Dyslipidemia in Women: Symptoms, Causes, and Treatment

In midlife, you might start noticing a word on your lab reports that you’ve never seen before: “dyslipidemia.” It’s a medical term that means your cholesterol or triglyceride levels are outside the healthy range. 

Even if you’ve had healthy cholesterol levels for years, you might find yourself facing dyslipidemia in midlife. That’s because the transition to menopause can cause cholesterol and triglycerides to shift, so dyslipidemia often shows up in women for the first time in their late 40s and early 50s.

Out-of-whack cholesterol levels are highly treatable. You’ll want to check in with a clinician to get a good sense of your heart-health risk factors. In the meantime, we’ll give you info about what the numbers mean, why there are no clear dyslipidemia symptoms, treatment options, and how a clinician trained in midlife health (like one at Midi) can help you get those numbers back in the healthy zone.

Menopause and High Cholesterol: Why the Connection What Is Dyslipidemia?

In terms of the dyslipidemia meaning, let’s break down the term: It refers to abnormal (“dys-”) levels of lipids (fats) in your blood (“-emia”).

That means it can cover levels that are both too high and too low for different types of blood fats:

• High LDL cholesterol: This is called “bad” cholesterol because it can form plaques in your arteries, reducing blood flow.
• High triglycerides: These fats are stored in your cells and can contribute to inflammation and plaque in your arteries.
• Low HDL cholesterol: This is called “good” cholesterol because it helps remove LDL cholesterol from your blood.

So, healthy levels are lower LDL and triglycerides numbers, with a higher HDL number.

You need some of all of these compounds for your body to operate optimally. But if your levels are chronically abnormal, you can be at a higher risk of atherosclerosis, the formation of fatty plaques along your artery walls. This plaque buildup can lead to downstream issues with blood flow, increasing your risk of heart attacks (caused by limited blood flow to the heart muscle) and strokes (caused by limited blood flow to the brain).

That’s why it’s so important to address dyslipidemia sooner rather than later. But because there are often no tangible dyslipidemia symptoms, knowing your numbers helps you identify whether you are at higher risk of developing atherosclerotic disease or are at risk for atherosclerosis and heart disease. This awareness creates valuable opportunities to lower your risk or manage existing disease.

Dyslipidemia vs. Hyperlipidemia: What’s the Difference?

What does it mean if you’ve been diagnosed with dyslipidemia vs. hyperlipidemia? The terms are often used interchangeably, but they actually mean slightly different things: 

• Hyperlipidemia: abnormally high levels of fats in the blood, such as high total cholesterol, high triglycerides, or high LDL cholesterol
• Dyslipidemia: a broader umbrella term referring to any imbalance or abnormal levels of fats in the blood, which include hyperlipidemia but also HDL cholesterol levels that are too low or changes in the ratio of lipid types

If you see one term or the other on your chart, don’t worry: One isn’t a “worse” diagnosis than the other. It may just reflect your clinician’s preference for the wording; many today prefer the word “dyslipidemia” because it’s more inclusive.

What Are the Types of Dyslipidemia?

Dyslipidemia is categorized into two main types: primary and secondary. Primary dyslipidemia is inherited, often caused by your genetic mutations or conditions (such as familial hypercholesterolemia). Secondary dyslipidemia is caused by lifestyle factors or other underlying medical conditions such as obesity or diabetes.

In either category, dyslipidemia can mean:

• LDL cholesterol is too high.
• Triglycerides are too high.
• Both LDL cholesterol and triglycerides are too high, often with low HDL cholesterol as well. This is sometimes called combined or mixed dyslipidemia. 

What Causes Dyslipidemia?

Your lipid numbers might be wonky for several different reasons. Some of them are within your control, and others aren’t:

• Age: You’re more likely to have rising lipid levels the older you are.
• Hormonal changes: As estrogen levels fluctuate and fall during perimenopause and menopause, the liver clears LDL less effectively, visceral fat and insulin resistance increase, and HDL functions less effectively. The result is a shift towards an atherogenic lipid profile that can increase the risk of plaque building up in the arterial wall. (More on this in just a bit.)
• Genes: Inherited causes of high cholesterol and a strong family history of heart disease can increase your risk.
• Other health conditions: If you have prediabetes or type 2 diabetes, an underactive thyroid, chronic kidney or liver disease, or polyendocrine metabolic ovarian syndrome (PMOS, formerly known as PCOS), you’re more likely to have abnormal lipid levels.
• Medication side effects: The estrogen component of combined hormonal contraceptives can raise triglyceride levels. (That said, it’s important to note that there is no strong association between combined hormonal contraceptives and the development of atherosclerosis.)
• Lifestyle habits: Eating a lot of saturated and trans fats, drinking a lot of alcohol, smoking cigarettes, and not getting much physical activity can all increase cholesterol levels.

Focusing on healthy eating and exercise can help, but many women find addressing hormonal changes has a much bigger impact on their lipid levels.

Why Does Dyslipidemia Rise During Perimenopause and Menopause?

That sudden, unexpected rise in women’s cholesterol numbers during their 40s and 50s can happen even if their eating and exercise habits haven’t changed.

This is often due to fluctuating estrogen levels beginning in perimenopause. Like we touched on earlier, these see-sawing hormone changes can impact lipid levels and risk factors for atherosclerotic heart disease due to higher LDL cholesterol, less effective HDL cholesterol, more visceral fat, and greater insulin resistance. (Keep reading for more on how dyslipidemia is diagnosed and treated.)

What Are the Symptoms of Dyslipidemia?

Abnormal cholesterol or triglyceride levels typically don’t cause any noticeable dyslipidemia symptoms or signs that something’s wrong.

In rare cases—typically only with inherited forms of dyslipidemia, such as familial hypercholesterolemia—you might notice yellowish skin deposits on your ankles, knees, elbows, hands, or eyelids. You might also notice a gray ring around the corneas of your eyes.

More urgently, dyslipidemia symptoms may occur when plaque in an arterial wall limits blood flow to a part of the body—for example, a heart attack caused by limited blood flow to the heart or a stroke caused by limited blood flow to the brain.

Ideally, any menopause-exacerbated cholesterol changes would be caught before they start to cause problems. And the only reliable way to do that is to get screened.

How Is Dyslipidemia Diagnosed? Reading Your Lipid Panel

Most healthy adults should aim to have a lipid panel test every 4 to 6 years. If you have a family history of dyslipidemia or other heart-related health concerns, your clinician might recommend you get tested more often. 

If you’ve already received a dyslipidemia diagnosis, you’ll likely have your levels rechecked after starting or adjusting treatment at an interval that’s personalized to meet your needs and guided by your clinician.

A standard lipid panel (sometimes called a lipoprotein panel) is a blood test that measures:

• total cholesterol
• LDL (“bad”) cholesterol 
• HDL (“good”) cholesterol
• triglycerides

Your clinician might ask you not to eat or drink anything for 8 to 12 hours before your test, but you don’t always have to fast for a lipid panel.

Optimal levels (measured as milligrams per deciliter of blood, or mg/dl) are:

• Total cholesterol: about 150 
• LDL cholesterol: about 100 
• HDL cholesterol: at least 40 for men and 50 for in women
• Triglycerides: less than 150 

Total cholesterol above 200 may be considered high.

Your clinician might also want to consider some additional measures, such as:

• Apolipoprotein B, also called ApoB: This is a protein found on particles that can deposit cholesterol in artery walls. The test measures the total number of these particles in your blood, and normal is 60 to 117 mg/dL.
• Lipoprotein(a), also called Lp(a): This is often a one-time test to measure your inherited levels of a protein in the blood that carries cholesterol. A level of 125 nanomole per liter (nmol/L) or higher is linked to greater chances of having a heart attack or stroke. (The American Heart Association’s recent guidelines suggest that all adults receive this test once in their lifetime.)
• Coronary artery calcium test: Your CAC score measures calcified plaque in the arteries of your heart with a CT scan. A score of 0 means you’re low risk. A score from 1 to 99 is mild or intermediate risk, and a score of 100 or higher is high risk.

Once your clinician has the information they need, they may use a 10-year risk calculator to estimate your chances of having a major cardiovascular event in the next decade. But it’s worth knowing that these risk calculators use data that underrepresents women and doesn’t take menopause and other unique risk factors into account. That’s another reason why it’s so helpful to seek care from a menopause-informed clinician like those at Midi.

How Is Dyslipidemia Treated? Lifestyle Changes First

Dyslipidemia treatment options vary depending on your specific results and risk factors. But the first step for most people is to make lifestyle changes that can help get your lipid levels back within the healthy ranges. This includes: 

• Adopting a heart-healthy diet: A Mediterranean or plant-based style of eating that’s rich in olive oil, nuts, legumes, lean proteins, and vegetables is linked to healthy lipids.
• Getting plenty of fiber: Aim to eat 25 to 30 grams of soluble fiber each day, which helps prevent cholesterol from getting reabsorbed during digestion. Chia seeds, flaxseeds, and oats are all good choices. Some people opt for a fiber supplement or other supplements to lower cholesterol.
• Exercising regularly: Try to get at least 150 minutes of moderate-intensity cardio exercise and 2 strength-training sessions each week.
• Limiting alcohol and quitting smoking: Both cause inflammation, so these steps can help lipid levels.
• Losing excess weight: Shedding just 10 pounds may lower LDL cholesterol, blood pressure, and blood sugar.

Medications for Dyslipidemia: Statins and Beyond

Whether to take medication for dyslipidemia is a highly individualized decision. It’s generally not a decision made on the basis of your numbers alone; a clinician will also consider your overall risk factors for heart disease or stroke.

For example, your clinician might recommend medication if you’ve already had a heart attack, you have peripheral arterial disease, or your LDL is higher than 70 and you have diabetes, according to the Centers for Disease Control and Prevention.

The first-line medication treatment is typically a statin, which slows down how much cholesterol your liver makes and helps your liver remove LDL cholesterol in your blood. Statins may also lower triglycerides.

If you’re pregnant or breastfeeding or have certain types of liver disease, you typically shouldn’t take statins. Women in the highest risk categories should weigh the risks and benefits with their clinician; some highest-risk women choose to stop breastfeeding in order to resume their hyperlipidemia therapy.  

Some people notice muscle aches and pains when they take the medication; a switch to a different statin might help that, and/or adjusting the dose can make a difference on side effects. But don’t stop taking the medication without talking with your clinician first. You may also need to avoid grapefruit while taking a statin.

A clinician may add other cholesterol-lowering medications or swap them for a statin, including:

• ezetimibe (Zetia), which slows how much cholesterol you absorb in your intestines to lower LDL
• PCSK9 inhibitors, which help clear LDL cholesterol in your blood
• bempedoic acid, which works like a statin and improves results especially for people with certain types of existing heart disease or familial hypercholesterolemia 

Taking prescription omega-3 fatty acids may also help lower triglycerides.

Unfortunately, heart disease is often still misperceived as a “man’s disease” even though it’s the leading cause of death in women in the United States. Women are less frequently prescribed medication to improve lipid levels than men, and when they do get a prescription, it’s less likely to help women than men reach optimal lipid levels. That makes it even more important to talk with your clinician about your risks.

Where Do Hormone Therapy and GLP-1 Medications Fit?

Starting HRT within 10 years of menopause (the point in time that’s 12 months after your last menstrual period) is a safe and an effective way to manage menopause symptoms and protect your bones, but data is limited on its direct impact on preventing atherosclerotic heart disease in women. HRT is not a replacement for a statin or another lipid-lowering medication if you need one.

Any impacts of HRT on cholesterol largely depend on the form of estrogen you take. Oral estradiol tends to lower LDL and raise HDL more than transdermal options like patches or gels, but they can also raise your triglycerides. Transdermal estradiol, on the other hand, has a milder effect on LDL and HDL but typically keeps triglycerides steady or helps lower them. (The differences come down to how the hormones are delivered—your body processes each type differently, which impacts how they interact with your liver and substances involved in plaque and clot formation.)

What about GLP-1s? There’s some evidence that these medications (such as semaglutide and tirzepatide) may produce minor lipid improvements after significant weight loss. But these medications aren’t a first-line treatment for dyslipidemia, and they’re not right for everyone. 

Ultimately, it might take a combination of lifestyle changes, medication, hormone therapy, and weight management to bring your lipid levels back into normal ranges. Any treatment decisions should take your full health into consideration. 

When Should You See a Clinician About Dyslipidemia?

For starters, take a look at your medical records to see whether it’s time for a lipid panel. If it’s been 4 to 6 years, schedule a visit. If you know your cholesterol results are high, you should regularly check in with your clinician, especially if you also have other risk factors like diabetes, high blood pressure, or a family history of heart disease.

When talking with a clinician about elevated cholesterol levels, be ready with info about your family history, current medications and supplements, any menopause symptoms you’re experiencing, and recent lab results. Some questions you may want to ask:

• What type of dyslipidemia do I have?
• What is my overall risk for heart disease or stroke?
• Would I benefit from lipid-lowering medication?
• Would I benefit from HRT?
• What lifestyle changes could help me?

Midi clinicians are used to fielding these questions—and more—about dyslipidemia and menopause symptoms as part of comprehensive midlife care. Book a visit today and start taking steps to protect your heart and your overall health.

Key Takeaways

• Dyslipidemia means cholesterol or triglycerides that are outside the healthy range. That’s different from hyperlipidemia, which means high lipid levels, although the two terms are often used interchangeably.
• Your genetics, age, medical history, medications, and lifestyle habits can all influence your risk of dyslipidemia. But menopause also often triggers lipid changes, due to the drop in natural estrogen production.
• Dyslipidemia doesn’t usually cause any symptoms. But left untreated, it can increase your risk of heart attack and stroke.
• Treatment can include lifestyle changes, weight loss, and prescription lipid-lowering medications.

Frequently Asked Questions (FAQs)

Is dyslipidemia the same as high cholesterol?

High cholesterol is a type of dyslipidemia. But they’re not exactly the same. Dyslipidemia is an umbrella term that can also include low HDL cholesterol.

What is the best treatment for dyslipidemia?

The best treatment for dyslipidemia depends on your lipid levels, heart health risk factors, and health history. Talk with a clinician about the best course of treatment for you, which might include lifestyle changes, weight management, hormone therapy, prescription cholesterol-lowering medications, or a combination of these. 

What is the main cause of hyperlipidemia?

There is no one main cause of hyperlipidemia, or elevated lipid levels. The most common causes include age, lack of exercise, and consumption of a lot of animal fats, as well as diabetes, kidney or liver disease, thyroid disease, and medication side effects.

Which doctors treat dyslipidemia?

Primary care doctors, cardiologists, endocrinologists, and lipidologists all work with people with dyslipidemia. So do specialists in menopause and midlife health, like Midi clinicians.

What is the ICD-10 code for dyslipidemia?

The ICD-10 is a global categorization system for medical diagnoses. Some codes that relate to dyslipidemia include:

• E78.00: pure hypercholesterolemia
• E78.41: elevated lipoprotein(a)
• E78.1: pure hypertriglyceridemia
• E78.5: hyperlipidemia, unspecified
• E78.2: mixed hyperlipidemia