Cholesterol

Cholesterol is a fatty substance in your blood. The NHS website says that when there is too much of it, it can block your blood vessels and make heart problems or a stroke more likely.

High cholesterol is not an illness you notice. It is a risk you find on a lab report. Doctors may call the test a lipid profile, and the problem dyslipidaemia, which covers cholesterol and the other blood fats measured with it.

Nothing. The NHS website says high cholesterol does not usually cause symptoms. You can feel well, walk to the market, climb the stairs, and still have a high reading.

If it turns up, better it turns up on a test you asked for.

The NHS website lists who is more likely to have high cholesterol: people over 50, men, women who have been through the menopause, and people of South Asian or sub-Saharan African origin. It also runs in families. Then there are the things you can change: fatty food, too little exercise, being overweight, smoking and alcohol.

The Pakistan Menopause Society's recommendations place unhealthy blood fats among the longer-term changes that can follow menopause, with weight around the middle and insulin resistance (Table 1). The European Menopause and Andropause Society (EMAS) gives a sense of scale: in its figures, high cholesterol is found in 37% of women aged 33 to 44, 59% of those aged 45 to 55 and 66% of those aged 55 to 64.

The same recommendations add a caution worth hearing: not every midlife health problem is down to falling estrogen. Age, lifestyle and other conditions all play a part (Table 1).

• The NHS website says you can lower your cholesterol by eating healthily and getting more exercise, and that some people also need medicine.
• The Pakistan Menopause Society names sweetened drinks and colas as drivers of weight around the middle and metabolic risk, and asks doctors to talk about food in the context of Pakistani eating habits (Table 5). It suggests whole grains, dals and other pulses, fish, eggs, nuts, seeds and healthy oils, and says a Mediterranean-style diet suits Pakistani tastes. Women's Health Concern says refined starches such as white rice and white bread can be part of a healthy diet and need not be avoided, though more wholegrain is the aim. More in nutrition.
• The same recommendations ask doctors to use the menopause visit to check blood fats along with blood pressure, sugar, weight and tobacco use (Table 1).

The NHS website says that if your cholesterol is high, a doctor or nurse will talk to you about lowering it, which might mean changing your diet or taking medicine, and may work out your risk of a heart attack or stroke over the next ten years. Which medicine, if any, is for the doctor who sees your results.

If you are considering HRT, the Pakistan Menopause Society asks doctors to get conditions such as high cholesterol under control before starting systemic treatment (Table 4).

The NHS website suggests asking your GP surgery for a cholesterol test if you have never had one and you are over 40, overweight, or high cholesterol or heart problems run in your family. In England, a test may also be part of the NHS Health Check for people over 40. EMAS suggests considering a check for women after the menopause or from 50, and for women who had an early menopause, or high blood pressure or pre-eclampsia in pregnancy.

Elsewhere, ask your doctor or a lab. The Pakistan Menopause Society accepts that testing depends on age, risk and affordability. If cost is the question, ask your doctor whether it can be done alongside other blood tests you need.

Women ask whether a cholesterol test means fasting, and how that fits around Ramadan. The NHS website says most people do not need to fast for one at all. Ask the lab or your doctor what they need.

Food is family business in most South Asian homes, and changing the cooking oil or the rice can feel like changing the household. The Pakistan Menopause Society lists shared healthy habits among the ways a husband and family can support a woman through menopause (4.2.6). If everyone eats from the same pot, that is where it starts.