Menopause Can Raise Your Cholesterol—Find Out How To Bring It Down and Improve Heart Health

We know that menopause can trigger significant physical, mental and emotional changes.. But did you know that menopause and cholesterol are connected as well, and they can affect your heart health? We asked doctors to share all the need-to-info about why your cholesterol might increase and what you can do about it.

How menopause affects your cholesterol

Monitoring your cholesterol levels during menopause is important. “High-density lipoprotein (HDL) cholesterol levels—the good cholesterol—usually decrease during menopause because estrogen significantly decreases,” says Jennie Stanford, MD, FAAFP, DipABOM, family physician and medical contributor for Drugwatch. “Estrogen helps promote higher levels of the cardioprotective HDL.”

Dr. Stanford notes that because HDL levels decrease, “low-density lipoprotein (LDL) levels, the bad cholesterol and triglycerides (circulating fat in the blood), often increase.” These changes can be tied to menopause, metabolic changes and more sedentary activity.  

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During menopause, increased cholesterol also accelerates plaque build-up in the arteries, which can increase heart disease risk, notes Michelle Routhenstein, MS RD CDCES CDN, Preventive Cardiology Dietitian at EntirelyNourished.com.

‘Good’ HDL cholesterol vs. ‘bad’ LDL cholesterol

Besides being known as bad cholesterol versus good cholesterol, Sara Gottfried, MD, a board-certified physician and medical advisor at ŌURA thinks of “LDL as fat that collects in the walls of blood vessels, leading to dysfunction and narrowing.” She compares it to trash that builds up. 

The good cholesterol, or HDL, “transports fat to the liver, like a trash collector,” adds Dr. Gottfried. “You want a good balance between trash generation and collection to keep your blood vessels healthy.”

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During menopause, Routhenstein points out that HDL can become dysfunctional. It’s important to evaluate LDL cholesterol levels as an independent risk factor for heart disease.

You want to try to maintain balanced levels of cholesterol. Too high or too low can cause dyslipidemia and plaque buildup, which increases your risk of heart disease. 

Dyslipidemia and its link to LDL

“Dyslipidemia is when you have an unhealthy level of one or more types of lipids (fat) in your blood,” says Dr. Gottfried. “That could be rising LDL, high triglycerides (TRG) or low or poorly functioning HDL.”

Dr. Stanford explains that high triglycerides occur as a result of a suboptimal diet. “While this can mean a diet high in cholesterol, it more commonly results from a diet that is high in saturated fats, sugars and other pro-inflammatory foods. These promote atherogenesis or plaque buildup.”

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How to balance your cholesterol levels 

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It’s important to keep your blood vessels healthy both before, during and after menopause. Routhenstein suggests monitoring your blood pressure at home to ensure optimal levels of 110/70mmHg.

You also want to keep an eye on menopausal symptoms, as those can impact cholesterol levels, too. For her patients, Dr. Gottfired does additional testing to see where a woman is in the menopause transition and how to personalize treatment, including: “advanced lipid profiling, lipoprotein (a), genetics, continuous glucose monitoring (CGM), wearables and coronary artery calcium score.”

If you’re unable to get your lipid profiles tested, Dr. Gottfried says you can also incorporate any of the following into your routine:

• Exercise: ⅔ of your efforts heavy weight lifting, 1/3 cardio
• Meditation for 20 minutes per day
• Healthy food low in carbs, personalized with continuous glucose monitor
• Foods lower in saturated fat (depending on your genetics and the specific type of saturated fat)
• Bioidentical hormone replacement therapy (BHRT)