You can eat well, move often, and still see your cholesterol climb in your forties. For many women, it’s not just about food — it’s about falling oestrogen. As hormone levels shift in perimenopause, cholesterol balance can change too, often showing up on blood tests long before other symptoms appear. Understanding why this happens — and what you can do about it — is the key to protecting both your heart and your hormones through midlife and beyond.