Published: November 22, 2023 | Updated: August 21, 2024
There are many factors that affect good cholesterol levels for women: age, nutrition, lifestyle and menopause, to name a few.
Cholesterol is a waxy substance found in two places: Your liver produces it, and cholesterol comes from animal products you eat (think meat, eggs and cheese). Like many other things in life, cholesterol is not good or bad until there’s too much of it. For women, high cholesterol can lead to heart disease, heart attack and stroke.
A cholesterol test (called a lipid panel or lipid profile) includes having blood drawn in a lab to examine high density lipoprotein (HDL), low density lipoprotein (LDL), triglycerides (fats) and total blood cholesterol. Then your provider examines the results that show your HDL cholesterol level, LDL cholesterol level, triglyceride level and total blood cholesterol.
“Think of it like this,” said Monalisa M. Tailor, M.D., internal medicine physician with Norton Community Medical Associates. “You want a high HDL cholesterol level and a low LDL cholesterol level. If you have a lot of that LDL, it can get stuck in your arteries. It’s like soap scum in the pipes of your home — a little bit gets flushed out, but too much of it starts to build up.”
And arteries, like plumbing, get clogged. Unlike with your bathroom sink, you might not know your high cholesterol has built up until it becomes a very serious health issue, such as coronary artery disease and cardiovascular disease.
As excess cholesterol builds up, it forms plaques that cling to the blood vessel walls. If these plaques break off, they can cause stroke and heart attack. High cholesterol levels also can contribute to high blood pressure, as the heart needs to pump harder to push blood past the clogged and stiffened arteries.
A cholesterol check involves a simple blood test that can be done at your primary care provider’s office.
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“A good HDL cholesterol level for a woman is higher than 60 [milligrams per deciliter]. We want the total cholesterol level to be under about 200 mg/dL,” Dr. Tailor said.
Here’s where things get tricky: Women generally have higher HDL than men due to the presence of estrogen. Being a smoker or having high blood pressure also can increase your risk of heart disease. Your health care provider will use this information along with your total cholesterol and HDL numbers to calculate an ASCVD (atherosclerotic cardiovascular disease) risk estimation. This tool predicts your 10-year risk of heart disease.
“The hormone estrogen reduces the overall amount of cholesterol in the body, but also increases the amount of HDL, or ‘good’ cholesterol,” Dr. Tailor said.
There is some evidence that estrogen also affects the immune system, which is responsible for inflammation caused by buildup of bad cholesterol in the arteries.
“Estrogen might protect women from heart disease, which is potentially good news,” Dr. Tailor said.
However, increasing estrogen levels with hormone replacement therapies (HRT) or any hormones taken via pill, cream, injection or infusion don’t appear to have any effect on healthy cholesterol levels.
“It’s really just the estrogen made by the body that makes a difference,” Dr. Tailor said.
The American Heart Association notes that cholesterol levels can rise in postmenopausal women as they lose the protection from naturally occurring estrogen. A person nearing menopause should be sure to have their cholesterol levels checked and discuss risk factors with their medical provider. The association also emphasizes the importance of physical activity in postmenopausal individuals to help with cholesterol levels.
“We recommend adults have cholesterol checked when they start seeing a primary care provider,” Dr. Tailor said.
Low-risk individuals will recheck every five years. Higher risk people may recheck every three years or more frequently, depending on risk factors.
“Talk to your provider. They will help you determine the best schedule for cholesterol checks,” Dr. Tailor said.
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