Women’s Cholesterol Levels Vary with Phase of Menstrual Cycle

NIH findings suggest a need to consider phase of cycle when measuring cholesterol

Research from the National Institutes of Health indicates that women’s cholesterol levels
correspond with monthly changes in estrogen levels. This natural variation may indicate a
need to take into account the phases of a woman’s monthly cycle before evaluating her
cholesterol measures. On average, the total cholesterol level of the women in the study
varied 19 percent over the course of the menstrual cycle.

In a typical cycle, estrogen levels steadily increase as the egg cell matures, peaking just
before ovulation. Previous studies have shown that taking formulations which contain
estrogen—oral contraceptives or menopausal hormone therapy—can affect cholesterol
levels. However, the results of studies examining the effects of naturally occurring
hormone levels on cholesterol have not been conclusive. According to the NIH’s National
Heart, Lung and Blood Institute, high blood cholesterol levels raise the risk for heart
disease.

The researchers found that as the level of estrogen rises, high-density lipoprotein (HDL)
cholesterol also rises, peaking at the time of ovulation. HDL cholesterol is believed to be
protective against heart disease.

In contrast, total cholesterol and low-density lipoprotein (LDL) cholesterol levels—as

well as another form of blood fat known as triglycerides—declined as estrogen levels
rose. The decline was not immediate, beginning a couple of days after the estrogen peak
at ovulation. Total cholesterol, LDL cholesterol and triglyceride levels reached their
lowest just before menstruation began. Additional information on the types of cholesterol
and triglycerides is available at
http://www.nhlbi.nih.gov/health/dci/Diseases/Hbc/HBC_Diagnosis.html.

The findings were published online in The Journal of Clinical Endocrinology and
Metabolism.

First author Sunni L.

Mumford, Ph.D., of the
Epidemiology Branch of
the Eunice Kennedy
Shriver National Institute
of Child Health and
Human Development
(NICHD) and her NICHD
colleague Enrique F.
Schisterman, Ph.D.,
conducted the research
with colleagues at the
University of North
Carolina, Chapel Hill; the
Figure 1 The study authors found that women's total cholesterol levels State University of New
rise as estrogen levels increase during the monthly menstrual cycle, York, Buffalo; and the
drop shortly before ovulation, then decrease more rapidly after University of Nevada
ovulation occurs.
Health Sciences System.
"It’s more likely cholesterol levels will be elevated in women before ovulation, which could
have a particular impact on women whose cholesterol levels are already high," Dr.
Schisterman said.
He explained that when a test shows a high cholesterol level, physicians will often order
an additional test to make sure the reading is accurate. Testing at the end of a woman’s
cycle when cholesterol levels are low might do away with the need for an additional test
to confirm a high cholesterol reading.

The study compared estrogen with cholesterol and triglyceride levels among 259 healthy
women between 18 and 44 years old. For 94 percent of the volunteers, researchers took
14 or more measurements over two menstrual cycles. Women charted the phases of their
cycles with at-home fertility monitors, which detect hormone levels that indicate
ovulation.

Most of the women were physically active and did not smoke. Only 5 percent
consistently had total cholesterol levels greater than 200 mg/dL, considered borderline
high-risk for heart disease. However, cholesterol levels among 19.7 percent of the women
reached 200 mg/dL at least once.
A small subset of obese women over 40 showed greater fluctuation in cholesterol levels
during their cycles than did the rest of the group.

"Other studies are needed to confirm our findings among obese women," Dr. Mumford
said. Further research may help clarify the optimal point in the cycle for doctors to
measure women’s cholesterol levels and help clinicians develop standardized procedures
for measuring cholesterol in premenopausal women and determining their heart disease
risk.

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The NICHD sponsors research on development, before and after birth; maternal, child, and family health;
reproductive biology and population issues; and medical rehabilitation. For more information, visit the
Institute's Web site at http://www.nichd.nih.gov/.

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and Centers and is a component of the U. S. Department of Health and Human Services. It is the primary
federal agency for conducting and supporting basic, clinical, and translational medical research, and it
investigates the causes, treatments, and cures for both common and rare diseases. For more information
about NIH and its programs, visit http://www.nih.gov.