The Heart-Risk Test You Were Told You Only Need Once May Deserve a Second Look at Menopause

Check it once. Is that still the whole story?

You had the blood test. Someone told you it only needed to be done once. You filed away the result and moved on.

Years later, you are going through menopause. Your periods have changed. Perhaps your cholesterol has too. Does that old test still tell your doctor what they need to know?

The test is called lipoprotein(a), or Lp(a). For most people, one check is enough. But for some women, a second check may be useful, especially if the first result was close to the high range.

The 2026 U.S. cholesterol guideline recommends that adults have this test at least once. It also recognizes that Lp(a) can change around menopause.

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First, what is Lp(a)?

Lp(a), pronounced L-P-little-a, is a tiny particle that carries cholesterol through your blood. It is similar to LDL, often called ‘bad cholesterol,’ but has an extra protein attached to it.

Too much Lp(a) can raise your chance of a heart attack or stroke. It can also contribute to calcium buildup in the aortic valve, the valve that lets blood leave your heart. Over time, that buildup can make the valve harder to open.

About one in five people has a high level. You usually cannot feel it. And your regular cholesterol test does not automatically include it. Lp(a) needs its own blood test.

Sources: 1, 2

Why were we told to test it only once?

Your level is mostly set by genes passed down from your parents. Eating differently, exercising, or losing weight usually does little to lower it. That is why one test can tell you something useful for years.

But genes are not the only influence. Pregnancy, some medicines, kidney, liver or thyroid disease, and menopause can affect the number too.

Your genes have not changed. The amount of Lp(a) in your blood can still change. Your doctor or other treating clinician can help decide whether that matters for you.

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Menopause may change the picture

You may already know that LDL cholesterol can rise around menopause. Lp(a) can change too.

A Danish study of more than 70,000 people found that women after menopause had Lp(a) levels about 27 percent higher than women who had not yet reached menopause. The researchers compared groups of women. They did not show that every woman’s number rises by that amount.

European heart-health experts have called attention to this. Their 2025 cholesterol guidance says a second test after menopause is reasonable, especially if the earlier result was borderline. Borderline means close to the level considered high.

This gives some women a reason to ask about another test. It does not mean every woman needs one each year.

Sources: 3, 4, 5

So should you repeat yours?

Ask: ‘Would checking this again change my care?’ If the old result was clearly low and your health has not changed much, your clinician may decide another test would add little.

If it was close to the high range and was checked before menopause, a repeat may help your clinician decide how to protect your heart now.

If it was already clearly high, you can discuss a plan now. You do not need to wait for another result before asking what to do next.

The number is only part of the answer. Your age, blood pressure, other cholesterol results, medicines, and family history matter too.

Before deciding on a repeat, put four details together:

• When was it measured?
• Was it before menopause?
• What was the actual number and unit, rather than simply ‘normal’?
• What does the rest of my heart story look like now?

Sources: 1, 5

What do the numbers mean?

Look at the letters beside your result. They tell you how the lab measured it. A result of ‘50’ means something different in mg/dL than it does in nmol/L.

The 2026 U.S. guideline uses these ranges:

• If your report says nmol/L: 125 or higher is considered high. A result from 75 to 124 falls between the low and high ranges.
• If your report says mg/dL: 50 or higher is considered high. A result from 30 to 49 falls between the low and high ranges.
• A result in that middle range is one reason a clinician may consider checking again. These ranges help guide care; they do not tell you whether you will have a heart attack.
• Keep the original report. There is no single exact formula for converting between these units. If two reports use different units, ask your clinician to compare them.

Sources: 1, 5

If your Lp(a) is high, what happens next?

A high result does not mean you are going to have a heart attack. It also cannot show whether you already have buildup inside an artery or a blockage.

It tells your clinician to pay closer attention to the things you can change, especially LDL cholesterol, blood pressure, blood sugar, and smoking.

You may not be able to lower your Lp(a) very much with lifestyle. You can still improve your overall heart health. Eating well, staying active, avoiding smoking, and treating high blood pressure or LDL cholesterol still matter, even when Lp(a) barely moves.

Ask what your result changes. Should you aim for a lower LDL cholesterol level? Would medicine help? When should you check in again? The answers should fit your health and history.

Sources: 1, 2, 6

Are there medicines for Lp(a)?

As of September 18, 2026, no medicine is approved specifically to lower Lp(a) to prevent heart attacks and strokes. Several are being studied.

One recent result shows why those studies matter. On September 4, Novartis reported that a medicine called pelacarsen lowered Lp(a) in a large study. But it did not meet the study’s main goal of reducing serious heart and blood-vessel problems. The participants already had heart or blood-vessel disease. The company said more detailed results would follow.

A lower blood-test number does not always mean fewer heart attacks or strokes. Researchers are still studying other medicines, including olpasiran, to see whether they can do both.

You do not have to wait for those answers to work on your LDL cholesterol, blood pressure, or other parts of your heart health.

Sources: 6, 7

Should your family be checked too?

If yours is high, ask whether your parents, siblings, and children should discuss testing with their own clinicians. High Lp(a) often runs in families.

This is especially worth discussing if relatives developed heart disease at a young age. For children, their clinician can help decide when testing makes sense.

Sometimes one woman’s blood test helps uncover a risk factor that has been moving quietly through a family for generations.

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What to bring to your next appointment

Find the original lab report, if you have one. Save the number, units, and date. Note whether it was before menopause and whether you were pregnant or taking hormone treatment when it was drawn.

Bring your recent cholesterol and blood-pressure results, current medications, and any family history of early heart disease. These details help your clinician decide whether the old Lp(a) result still answers today’s question.

Then ask: ‘Would repeating this test change what we do?’

You may leave with a plan to repeat it. You may leave knowing that the earlier result is enough. Either way, you should understand what the number means for your care.

If you have never had the test, ask about it at your next routine visit.

This is what I want HEART RESERVE to help women do: know their own history, bring it into the room, and understand the plan they make with their clinician.

Your genes may have written much of your Lp(a) story. Menopause may change the number. Together, you and your clinician can decide whether it is worth looking again.

Keep the conversation going

• What does a high Lp(a) result mean?
• What the 2026 cholesterol guideline means for women
• Why cholesterol can rise around menopause
• Heart Tests, in Plain English