Cholesterol is a waxy, fat-like substance that our bodies produce, mainly in the liver. Our bodies use it to build cell membranes, produce hormones like estrogen and testosterone and vitamin D, and make bile acids. Contrary to popular belief, cholesterol does not float freely in the blood, but is carried on small biological “boats” called lipoproteins, which are made of fat (lipids) on the inside and fat and protein on the outside.
High cholesterol is a leading risk factor for heart disease, which kills more women than any other cause, including all forms of cancer combined. And the longer a person lives with high cholesterol, the greater the chance it will build up in their arteries and cause a heart attack or stroke.
Many factors around midlife combine to push cholesterol levels up, such as a sedentary lifestyle, poor diet, and weight gain. But the most prominent factor that clearly drives this change is the sudden, inevitable drop in estrogen levels at menopause. Unlike other problems that begin during perimenopause (mood swings, hot flashes, fatigue), the rise in cholesterol tends to happen quite suddenly, usually in the year before or after menopause.
And menopause marks an essential time for women to take stock of their health. The protective effects of estrogen on cholesterol are evident even before menopause, as cholesterol levels rise and fall slightly in response to estrogen fluctuations throughout each menstrual cycle.
The link between menopause and high cholesterol
The impact of menopause on cholesterol is significant, with women experiencing a decrease in high-density lipoprotein, or HDL, (“good”) cholesterol and an increase in low-density lipoprotein, or LDL, (“bad”) cholesterol of about 10% to 15%.
Like most of the symptoms of menopause (poor sleep, night sweats, and hot flashes), the increase in cholesterol is driven by hormones, primarily due to changes in estrogen levels. Estrogen helps regulate cholesterol by aiding the metabolism of fats in the liver and also helps remove cholesterol from your tissues and into your waste, allowing it to leave your body.
When estrogen levels drop during menopause, bad cholesterol may increase and good cholesterol may decrease.
Similarly, a drop in anti-Müllerian hormone (AMH) levels during menopause may be linked to worse cholesterol. Some research on the relationship between this hormone and cholesterol suggests that AMH may be linked to increased steroid hormones that can contribute to a metabolic disorder called dyslipidemia. Lifestyle factors can also increase cholesterol in women at this time. Along with a drop in estrogen levels, we see a decrease in exercise and often changes in eating habits as we age, all of which contribute to an increase in your cholesterol. After menopause, cholesterol levels can continue to rise. Research shows that women who were six years postmenopausal had significantly lower HDL and significantly higher LDL scores than women who had been through menopause less than two years earlier.
What can women do to better manage their cholesterol?
Every woman has a different baseline level of cardiovascular and metabolic risk before menopause. This is based on their genetics and family history, diet, and lifestyle.
But all women can reduce their risk of cardiovascular disease after menopause by:
- Regular moderate-intensity exercise such as brisk walking, lawnmower riding, cycling, or water aerobics for 30 minutes, four or five times a week
- Eating a heart-healthy diet with smaller portions (try using smaller plates or bowls) and plenty of low-calorie, nutrient-dense foods such as vegetables, fruits, and whole grains
- Consuming plant sterols (unrefined vegetable oils, nuts, seeds, and cereals) every day. Some studies have shown that plant sterols, at doses of at least 2 grams per day, produce an average reduction in serum LDL-C (bad cholesterol) of about 9–14%. This can reduce your risk of heart disease by up to 25% over two years
- Limit unhealthy fats (saturated or trans) and include more lean protein sources (lean meat, poultry, fish – especially oily fish high in omega-3 fatty acids), legumes and low-fat dairy
- Less high-calorie, high-sodium foods such as processed foods or fast foods
- Reduce or stop smoking (nicotine or marijuana) and alcohol
- Control weight gain.
