Blood Vessels & Heart

What Causes High Cholesterol in Women, and Which Tests Find the Cause

Menopause, pregnancy, PMOS, an underactive thyroid, some medicines, and inherited conditions can all raise cholesterol in women. Here is how each cause maps to a life stage, and which blood tests help tell them apart.

Published

October 2, 2026

Read time

11 min read

Medically reviewed by

Rhonda Collins, FNP-C

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High cholesterol in women usually comes from one or more of four sources: a life-stage change in hormones (menopause and pregnancy are the big two), another medical condition such as an underactive thyroid, PMOS, or diabetes, a medicine, or genes. Diet, activity, smoking, alcohol, and sleep add on top of all of these (NHLBI, MedlinePlus). Because high cholesterol rarely causes symptoms, a blood test is the only way to know your level and, often, to find the cause (CDC). A standard lipid panel shows how high your cholesterol is. TSH, glucose, and HbA1c check for conditions that raise it. Lipoprotein(a), which the 2026 ACC/AHA dyslipidemia guideline says every adult should have measured at least once, checks for an inherited risk that a lipid panel does not measure (ACC).

Causes of high cholesterol in women, by life stage

Most articles list the causes. The more useful question is which causes fit your stage of life, and which test checks each one. This map pairs them. Each row is explained in its own section below.

The sources for each row are cited in the sections that follow. For what counts as a normal level at each age, see cholesterol levels by age.

Estrogen, LDL, and what changes at menopause

Falling hormone levels at menopause are a well-documented reason cholesterol rises in women. Before menopause, female hormones may help protect against high cholesterol. Between ages 20 and 39, men have a higher risk of high total cholesterol than women. After menopause, that hormone level falls, and total and LDL cholesterol tend to rise while HDL cholesterol tends to fall (NHLBI).

The timing is specific. The Study of Women’s Health Across the Nation (SWAN) followed 3,302 women through the menopause transition and analyzed 1,054 who reached a natural final menstrual period. Total cholesterol, LDL cholesterol, and apolipoprotein B (ApoB) rose substantially within the year before and after the final period. The researchers found the same pattern across ethnic groups. The other heart risk factors they measured, including blood pressure, glucose, and insulin, changed steadily with age instead (Matthews et al., 2009). The authors concluded that monitoring lipids in perimenopausal women should help prevent heart disease.

A 2020 American Heart Association scientific statement reached the same view. It describes adverse changes in body composition, lipids, and blood vessel health across the menopause transition, and calls midlife a critical window to start prevention (El Khoudary et al., 2020).

If you are in perimenopause and your cholesterol has jumped since your last test, menopause is a likely contributor. It is still worth checking thyroid function, because hypothyroidism can raise cholesterol and some of its symptoms, such as fatigue, weight gain, and menstrual changes, overlap with perimenopause (NIDDK). For the hormone side of perimenopause, see perimenopause symptoms and blood tests and estradiol and progesterone in perimenopause.

Pregnancy and the months after birth

Cholesterol rises during a healthy pregnancy. MedlinePlus lists pregnancy, and other conditions that raise female hormone levels, among the conditions that can lead to abnormal cholesterol levels (MedlinePlus). A 2025 meta-analysis of 13 studies covering 54,517 healthy women with singleton pregnancies found that the reference ranges for total cholesterol, LDL cholesterol, and triglycerides all climb from the first to the third trimester. The authors argue that standard adult ranges do not fit pregnancy and that trimester-specific ranges are needed (Sun et al., 2025).

That rise does not reverse the day you give birth. A lipid panel drawn soon after delivery can reflect pregnancy rather than your usual baseline. The postpartum high cholesterol guide covers how lipids reset after birth and when retesting gives a truer picture.

The postpartum months also raise a second, separate question. Having been pregnant in the past 6 months is a risk factor for hypothyroidism, and hypothyroidism can contribute to high cholesterol (NIDDK). If your cholesterol stays high after the expected reset, or you also have fatigue, weight gain, or feel cold, a TSH test helps rule a thyroid cause in or out.

PMOS

PMOS, polyendocrine metabolic ovarian syndrome, is the current name for the condition previously called polycystic ovary syndrome. Both NHLBI and MedlinePlus list it among the medical conditions that can raise cholesterol (NHLBI, MedlinePlus).

The 2023 international guideline for the condition treats lipids and blood sugar as part of the standard workup. It recommends that everyone with the diagnosis, regardless of age and body weight, have a lipid profile (total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides) at diagnosis, with later testing based on results and other risk factors. It also recommends assessing blood sugar status at diagnosis and every 1 to 3 years after that (Teede et al., 2023).

So if you have PMOS and have never had a lipid panel, or if irregular periods and other signs suggest PMOS and your cholesterol is high, test both lipids and blood sugar. The full hormone workup for PMOS is covered in blood tests for PMOS.

Hypothyroidism: a cause worth ruling out with TSH

An underactive thyroid is a secondary cause of high cholesterol worth ruling out, and it is much more common in women. NIDDK states that hypothyroidism can contribute to high cholesterol, that women are much more likely than men to develop it, and that it is more common after age 60 (NIDDK). Symptoms such as fatigue, weight gain, and trouble tolerating cold often develop slowly, over months or years, so they are easy to miss.

The standard first test is thyroid-stimulating hormone (TSH). When thyroid hormone levels are too low, the pituitary gland makes more TSH, so a high TSH usually points to an underactive thyroid (MedlinePlus). MedlinePlus lists thyroid function tests among the tests used to look for an underactive thyroid in someone with high cholesterol (MedlinePlus). For what a TSH result means, see the TSH biomarker guide and TSH levels explained.

Medicines and hormonal birth control

Some medicines taken for other reasons can raise LDL cholesterol or lower HDL cholesterol. NHLBI lists amiodarone (for heart rhythm problems), beta-blockers, some chemotherapy drugs, thiazide diuretics, cyclosporine and other immunosuppressants, retinoids, and steroids such as prednisone (NHLBI). MedlinePlus adds certain types of birth control pills and antidepressants to that list (MedlinePlus).

Two of these matter especially for women. Retinoids are used for acne, and hormonal birth control pills are used by many women for years at a time. Not every pill has this effect: MedlinePlus says “certain types.” If your cholesterol rose after you started a new medicine, note when you started it, and keep taking it unless your prescriber changes it. Oral estrogen can also affect a lipoprotein(a) result, which is worth mentioning when you have that test (MedlinePlus).

Inherited causes: familial hypercholesterolemia and Lp(a)

Two inherited causes can raise heart risk at any age, regardless of life stage or lifestyle.

Familial hypercholesterolemia (FH). Family members usually have similar cholesterol levels. Gene changes passed from parent to child can cause FH, which makes it harder for the body to clear LDL cholesterol from the blood (NHLBI). A very high LDL result at a young age, or high cholesterol in several relatives, points toward it. A standard lipid panel shows the high LDL.

Lipoprotein(a), or Lp(a). Lp(a) is a type of LDL particle that is stickier than other LDL particles, which makes it more likely to contribute to blockages and clots. Your genes control how much you make. Most people reach their adult level by age 5, and it tends to stay about the same for life. Diet and exercise may not change it (MedlinePlus). A routine lipid panel does not include it.

The 2026 ACC/AHA dyslipidemia guideline, which replaced the 2018 cholesterol guideline, recommends measuring Lp(a) at least once in adulthood. Because lifestyle changes have little effect on it, repeat testing is generally not needed (guideline record, ACC summary). The ACC describes levels around 125 nmol/L (50 mg/dL) as meaningful risk, and around 250 nmol/L (100 mg/dL) as substantially higher risk (ACC). More on what a result means is in the Lp(a) biomarker guide and why Lp(a) matters for heart health.

Lifestyle factors

Habits rarely explain everything, but they add to every other cause. NHLBI lists eating foods high in saturated fat, low physical activity, smoking, chronic stress, drinking too much alcohol, and poor sleep as habits that affect cholesterol (NHLBI). Smoking can also lower HDL cholesterol, and overweight and obesity are linked to abnormal levels (MedlinePlus). For specific diet and activity changes, see how to lower LDL cholesterol naturally.

Does high cholesterol cause symptoms in women?

Usually not. High LDL cholesterol usually does not cause symptoms (NHLBI), and the only way to know whether you have high cholesterol is to get it checked (CDC).

There are two visible signs, and both are uncommon. Fatty bumps on the skin (xanthomas), especially on the elbows, knees, hands, ankles, or buttocks, and grayish-white rings around the cornea of the eye (corneal arcus) can appear when cholesterol is very high. NHLBI notes that these signs develop mostly in people with familial hypercholesterolemia (NHLBI). Symptoms such as tiredness or weight gain are not signs of high cholesterol itself, though they can be signs of hypothyroidism, which can raise it.

Which tests to ask for, and why

Each test below answers a different question. Together they cover how high your cholesterol is, what may be driving it, and whether an inherited risk sits on top.

Lipid panel. This is the starting test. It measures total cholesterol, LDL, HDL, and triglycerides, and it is how high cholesterol is found in the first place (CDC).

ApoB. Each LDL, VLDL, and Lp(a) particle carries a single ApoB molecule, so the ApoB level is a direct measure of how many of these particles are circulating, regardless of how much cholesterol they carry (Behbodikhah et al., 2021). The 2026 guideline recommends measuring it selectively, not for everyone: it can be used to assess remaining risk and guide treatment in people with cardiovascular-kidney-metabolic syndrome, type 2 diabetes, high triglycerides, or known heart disease who have already reached their LDL and non-HDL cholesterol goals (ACC). For women in midlife, it also tracks one of the three lipid measures that rose most around the final menstrual period in SWAN (Matthews et al., 2009). See what ApoB tells you.

Lp(a), once in adulthood. If you have never had it measured, the 2026 guideline says to do it once. It is especially useful if you have a family history of early heart disease, LDL that stays high despite treatment, or heart disease with normal cholesterol, which are among the reasons MedlinePlus lists for testing (MedlinePlus).

TSH. It checks for an underactive thyroid, a cause of high cholesterol that is much more common in women (NIDDK).

Glucose and HbA1c. Diabetes is one of the conditions that can raise cholesterol, and MedlinePlus lists a blood sugar test among the tests used to look for it in someone with high cholesterol (NHLBI, MedlinePlus). For women with PMOS, the 2023 guideline also recommends regular blood sugar checks (Teede et al., 2023).

When to see a clinician

Some results and situations call for a clinician’s evaluation rather than a retest on your own:

• Very high LDL, or signs of FH. Fatty skin bumps (xanthomas) or rings around the cornea at a young age suggest familial hypercholesterolemia (NHLBI).
• A family history of early heart attack or stroke, or several relatives with high cholesterol.
• A high Lp(a) result, especially around 125 nmol/L (50 mg/dL) or above (ACC).
• A high TSH, or cholesterol that stays high after the expected postpartum reset.
• Cholesterol that rose after starting a new medicine, including a new birth control pill.
• PMOS, if you have not yet had a lipid profile and blood sugar check.

Bring your results, the date of your last menstrual period or delivery if relevant, and a list of the medicines you take. Treatment decisions, including whether medicine is needed, depend on your overall heart risk and belong in that conversation.

Your next step

If you have never had Lp(a) or ApoB measured, the Advanced Cholesterol Panel covers a standard lipid profile, ApoB, Lp(a), and LDL particle size in one blood draw. That handles the “how high” and “is it inherited” questions together. If your cholesterol rose without an obvious reason, add a TSH test and a blood sugar check with HbA1c, so the full set of results can be read together.