Did you know that anytime you have your lipid (i.e. cholesterol) levels tested, your results are compared to what would be considered the average range for male values? As is the case with many different lab types, women’s averages are generally lumped together with male averages. This happens because women are often underrepresented in research studies, and without enough women to represent a general population, “the normal range” is biased in the direction of “normal” for men.
Why does this matter in terms of your cholesterol? Elevated cholesterol among other lifestyle risk factors may influence your physician to recommend lipid-lowering therapies in order to decrease future cardiovascular risk. The problem is that cholesterol risk factors are different in women compared to men and can vary greatly throughout different stages of the menstrual cycle. I’m not just referring to cholesterol variations from menache to menopause but also, different phases of a monthly cycle for those still menstruating. Furthermore, variations in how a woman may experience her menses may influence her risk. Early menarche, early or premature menopause, and the presence of premenstrual syndrome (PMS) symptoms are considered risk factors for future cardiovascular disease.
Research shows that cholesterol levels vary in response to changing estrogen levels. Among the various components of a cholesterol panel, certain indicators are more telling of future risk than others, which vary for women compared to men. Low HDL, rather than high LDL cholesterol, is more predictive of coronary risk for women than for men. HDL cholesterol levels fluctuate with the menstrual cycle being highest during the ovulatory phase. Elevated total cholesterol is associated with increased coronary risk only in premenopausal women or women with very high levels, and total cholesterol levels are highest in the follicular phase of the menstrual cycle. Triglycerides also appear to influence coronary risk more in post-menopausal women than pre-menopausal.
Are you starting to feel like having your cholesterol results compared to the “normal range” for men isn’t fair? I do too. Here’s what you can do about it. First, if you are still menstruating, schedule your cholesterol blood draws to occur during your menses now and for any future reassessment. This will give you a neutral and consistent baseline to assess your values from. Second, find an astute doctor who will take into account the varying other potential risk factors for future cardiovascular disease, in addition to elevated cholesterol, so that you can make the most well-rounded decision about any future lipid-lowering therapies. Finally, and as an unabashed plug for naturopathic medicine, consider an ND consult to discuss the varying lifestyle, dietary, botanical, and nutraceutical options you have to help lower your cholesterol aside from statin therapy.
Mumford, Sunni L., Sonya Dasharathy, and Anna Z. Pollack. "Variations in lipid levels according to menstrual cycle phase: clinical implications." Clinical lipidology 6.2 (2011): 225-234.