Too much cholesterol in your blood may increase your risk of heart disease. Before the menopause, oestrogen provides some protection, but as your hormone levels change, your cholesterol levels and risk of heart disease rise rapidly to match that of men. In the UK, more than 8.3 million women aged 45 to 64 years have elevated cholesterol levels. So it’s important to understand about cholesterol and what can be done to help keep your levels healthy.

This article was included in issue 96 (spring 2023) of The Menopause Exchange newsletter.

What is cholesterol?
Cholesterol is a waxy substance that’s needed in small amounts for cell walls and to make hormones such as oestrogen, testosterone, and vitamin D. The liver uses cholesterol to make bile salts, which enable you to digest the fats you eat. You need some cholesterol, but not too much.

Testing your cholesterol levels
You may be given a total cholesterol level or several different figures:
Total cholesterol, as the name suggests, is the total amount of all types of cholesterol.
HDL or High-Density Lipoproteins or ‘good cholesterol’ are carried off to your liver to be disposed of.
LDL or Low-Density Lipoproteins or ‘bad cholesterol’ can build up inside your blood vessels, causing blockages over time.
TC:HDL ratio compares the amount of total cholesterol to HDL.
Triglycerides aren’t cholesterol but are often measured at the same time, as high levels also increase the risk of heart disease.

See the box below for ideal cholesterol levels for a healthy adult. Those at higher risk of heart disease, including having diabetes or raised blood pressure, may have different goal levels. Your GP, practice nurse or pharmacist will advise on what’s appropriate for you. Very high cholesterol levels may be inherited (called familial hypercholesterolaemia), so if you have a family history of heart disease or raised cholesterol, it’s important to have your levels checked. You want a moderate total cholesterol, with low levels of LDL and triglycerides and higher levels of HDL.

Cholesterol goals

Type of cholesterol – – – – – – – – – – Goal level (mmol/l)
Total cholesterol – – – – – – – – – – – – 5 or below
HDL (good) cholesterol – – – – above 1.0 (man)
– – – – – – – – – – – – – – – – – – – – – above 1.2 (woman)
LDL (bad) cholesterol – – – – – – – – – 3 or below
Fasting triglycerides – – – – – – – – – 1.7 or below
Total cholesterol: HDL ratio– – – – –6 or below

High cholesterol levels don’t always mean you need to take medicines. Often you will be asked to look at your diet and make lifestyle changes first.

Keep cholesterol in check
You can do a number of things to help keep your cholesterol levels in check. Some foods that are part of a healthy balanced diet can actively help to lower your cholesterol too. Each of these works slightly differently, so building a ‘portfolio’ of small changes can give you bigger improvements:

Choose fats wisely
Cut back on all fats, but especially saturated fats, which tend to increase cholesterol. Saturated fats include butter, lard, ghee, coconut and palm oils, visible fats on meats and processed meats. Unsaturated fats are healthier if they’re consumed in moderation. These include monounsaturated (olive and rapeseed oils and spreads) and polyunsaturated (sunflower, safflower, and corn oils). Vegetable oils are likely to have a high palm oil content so pick a pure oil whenever you can. Include one to two portions of omega-3-rich oily fish every week (such as salmon, tuna, mackerel, sardines or trout). Omega-3 fats are also found in some plant foods such as flaxseed (linseed) and walnuts.

Embrace oats and barley
Oats and barley contain a soluble (gel-forming) fibre called beta-glucan. This hangs on to cholesterol and bile acids during digestion and helps to reduce cholesterol. Oats, barley and foods made from these can help lower cholesterol, provided these contain at least 1g of beta-glucan per portion, which is one third of the 3g of beta-glucan recommended daily.

Eat a rainbow
Fruits and vegetables contain fibre, vitamins, minerals and a range of plant compounds, all of which help you to stay healthy and protect your heart. Different colours mean different plant compounds, so try to eat a rainbow of different colours over a day or a week. Pulses such as beans, peas and lentils are also rich in soluble fibre so eat these as often as you can.

Plant sterols and stanols
Plant sterols and stanols are similar in size and shape to cholesterol and block some cholesterol absorption from your gut. Over time, this lowers the amount of cholesterol in your blood. There are tiny amounts in plant foods, but to get the effective dose of 3g/day you need to consume foods with added plant sterols and stanols, such as mini shot-style drinks, fat spreads or yogurts. Read the labels and don’t have too much, as this won’t give you further benefit. These only work while you eat them and stop when you don’t. It’s fine to skip a week or two on holiday, but if your cholesterol comes down, keep going as they are obviously working.

Nuts and soya
Research shows that nuts and soya foods, rich in protein and fibre, minerals and plant compounds, can help to support heart health. Snack on a small handful of nuts rather than less healthy options, or toast them and sprinkle over a salad or soup for a protein boost. Try experimenting with plant-based meals using soya mince, edamame beans or tofu to replace normal protein.

About the author
Angie Jefferson is a consultant dietitian. She runs online Great Nutrition for the Menopause webinars at These dietitian-led menopause workshops are on a range of topics including managing waist gain and controlling cholesterol.

Created Spring 2023
Copyright © The Menopause Exchange 2023

Tags: barley, cholesterol, dietitian, fats, HDL, LDL, lentils, menopause, oats, Omega-3, peas, plant stanols, plant sterols, soluble fibre, soya, Triglycerides