High cholesterol increases your risk of heart disease and stroke, and menopause itself is linked to a higher risk of heart disease owing to several changes happening in your body. You can keep your heart healthy by understanding how menopause affects cholesterol and how to manage these changes.
Some of the changes that occur during the menopausal transition can affect your cholesterol levels. These include decreased estrogen, loss of muscle mass, weight gain, and insulin resistance.
Decreased Estrogen
Cholesterol — which includes low-density lipoprotein (LDL), or “bad cholesterol,” and high-density lipoprotein (HDL), or “good cholesterol” — plays many roles in the body. But it relies on special receptors to move from the bloodstream into the cells to do its job.Estrogen is a hormone that helps these LDL receptors function efficiently, says Elizabeth Klodas, MD, a cardiologist based in Minnesota and the founder of Step One Foods.
When estrogen levels drop during menopause, these receptors don’t work as well, allowing more LDL (bad cholesterol) to remain in the bloodstream, explains Dr. Klodas. This can cause LDL levels to rise, increasing the risk of heart disease and stroke, even without changes in diet, exercise, or weight, she notes.
At the same time, HDL levels can decrease as estrogen levels drop. HDL helps remove excess cholesterol from the bloodstream. Low HDL levels mean the body isn’t as efficient at getting rid of “bad cholesterol,” which can further increase the risk of heart disease and stroke.
Loss of Muscle Mass (Sarcopenia)
Another important change during menopause is the loss of muscle mass, also known as sarcopenia. Muscles help the body use glucose (blood sugar) and fats, says Christopher Davis, MD, a board-certified cardiologist and the chief cardiologist at HumanN.
As muscle mass decreases during menopause, the body becomes less efficient at managing fats and sugars, which leads to unhealthy changes in cholesterol, adds Dr. Davis. This can result in higher levels of triglycerides (a type of fat in your blood), lower or less-effective HDL (good cholesterol), and higher LDL levels.
Weight Gain and Insulin Resistance
Many women find it difficult to maintain a healthy weight during menopause, and excess weight can affect cholesterol levels through insulin resistance, says Klodas. When the body becomes insulin resistant, it needs more insulin than usual to process blood sugar.
High insulin levels can lead to increased LDL and total cholesterol (the combined amount of LDL, HDL, and other fats in the blood).
A small blood sample is used to test your cholesterol level. For menopausal women, recommended cholesterol targets are the same as those for the general adult population, explains Davis. These are:
Total cholesterol below 200 milligrams per deciliter (mg/dL)
LDL below 100 mg/dL
HDL above 50 mg/dL
Triglycerides below 150 mg/dL
If you have risk factors for heart disease, such as high blood pressure, diabetes, or a family history of heart problems, your healthcare provider might recommend different targets for your cholesterol levels. This is especially important since the risk of heart disease increases after menopause, says Davis. Knowing your target cholesterol numbers is an important part of managing your heart health. Work with your healthcare team to understand your numbers and what they mean for you.
You may not always be able to change certain factors, like estrogen loss, but there are ways to manage cholesterol levels during menopause.
Add whole-food fiber, omega-3 fatty acids, antioxidants, and plant sterols (natural plant components that block cholesterol absorption) to your diet, notes Klodas. Good sources include:
Beans and legumes
Leafy greens and vegetables
Fruits
Nuts and seeds
Whole grains
Fatty fish like salmon, tuna, and mackerel
Keeping a healthy weight is equally important to help lower the risk of heart disease.
The American Heart Association recommends at least 150 minutes of aerobic activity per week and strength training two to three times per week.
“Managing stress, quitting smoking, and moderating alcohol intake are also essential, as they influence both cholesterol and overall heart health,” says Davis.
If lifestyle changes aren’t enough to manage your cholesterol, your healthcare provider might recommend medication.
Statins
Statins, such as atorvastatin (Lipitor) and simvastatin (Zocor), are the most commonly prescribed cholesterol-lowering medications. They work by slowing down your body’s production of cholesterol and helping your liver remove LDL from your bloodstream. Some people may experience side effects like muscle pain, liver damage, or increased blood sugar when taking statins. Increased blood sugar could lead to a higher risk of type 2 diabetes, so it is important to discuss the risks with your doctor before choosing to take statins.
Klodas notes that for people without a history of heart problems, stroke, or other medical conditions, testing may help determine if cholesterol-lowering medication is necessary. “I often use a coronary artery calcium scan [a computer tomography (CT) scan that measures calcium deposits in the heart’s arteries] to determine whether a postmenopausal woman should be placed on a statin,” she explains. “In general, anything but a score of 0 pushes me in the direction of prescribing a statin,” she adds.
Other Cholesterol Medications
Other cholesterol-lowering medications include:
Selective cholesterol absorption inhibitors, like ezetimibe (Zetia). Side effects include stomach pain, diarrhea, fatigue, and muscle soreness.
PCSK9 inhibitors, like evolocumab (Repatha), which are injected into the bloodstream. Side effects are swelling, itching, or pain at the injection site.
Fibrates, like fenofibrate (Antara) or gemfibrozil (Lopid). Nausea, stomach pain, and muscle pain are common side effects.
Niacin (Niacor or Niaspan) Facial flushing, itching, upset stomach, and blood sugar increase are possible side effects.
Bile acid sequestrants, such as cholestyramine (Prevalite). Side effects tend to be gastrointestinal issues, such as constipation.
PCSK9 inhibitors are used for people who have heart disease and can’t take statins or for treating familial hypercholesterolemia, a genetic disorder that causes high LDL (“bad” cholesterol) levels. Others, such as ezetimibe, are often used in combination with statins to further reduce cholesterol levels.
Hormone Replacement Therapy
Hormone replacement therapy (HRT) is often used to manage menopause symptoms like hot flashes and sleep disturbances, but its effects on cholesterol are limited.
HRT may have a small impact on cholesterol levels, but it’s unlikely to get those levels back to what they were before menopause, explains Klodas. For this reason, HRT should be primarily considered for managing menopausal symptoms rather than cholesterol levels, she adds.
Hormone therapy is not intended to prevent heart disease, either, says Dweck, though women who start menopause hormone therapy (MHT) before age 60 and within 10 years of menopause may see some heart health benefits.
If you’re considering hormone therapy, discuss the potential benefits and risks with your healthcare provider.
Supplements
Certain supplements may help support healthy cholesterol levels during menopause, though they’re not a replacement for lifestyle changes or prescribed medications. Adding omega-3 supplements, such as fish oil, to your routine may help lower triglycerides and boost HDL cholesterol, though it may also slightly increase LDL, says Dweck.
Here are some supplements that may improve cholesterol levels:
Plant stanols and sterols: These natural compounds found in plants may reduce LDL cholesterol, but they can cause digestive issues like diarrhea.
Ground flaxseed: May help lower LDL cholesterol while providing fiber and omega-3s.
Berberine: This natural compound found in plants may reduce LDL cholesterol and triglycerides, but can cause digestive issues like diarrhea and nausea.
Green tea extract: May help lower LDL cholesterol.
Garlic: May slightly lower cholesterol, though research is mixed. It can cause digestive issues and may interact with blood thinners.
Always speak with your healthcare provider before starting any supplement, as some supplements can interact with medications or have side effects.
The Takeaway
Decreased estrogen, muscle loss, and weight gain during menopause can affect cholesterol levels.
Low-density lipoprotein (LDL), triglycerides, and total cholesterol tend to rise after menopause, while high-density lipoprotein (HDL) levels may decrease, increasing the risk of heart disease and stroke.
Heart-healthy habits like Mediterranean-style eating, healthy weight, and regular exercise can help manage cholesterol levels.
If lifestyle changes aren’t enough, medications like statins can be used to manage cholesterol. Discuss the benefits and risks with your healthcare provider.
