Testing
Menopause transition triggers a fourfold larger Lp(a) rise than staying pre- or postmenopausal, UK Biobank preprint of 4,562 women (medRxiv 2026)
Original title: Heterogeneity in Lipoprotein(a) Profile Changes Across the Menopausal Transition
Preprint UK Biobank analysis of 4,562 women with Lp(a) measured at two visits (mean age at visit 1, 57±7 years; median 4 years between visits), comparing Lp(a) change by menopausal status: transitioned through menopause (n=415), remained premenopausal (n=532), remained postmenopausal (n=3615). At visit 1, median Lp(a) was slightly higher in postmenopausal (23 nmol/L) than premenopausal women (19 nmol/L). Among women with intermediate visit-1 Lp(a) (75-125 nmol/L), those transitioning through menopause had a median Lp(a) increase of 34.9 nmol/L between visits, roughly fourfold larger than those remaining premenopausal (7.9 nmol/L) or postmenopausal (8.0 nmol/L). 56% of menopause-transition women with intermediate baseline Lp(a) reached Lp(a) 125 nmol/L or more at visit 2, versus 29% and 28% of those remaining pre- or postmenopausal (age-adjusted risk ratio 2.26, 95% CI 1.31-3.90). The authors conclude a single lifetime Lp(a) measurement may miss clinically relevant menopause-related rises, supporting repeat testing as women age.
Original abstract
Introduction: Menopause may coincide with rising Lp(a) levels, a causal risk factor for atherosclerotic cardiovascular disease (ASCVD). Characterizing changes in Lp(a) across menopause may inform risk stratification and testing recommendations. .
Methods: We examined changes in serum Lp(a) levels by menopausal status among women with Lp(a) measured at visits 1 and 2 in the UK Biobank. Lp(a) analyses were examined by menopausal status: those who underwent menopause (N=415), those who remained premenopausal (N=532), and those who remained postmenopausal (N=3,615) between visits. We examined the change in Lp(a) between visits stratified by visit 1 Lp(a) levels. The primary outcome was incident Lp(a) ≥125 nmol/L at visit 2, estimated using Poisson regression with adjustment for baseline age.
Results: Data were available for 4,562 women (mean age at visit 1 = 57±7 years; median Lp(a) at visit 1 = 22 (IQR: 47) nmol/L; median time between visits = 4 (IQR: 1) years). At visit 1, median Lp(a) was slightly higher in postmenopausal women (23 nmol/L) than premenopausal women (19 nmol/L). Overall, median changes in Lp(a) between visits 1 and 2 were modest. Among women with intermediate visit 1 Lp(a) levels (75-125 nmol/L), those who transitioned through menopause experienced a median increase of 34.9 (-6.7, 53.0) nmol/L between visits, an approximately fourfold greater increase than for women who remained pre- (7.9 nmol/L) or postmenopausal (8.0 nmol/L). Further, 56% of women with intermediate visit 1 Lp(a) levels who transitioned through menopause between visits had incident Lp(a) ≥125 nmol/L at visit 2, compared with 29% and 28% of women who remained pre- or postmenopausal, representing an age-adjusted risk ratio of 2.26 (95% CI: 1.31, 3.90).
Conclusion: Relying on a single lifetime Lp(a) measurement may miss clinically relevant increases during menopause. Repeat testing in women as they age may improve identification of those at high risk for ASCVD.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.