Lipids
Triglycerides, HDL-cholesterol and LDL-cholesterol
What it is
A lipid panel measures circulating fats in the blood. It includes triglycerides (TG), HDL-cholesterol (so-called "good cholesterol"), LDL-cholesterol (so-called "bad cholesterol"), and total cholesterol. The test requires fasting for at least 12 hours before the blood draw.
The ESHRE 2023 guidelines explicitly include a lipid panel in the initial workup of any person diagnosed with PCOS, due to the increased long-term cardiovascular risk associated with the condition.
Dyslipidaemia in PCOS
PCOS is frequently associated with an unfavourable lipid profile, even in lean individuals. The most typical pattern is atherogenic dyslipidaemia:
- Elevated triglycerides — often > 1.7 mmol/L
- Low HDL — the "protective" cholesterol is reduced
- Small dense LDL (sdLDL) — more atherogenic than normal LDL particles, not always detected on a standard panel
This combination is a marker of insulin resistance and increases the long-term risk of cardiovascular disease — independently of body weight.
Reference values
- Triglycerides: normal < 1.7 mmol/L (150 mg/dL). > 2.3 mmol/L = elevated
- HDL-cholesterol (women): normal > 1.3 mmol/L (50 mg/dL). < 1.0 mmol/L = very low
- LDL-cholesterol: target < 3.4 mmol/L (130 mg/dL) in primary prevention, lower if high cardiovascular risk
Cardiovascular risk in PCOS
People with PCOS have an increased long-term risk of cardiovascular disease, hypertension, and type 2 diabetes. Dyslipidaemia contributes to this risk. Even in the absence of short-term symptoms, regular lipid monitoring (every 2 to 5 years depending on risk factors) is recommended.
A diet favouring unsaturated fatty acids (oily fish, olive oil, nuts), reducing simple sugars, and regular physical activity are the primary levers for improving the lipid profile in PCOS.
Key takeaways
- Fasting test (12h) including TG, HDL, LDL and total cholesterol
- Atherogenic dyslipidaemia common in PCOS (TG ↑, HDL ↓, dense LDL)
- Normal TG < 1.7 mmol/L; HDL women > 1.3 mmol/L; LDL < 3.4 mmol/L
- Increased long-term cardiovascular risk
- Recommended by ESHRE 2023 in initial PCOS workup