High cholesterol in females can increase their risk of developing heart disease.

Cholesterol is a wax-like substance that the body naturally produces. It is required for several processes in the body, including building cells. However, cholesterol levels that are too high can put a person at risk of developing heart disease.

Females often have lower cholesterol levels during their reproductive years, but once they go through menopause, their levels can increase. This may relate to estrogen levels.

This article reviews how cholesterol affects females, the connection between high cholesterol and heart disease, and the risk factors for high cholesterol in females.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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Differences in sex can affect a person’s cholesterol levels.

Females under the age of 55 years or before the onset of menopause typically have lower levels of low-density lipoprotein (LDL), or “bad,” cholesterol than males. And males typically have lower levels of high-density lipoprotein (HDL), or “good,” cholesterol at any age.

The variation in cholesterol levels may be related to estrogen levels. An older 2010 study from the National Institutes of Health found that monthly fluctuations in estrogen levels affected total cholesterol levels.

The fluctuation could vary as much as 19% over the course of the menstrual cycle. Females with obesity had the highest levels of fluctuation.

The researchers found that as estrogen levels increase, the amount of HDL cholesterol also increases. At the time of ovulation, the estrogen and HDL cholesterol levels peak.

At the same time, levels of LDL cholesterol and triglycerides — another form of fat in the blood — fall as estrogen levels go up. The lowering process takes a few days. The researchers found that total cholesterol, LDL cholesterol, and triglyceride levels all reach their lowest point around the time the person starts menstruation.

When menopause occurs, a female’s cholesterol levels tend to rise. A 2017 review notes that estrogen plays a protective role against heart disease before menopause.

A study from 2019 found that hormone replacement therapy helped decrease total cholesterol levels and provided an anti-clotting effect in postmenopausal people.

However, not all evidence agrees on the exact effect estrogen levels have in postmenopausal people. In another 2019 study, researchers found that total estrogen levels did not show any correlation to total cholesterol levels.

During pregnancy, a person’s cholesterol levels rise to accommodate the needs of the developing fetus. This can be particularly problematic for people with naturally high cholesterol levels because they cannot continue taking cholesterol-lowering medications during pregnancy.

High cholesterol levels can increase a person’s risk of heart disease and stroke.

High cholesterol levels in the blood can lead to the buildup of plaque in the arteries. As the amount of plaque increases, the arteries narrow.

Narrowed arteries can block blood flow to the heart and other organs. If not enough blood reaches the heart or brain, a person may experience a heart attack or stroke.

Heart disease is the number one cause of death in females, accounting for 1 in 5 deaths in 2021, according to the Centers for Disease Control and Prevention (CDC).

Doctors measure cholesterol levels in milligrams (mg) of cholesterol per deciliter (dL) of blood. When a person undergoes cholesterol level tests, they will receive values for total, HDL, and LDL cholesterol levels.

A person should aim to have a total cholesterol level lower than 200 mg/dL. A total cholesterol level of 200–239 mg/dL is borderline high, and 240 mg/dL or more is high.


HDL cholesterol levels should be higher to help reduce the risk of heart disease.

For some protection against heart disease, a person should have an HDL level of 60 mg/dL or more. People with an HDL level lower than 40 mg/dL have a major risk factor for heart disease.


LDL should remain low.

The following table shows what different levels of LDL cholesterol mean for a person’s health.

LDL levelLDL cholesterol category
less than 100 mg/dLoptimal
100–129 mg/dLnearly optimal
130–159 mg/dLborderline high
160–189 mg/dLhigh
190 mg/dL and upvery high

In addition to high total cholesterol levels, several other factors can increase a female’s risk of developing heart disease.

High blood pressure is a leading risk factor. Doctors do not always accurately diagnose it in females, and fewer than 1 in 4 have proper management of their high blood pressure.

Other risk factors for heart disease include:

  • physical inactivity
  • stress
  • excess weight
  • excessive alcohol consumption
  • unhealthy diet
  • diabetes
  • smoking
  • depression

About 1 in 5 females have high blood pressure during their reproductive years. Reproductive health and pregnancy can also influence a person’s risk of heart disease. A person may have an increased risk of heart disease if they:

  • have a preterm delivery
  • have polycystic ovary syndrome (PCOS)
  • enter menopause before age 40
  • have high blood pressure during pregnancy
  • have gestational diabetes
  • deliver an infant with either low or high birth weight
  • have their first period before age 11 years

General guidelines for screening cholesterol levels vary by age. The National Heart, Lung, and Blood Institute suggests that people get their cholesterol checked on the following schedule:

Age groupScreening schedule
19 or youngeronce every 5 years, beginning at age 9–11
20–54every 5 years
55–65every 1–2 years
over 65every year

Other risk factors, such as a family history of high cholesterol, can also affect how often a person should have a cholesterol check. A person should discuss their screening schedule with a healthcare professional.

A person can take several steps to help lower their total cholesterol, including:

  • making efforts to maintain a moderate weight
  • limiting alcohol intake
  • quitting or avoiding smoking
  • getting about 2 hours and 30 minutes of physical activity each week
  • eating a healthful diet that limits saturated fats, trans fats, and salt and emphasizes fiber, vegetables, and fruit

Even after a person has taken steps to lower their cholesterol, their levels may remain high. A person should discuss treatment options with a healthcare professional if the steps they take at home do not help lower their cholesterol levels.

High cholesterol in females can lead to serious health conditions such as heart disease. A person should know their cholesterol numbers and, if necessary, take steps to lower their bad cholesterol and total cholesterol.

High cholesterol does not generally cause any symptoms. A person should have a cholesterol check at least every 5 years, depending on their age and the recommendations of a healthcare professional.

Estrogen may play a protective role in managing cholesterol. Estrogen levels decrease after menopause, which can put many people at higher risk of high cholesterol.

A person can take steps to lower their cholesterol, such as getting enough physical activity and limiting saturated fat intake. If this is not enough, a person should discuss treatment options with a healthcare professional.