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Women with PCOS may be at a higher risk of high cholesterol, something that doesn't cause symptoms but increases your risk of heart disease. What do you need to know about hypercholesterolemia?

Women with PCOS are more likely to suffer from hypercholesterolemia — high cholesterol — as well as abnormally high levels of other lipids, like triglycerides. Diet, weight, insulin resistance, and diabetes all play a role in raising your odds of encountering hypercholesterolemia, a condition that is especially concerning because it doesn't cause any symptoms and instead silently adds to your risk of heart disease

What should you know about high cholesterol levels if you have polycystic ovary syndrome?

1. Polycystic ovary syndrome and cholesterol: The good, the bad, and the dangerous

You'll have heard of two different types of cholesterol:

  • Low-density lipoprotein (or LDL) cholesterol is usually referred to as "bad" cholesterol, because high levels make people more vulnerable to cardiovascular disease. 
  • High density lipoprotein cholesterol, or HDL cholesterol, is the "good" kind — it helps your liver eliminate bad cholesterol by getting it there. Higher levels of HDL cholesterol are good news. 

To determine your cholesterol levels, HDL levels are subtracted from the total. PCOS patients often have high levels of HDL cholesterol relative to their LDL cholesterol levels, which is what causes a higher risk of cardiovascular diseases including heart attack, stroke, and atherosclerosis, in which plaque builds up in the lining of arterial walls. PCOS can also impact the rest of your lipid (blood fat) profile, including VLDL cholesterol and triglyceride levels. 

2. Why are PCOS patients more likely to have high cholesterol levels?

PCOS is often described as a condition of the reproductive system, but this endocrine disorder affects the whole body, as you'll know all too well if you have it. The reasons behind the increased risk of hypercholesterolemia in women with PCOS are manifold, and among them are:

  • Your weight. Many women with PCOS struggle with overweight or obesity, with research indicating that as many as eight in 10 patients in the US are obese. This greatly contributes to your risk of high cholesterol levels. 
  • Hormones. If you have PCOS, you'll have higher levels of "male" hormones, androgens, as well as increased estrogen levels relative to progesterone. This, too, has a negative impact on your cholesterol.
  • Insulin resistance is another very common thing in women who live with polycystic ovary syndrome. It increases your risk of type 2 diabetes, of course, but it also impacts your lipid profile, including cholesterol levels. 

3. What can you do to fight or prevent high cholesterol if you have PCOS?

A combination of lifestyle changes — such as increasing the frequency with which you exercise, adjusting your diet, and quitting smoking — can have a great impact on your cholesterol levels, but medications are also available. The first step, however, is seeing whether you indeed have high cholesterol levels. Talk to your doctor about getting that tested. If your lipid profile comes back with only moderately concerning results, you will be asked to go with the lifestyle changes, while higher cholesterol levels may cause your doctor to suggest medications right away. Even if your cholesterol levels aren't yet high, the common-sense lifestyle choices that are recommended will help you keep it that way. 

4. Controlling your PCOS means managing your cholesterol

Because PCOS does affect the whole body, it is important to work with a doctor on the management of all its symptoms and effects, something that will also have a positive impact on your cholesterol levels. This includes trying to improve your insulin resistance, something that can be achieved with diet, weight loss, and medications. Drugs that may be prescribed to women with PCOS include:

  • Birth control pills to regulate hormones
  • Clomid and letrozole (Femara) if you are trying to get pregnant
  • Metformin, a diabetes drug that can help you with insulin resistance and weight loss but also brings your cholesterol levels down

5. What kind of diet do you need?

You'll have heard various dietary suggestions to manage your PCOS symptoms, including a low glycemic index diet to improve insulin resistance and a DASH diet to manage hypertension. To lower cholesterol levels, eating habits that shun saturated and trans fats are best.

The good news is this kind of low-fat diet is compatible with other suggestions that will be made to you, as it means:

  • Cutting down on processed foods, red meat, full-fat dairy products, and added sugars.
  • Including as many vegetables and fruits in your diet as possible, along with whole grains, seeds, and nuts.
  • A low-fat diet doesn't mean not eating any fats! Healthy monounsaturated fats, like those found in olive oil, avocados, and fatty fish are indeed very good for your health.

6. Regular exercise: Good for fighting high cholesterol, too

Women with PCOS should ideally be working out five times a week, whether this means hitting the gym, doing a home workout routine, jogging, cycling, or swimming, or simply keeping active through daily activities. This will help you with insulin resistance, weight loss, overall fitness, and even improve your hormonal balance, but it also helps with your cholesterol levels. Regular exercise is believed to raise your HDL levels, something that will help lower your LDL cholesterol. 

7. Plant sterols and stanols to reduce your cholesterol levels

While people with high cholesterol levels will be prescribed statins, you can also consider using plant sterols and stanols in a bid to lower your cholesterol levels. These are cholesterol-like compounds in plants that make it more difficult for your body to absorb cholesterol from meat sources, which is a good thing. It will help increase your LDL, or "good", cholesterol and thereby allow your liver to get rid of some of the bad cholesterol. The end result is that your good cholesterol goes up while your bad cholesterol goes down. 

Good sources of sterols and stanols include:

  • Vegetable oils — olive, canola, and sesame among others
  • Margarine may be fortified with it
  • Whole grains
  • Legumes
  • Vegetables
  • Nuts and seeds

8. If relevant to you, stop smoking

So, I've been doing a lot of writing about the different complications of PCOS — things like sleep apnea, heart disease, high blood pressure, endometrial cancer, and diabetes. You won't be surprised to hear that quitting smoking lowers your risk of nearly all of them, because you know very well that smoking is very bad news. If you smoke, your levels of "good" cholesterol go down, and your risk of heart disease goes up. Way up. If you're still doing it, stop it. Have you tried and failed? Ask your doctor for advice. They can help.

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