When most people hear the words "your cholesterol is high," they immediately imagine blocked arteries and an impending cardiac event. The reality is more nuanced — and more manageable — than that. Understanding what your results actually mean is the first step to doing something useful about them.
The four numbers that matter
A standard lipid panel measures four things:
Total cholesterol is the sum of all cholesterol types in your blood. It gets reported first, but it's the least useful number in isolation. A high total cholesterol in someone with excellent HDL can be far less concerning than a moderate total in someone with very low HDL and elevated triglycerides.
LDL cholesterol (low-density lipoprotein) is often called the "bad" cholesterol, though that's an oversimplification. LDL carries cholesterol from the liver to the cells that need it. Problems arise when LDL particles become damaged or oxidised — which is influenced by many factors beyond total LDL levels, including inflammation, insulin resistance, and the type of LDL particles present.
HDL cholesterol (high-density lipoprotein) does the opposite: it collects excess cholesterol from the blood and tissues and returns it to the liver for processing. Higher HDL is generally protective. Exercise, moderate alcohol, omega-3 fats, and oestrogen all tend to raise HDL — which is one reason why HDL often falls during perimenopause.
Triglycerides are fats derived mainly from carbohydrate in the diet. Elevated triglycerides — particularly above 1.7 mmol/L — are a significant independent risk factor for cardiovascular disease, especially in women. They are strongly influenced by refined carbohydrate and alcohol intake, and by insulin resistance.
What changes during perimenopause — and why
Here is what most women are not told: the sharp rise in LDL cholesterol that many women experience in their forties and fifties is not simply a consequence of eating more saturated fat. It is a predictable hormonal consequence of declining oestrogen.
Oestrogen plays a critical role in regulating how the liver processes LDL. As oestrogen levels fluctuate and eventually fall, the liver becomes less efficient at clearing LDL from the bloodstream. This can result in a rise of 10–20% in LDL levels within a relatively short period — entirely independent of dietary change.
This is why a leaflet about reducing saturated fat often misses the point. The intervention needs to match the mechanism.
What a "normal" result actually means
Reference ranges vary between labs, but broadly:
- Total cholesterol below 5.0 mmol/L is considered optimal
- LDL below 3.0 mmol/L is the general target (lower if cardiovascular risk factors are present)
- HDL above 1.2 mmol/L in women is considered protective
- Triglycerides below 1.7 mmol/L is desirable
However, these numbers need to be understood in context. A cardiologist reviewing your lipid panel alongside your age, blood pressure, smoking status, family history, and inflammatory markers will come to a very different conclusion than a simple comparison to a reference range.
What you can actually do
Dietary change can influence cholesterol, but the evidence is more specific than most people are led to believe. The interventions with the strongest evidence base include:
- Increasing soluble fibre (oats, legumes, psyllium) — reduces LDL by binding bile acids in the gut
- Including plant sterols (fortified foods, or supplements) — can reduce LDL by 10–15% consistently
- Replacing saturated fats with unsaturated fats — particularly swapping butter for olive oil and oily fish
- Reducing refined carbohydrate and alcohol — primarily targets triglycerides
- Regular aerobic exercise — raises HDL, reduces triglycerides, improves insulin sensitivity
What the evidence does not support: the idea that eating less cholesterol-containing food (eggs, shellfish) will significantly lower your blood cholesterol. Dietary cholesterol has a minimal effect on most people's blood levels, and the egg obsession of the 1980s and 1990s has not aged well.
When to ask for more
If your results show elevated LDL alongside low HDL and elevated triglycerides — a pattern sometimes called atherogenic dyslipidaemia — it is worth asking your GP for:
- An ApoB or non-HDL cholesterol calculation (a more sensitive marker of cardiovascular risk)
- A fasting blood glucose or HbA1c (to rule out insulin resistance as a driver)
- A CRP (C-reactive protein) test (to assess inflammation)
These additional data points can significantly change the picture — and the appropriate response.
If you'd like a personalised review of your blood results and a clear, practical action plan, the Clarity Consultation is designed for exactly this.