What Women Need to Know About Cholesterol (And How to Lower It)
Cholesterol is often talked about in a negative way — but the reality is more nuanced.
For many women, especially in their 30s, 40s and beyond, cholesterol levels can start to rise… often without any obvious changes in diet or lifestyle.
And if you’ve ever wondered:
What is normal cholesterol?
Should I be worried about mine?
How can I lower cholesterol naturally?
You’re not alone.
Heart disease remains one of the leading causes of death in women in the UK, yet many women don’t realise their risk — or get their cholesterol checked early enough.
In this blog, we’ll break down what cholesterol actually is, what’s considered normal, and what you can do to support healthy levels.
What is Cholesterol?
High cholesterol is closely linked to cardiovascular disease. While heart disease is often thought of as a “male issue”, it remains one of the leading causes of death in women — second only to dementia and Alzheimer’s disease in the UK. Despite this, women are still less likely to be screened early or recognise their own risk.
Cholesterol is essential for our health. It's used to make hormones, vitamin D and bile acids, which help us digest fats. Our bodies produce cholesterol naturally, mainly in the liver, and we also obtain some from animal-based foods.
Good V Bad Cholesterol:
You've probably heard cholesterol described as either 'good' or 'bad', but these labels are a little misleading.
LDL and HDL are actually lipoproteins that transport cholesterol around the body.
LDL (the one they call "bad") carries cholesterol through the bloodstream to tissues that need it. However, when LDL levels are elevated, more LDL particles can become trapped in artery walls, contributing to plaque formation and increasing cardiovascular risk.
HDL (the one they call "good") is involved in transporting cholesterol away from tissues, including back towards the liver.
Both have important functions, but higher HDL doesn't automatically cancel out the risks associated with raised LDL cholesterol.
What is Normal Cholesterol
This is one of the most common questions I get asked.
Rather than focusing on one number, it’s important to look at the overall picture.
General UK guidelines:
Total cholesterol: ideally below 5 mmol/L
LDL (bad cholesterol): ideally below 3 mmol/L
HDL (good cholesterol): above 1.2 mmol/L (women)
Cholesterol ratio (total ÷ HDL): ideally below 6
However, cholesterol is only one part of the picture and whilst these figures are useful, cholesterol results shouldn't be interpreted in isolation.
Age, blood pressure, smoking, diabetes, family history and other health factors also influence cardiovascular risk.
In the UK, healthcare professionals commonly use tools such as QRISK3 to help assess someone's overall risk and decide whether further action is appropriate.
Why Cholesterol Changes In Women
Whilst cholesterol levels are quite similar between males and females there are some key elements to consider. In particular it is good to note that cholesterol behaves differently in women especially during hormonal transitions.
- Women of childbearing age naturally have higher HDL (good) cholesterol
- Low thyroid hormones (those with hypothyroidism) are well known to increase LDL and decrease HDL levels
- The drop in oestrogen during perimenopause and menopause is linked to higher LDL. Changes in HDL are more complex and may involve alterations in HDL particle characteristics and function, rather than simply a reduction in HDL cholesterol levels.
This helps explain why some women notice changes in their cholesterol results despite no obvious changes in their diet or lifestyle. - Women often experience higher or more sustained levels of stress. Chronic stress may also influence cardiovascular health, both through physiological pathways and its effects on sleep, activity and eating habits.
- Although diabetes is more common in men, women with diabetes are more at risk of developing heart disease than men with diabetes
- Women (and also men) are at a higher risk of high LDL cholesterol if they are of South Asian or sub-Saharan African origin.
How Does What You Eat Impact Cholesterol?
I never recommend cutting out particular foods simply because of their cholesterol content or nutritional profile. However, what we eat regularly can influence our cholesterol levels, and some dietary patterns are more supportive of cardiovascular health than others.
Rather than thinking about foods we should avoid, it's more helpful to understand where a few adjustments might make a difference.
Saturated fats
Diets higher in saturated fat may increase LDL cholesterol, particularly when saturated fats replace unsaturated fats.
Foods such as butter, fatty cuts of meat, some processed meats and certain baked goods can contribute to our saturated fat intake.
This doesn't mean these foods need to disappear from our diets completely. It's about looking at how frequently we eat them and where we might include more unsaturated fats from foods such as olive oil, nuts, seeds and oily fish.
Added sugars
Regularly consuming large amounts of added sugars, particularly through confectionery and sugary drinks, can contribute to higher triglyceride levels.
This is again more about our overall dietary pattern than demonising an occasional cake, biscuit or dessert.
Ultra-processed foods
Some ultra-processed foods contain substantial amounts of saturated fat, added sugars or salt, and diets high in certain UPFs have been associated with poorer cardiovascular health.
However, not all UPFs are nutritionally equivalent. A wholegrain supermarket loaf and a packet of chocolate biscuits may both be classified as ultra-processed, but their nutritional contributions are very different.
If you'd like to understand more about UPFs and how to make realistic choices, you can read my UPF blog.
And what about fried foods?
Frying itself isn't automatically a problem. The type of oil used, how it's used and the overall composition of the meal are more relevant than whether something has been fried.
The aim isn't to create a list of foods we can and can't eat. It's to make informed choices about our usual eating habits whilst leaving room for convenience, enjoyment and flexibility.
How To Lower Cholesterol Naturally
Dietary and lifestyle adjustment may be very helpful as some of our cholesterol levels can be moderated from the foods we eat. Genetics definitely play a big role but there is still things that can be done!
Simple changes include
More fibre: Certain types of soluble fibre can help reduce LDL cholesterol by interfering with the reabsorption of bile acids, encouraging the liver to use more cholesterol to replace them.
Oats, barley, beans, lentils and psyllium are particularly useful sources.
💗 Choose more unsaturated fats
Replacing some saturated fats with unsaturated fats can help lower LDL cholesterol.
This might mean using olive or rapeseed oil more often, including nuts and seeds regularly, or choosing oily fish as part of your usual meals.
It's not about eliminating butter, cheese or other foods you enjoy, but considering the overall balance of fats in your diet.
More protein: Adequate protein supports blood sugar balance and metabolic health, and some evidence suggests whey protein may help reduce LDL cholesterol.
Keep Moving: Helps to boost HDL production and supports weight management, stress and diabetes
Stop smoking: it's linked to poor vascular health
Do Cholesterol Lowering Products Work?
A quick word on ‘cholesterol-lowering’ products
You've probably seen the margarines, yoghurt drinks and other products marketed specifically to lower cholesterol.
Many contain added plant sterols or stanols, which have been shown to reduce LDL cholesterol when consumed in sufficient quantities.
But does that mean we should all be buying them?
Not necessarily.
Whilst research shows that these ingredients can lower LDL cholesterol, we don't yet have strong evidence from clinical trials that consuming these products reduces the risk of heart attacks or strokes.
They're also often considerably more expensive than everyday alternatives.
And importantly, we already have good evidence that dietary changes such as increasing soluble fibre and replacing some saturated fats with unsaturated fats can improve cholesterol levels, alongside other aspects of cardiovascular health.
My preference is to start by looking at someone's overall diet and lifestyle rather than recommending a product marketed around a single health claim.
That's not to say these products can't be useful in certain circumstances. But I don't believe they're an essential purchase, and I would encourage women to look beyond the marketing before deciding whether they're worth including.
If you’re concerned about your cholesterol levels, or simply want a clearer picture of your heart health, checking your levels is a valuable first step. At my clinic I offer finger-prick testing (with the understanding that a full blood test remains the gold standard).
If cholesterol levels are already raised, support can make a real difference. With the right nutrition, lifestyle adjustments and personalised guidance, it’s often possible to improve cholesterol balance without extremes.
Why not come and see me and we can work on a plan to support you
Janet x