High cholesterol in women can arise from modifiable factors like diet and activity, or non-modifiable ones like age, hormones, and genetics. Some factors can’t be changed, but healthy lifestyle choices can lower your chances of high cholesterol.

1. Hormone Changes

Due to hormonal changes, cholesterol may increase during perimenopause and menopause. 

Estrogen decline is linked to higher total cholesterol, low-density lipoprotein (LDL), and triglycerides. Anti-Müllerian hormone (AMH) reflects a woman’s egg supply and helps assess fertility. As menopause nears, AMH declines and often coincides with cholesterol changes, including increased total and high-density lipoprotein (HDL, or “good” cholesterol). 

Hormonal changes lead to higher cholesterol, affecting the risk of heart disease later in life.

2. Age

Cholesterol levels may rise with age as the body becomes less efficient at clearing cholesterol from the blood. This effect may be more pronounced in females due to aging and menopause. 

3. Health Conditions

Specific health conditions increase the risk of elevated cholesterol. In some cases, both the condition and the medications used to treat it may raise cholesterol levels, including:

• Diabetes
• Chronic kidney disease
• Lupus
• Human immunodeficiency virus (HIV)
• Hypothyroidism
• Sleep apnea
• Polycystic ovary syndrome (PCOS)

Living with these conditions does not necessarily mean you will have high cholesterol. Lifestyle modifications can help prevent high cholesterol.

4. Lifestyle Factors

Specific lifestyle factors cause high cholesterol in women, including the following:

• Suboptimal diet, high in saturated fat and trans fat
• Stress
• Physical inactivity
• Alcohol 
• Smoking
• Being overweight or having obesity
• Little or low-quality sleep

You can change your lifestyle. And for most people, doing so helps lower the risk of high cholesterol

5. Medications

Specific medications can raise your cholesterol, including the following:

• Steroids
• Specific antipsychotic and anticonvulsant medications
• Immunosuppressants like cyclosporine and tacrolimus
• Arrhythmia medicines, such as amiodarone
• Diabetes medications like Jardiance and Farxiga
• Beta-blockers
• Diuretics
• Retinols like Accutane

Talk with your healthcare provider regarding the potential effects on cholesterol from your medication.

6. Genetics

High cholesterol can run in families due to genetics. Genetic mutations cause familial hypercholesterolemia (FH), leading to very high LDL cholesterol levels that can increase with age if left untreated. 

Cholesterol tends to be higher in females with FH than in males due to delayed diagnosis. 

FH is relatively rare. Still, a family history of high cholesterol may increase your chance of having elevated cholesterol. 

Preventing High Cholesterol

Adopting a healthy lifestyle helps prevent high cholesterol.

• Maintain a healthy weight: Excess body fat affects cholesterol metabolism and makes removing it more challenging for your body. 
• Follow a healthy diet: A healthy diet emphasizing soluble fiber, fruits, vegetables, whole grains, lean proteins, and omega-3 fatty acids helps prevent high cholesterol. Prioritize fiber-rich foods like legumes (peas, lentils, beans), berries, and oats to prevent high cholesterol. Limit saturated and trans fats, sodium, and added sugars.  
• Get regular exercise: Add regular exercise to your routine to prevent high cholesterol. Physical activity is essential for heart health and maintaining a healthy weight.
• Get sufficient sleep: Sleeping less than six hours nightly raises cholesterol. Aim for seven to nine hours of sleep. Sleep helps repair the heart and blood vessels and reduces the risk of heart disease. 
• Practice stress management: Engage in stress management techniques like meditation, journaling, yoga, or deep breathing. Stress increases specific hormones like corticosteroids, which cause your body to produce more cholesterol. 
• Quit smoking: Smoking raises LDL cholesterol and lowers HDL cholesterol, especially in women. 
• Reduce alcohol intake: Limit alcohol to the recommended one standard drink per day for women. Drinking more than this can raise your total cholesterol level. 

How to Reduce It

• Eat oats regularly: Oats contain the fiber beta-glucan, which forms a gel-like substance in your body that attracts cholesterol and removes it from the body. A half-cup serving of old-fashioned oats provides 3 grams (g) of beta-glucan, the recommended amount to benefit cholesterol.  
• Choose healthier fats: Limit your total fat intake to 25–35% of your daily calories, with less than 7% from saturated fat. On a 2,000-calorie diet, that’s 500–700 calories from fat, and no more than 140 (15g) from saturated fat. Swap saturated fats (from red meat, butter, deep-fried and processed foods) for healthy mono- and polyunsaturated fats from nuts, seeds, and avocados. 
• Increase omega-3 intake: Omega-3-rich foods include fatty fish (salmon, mackerel, sardines, and anchovies), walnuts, chia seeds, flax seeds, and hemp seeds. Replace red meat with omega-3-rich fish to help lower LDL cholesterol and triglycerides. 
• Eat more beans: Beans like chickpeas, black beans, and kidney beans are packed with soluble fiber and phytochemicals that benefit cholesterol. Regularly eating three-fourths cup to 1 cup of beans lowers LDL cholesterol levels. Try replacing red meat with beans at one meal weekly.
• Add more plant stanols and sterols to your diet: Stanols and sterols are compounds found in whole grains, nuts, beans, lentils, and olive oil that prevent your body from absorbing cholesterol. Aim for 2 g of plant stanols and sterols per day. 
• Incorporate some soy foods: Natural soy proteins like tofu, tempeh, soybeans, edamame, and soy milk may have a small cholesterol-lowering effect. Replace deep-fried or processed snacks with edamame or soybeans.
• Consider medication: Statin medications lower cholesterol levels, especially with lifestyle changes. 
• Incorporate physical activity: Exercise helps combat the cholesterol increases that may accompany age, perimenopause, and menopause. Regular physical activity lowers LDL cholesterol while raising HDL levels. 
• Professional help: Consider working with a registered dietitian nutritionist to help tailor a supportive plan for nutrition and lifestyle changes.

Key Takeaways

• Genetics, medications, age, hormonal changes, and preexisting health conditions may contribute to high cholesterol in women. 
• Lifestyle factors that cause high cholesterol can be modified to support heart health in women.
• Dietary modifications such as reducing saturated fat and increasing fiber intake help lower cholesterol.