk. That also depends on your blood pressure, whether you smoke, your family history, diabetes and your age. Your GP or an NHS Health Check usually puts these together in a calculator such as QRISK.
• What you should do next. If your results are outside the reference range, your GP is the right person to talk to about what that means for you.

Claryty Complete doesn't include ApoB or lipoprotein(a), two markers that are sometimes discussed alongside cholesterol.

Cholesterol in Claryty Complete

Claryty Complete (£179, 39 markers) includes all six cholesterol markers, alongside thyroid, female hormones including oestradiol, iron and vitamins, liver, kidneys and inflammation. That means you can see your cholesterol next to some of the other things that affect it, such as your thyroid.

It uses a home finger-prick kit. Samples are analysed by our UK laboratory partner, and results typically arrive 1–2 working days after your sample reaches the lab. Every marker comes with your result, the reference range used, what it measures and what can influence it, in plain English.

When to speak to your GP

Speak to your GP if a result is outside the reference range, if high cholesterol or early heart disease runs in your family, or if you'd like your overall heart risk checked. If you're aged 40 to 74, you may be eligible for a free NHS Health Check. Claryty provides information, not diagnosis.