Menopause and cholesterol: what you need to know

Advice on lowering your cholesterol level to keep your heart healthy

Cholesterol in your blood rises during menopause
Women may not realise and there are usually no symptoms
Diet changes and medications can help reduce your levels

In adults aged 16 to 44, men are more likely than women to have raised cholesterol levels (53% compared to 46%) [1].

But during the menopause, the situation reverses – of those aged 45 to 64, 77% of women have raised cholesterol compared to 67% of men. So what’s going on?

The hormone oestrogen is known for its protective effect on your heart. One of these benefits is its ability to reduce the levels of ‘bad’ cholesterol in your blood. This is a type of fat that can clog the arteries and increase the risk of heart attack, heart disease and stroke. During the perimenopause, oestrogen levels fluctuate and during the menopause, levels fall. The cholesterol in your blood often rises during menopause and this continues into old age, with 65% of women aged 65 and over having raised cholesterol compared to 48% of men [1].

RELATED: menopause and your heart

Understanding your cholesterol

Between the ages of 40-74, if you are well and have no other medical conditions, you can have an NHS health check. As part of this your blood is taken and one of the levels monitored is your cholesterol. This is important around the time of your menopause as there are usually no symptoms of high cholesterol. These health checks are largely carried out in GP surgeries and local pharmacies, in some areas they may be offered in mobile units or leisure centres.

When you get your cholesterol tested, you may be told the figure for your total cholesterol – a healthy level is considered to be 5mmol/L or below. Heart UK recommends you ask for a breakdown of the results as it’s possible to have a healthy total cholesterol but an unhealthy balance of the different types of cholesterol.

Women naturally have higher levels of ‘good’ cholesterol – which is called HDL – than men. Women should aim for above 1.2mmol/L, while men should aim for above 1mmol/L [2]. A healthy level of your ‘bad’ cholesterol, known as LDL or non-HDL, is considered to be below 3.0mmol/L.

Don’t be alarmed if you discover your cholesterol has increased since going through the menopause – menopause is associated with not only an increase in total cholesterol but, in particular, an increase in LDL and a decrease in HDL [4]. This is something you should discuss with your healthcare professional as there are actions you can take to help reduce your cholesterol level.

What else causes high cholesterol?

High cholesterol can be caused by eating fatty food, not exercising enough, being overweight, smoking and drinking alcohol.

However, even if you eat well, exercise and are a healthy weight, you can still have high cholesterol. This is because your family history and ethnic background can mean you’re more likely to develop high cholesterol – for instance, people from South Asian or sub-Saharan African origin have a higher risk of diseases of the heart and blood vessels.

Your general health can also affect your risk – some medical conditions and medications can impact your cholesterol.

Lifestyle changes to lower cholesterol

A combination of diet and lifestyle changes can help reduce cholesterol. Regular exercise will make your heart and blood circulatory system more efficient, lower your cholesterol level, and keep your blood pressure at a healthy level.

RELATED: the importance of exercise

As well as eating a well-balanced diet that includes your five-a-day, replacing saturated fat with unsaturated fat, eating more plant proteins and wholegrains, and less foods that are high in salt, fat and/or sugar, there are four types of foods that will help manage your cholesterol level. These are: soya foods; oats, barley and other soluble fibre-rich foods; nuts; and sterols and stanols.

Studies have shown that when 3-5g beta-glucan (a soluble fibre found in oats) is eaten daily, it can support cholesterol lowering in the range of 2-5%. Eating 25g per day of soya protein (found in soy-based products) as part of a low-fat diet has also been shown to lower cholesterol by 3-5% [3].

Sterols and stanols are the plant equivalent of cholesterol and many foods have been fortified with these. Taking 2-2.5g of plant sterols per day is thought to lower LDL cholesterol by an average of 10% within two to three weeks [4].

Treatments to lower cholesterol

As only about 20% of the cholesterol in your bloodstream comes from the food you eat (your body makes the rest), you may need to look beyond diet to manage your cholesterol levels.

Taking body-identical HRT usually lowers cholesterol – oestrogen can decrease LDL cholesterol and increase ‘good’ HDL cholesterol. By correcting the hormone deficiency and replacing the missing hormones, HRT helps to lower your risk of heart disease in future.

Statins can reduce your LDL cholesterol by around 30%, sometimes even 50% with high doses. Your clinician will be able to discuss the most suitable approach based on your personal situation.

References

1. NHS health survey for England 2021

2. Heart UK

3. Currie H., Williams C. (2008), ‘Menopause, Cholesterol and Cardiovascular Disease, US Cardiology; 5(1):12–4 USC Journal

4. Katan M.B., Grundy S.M., Jones P., Law M., Miettinen T. (2003), ‘Efficacy and safety of plant stanols and sterols in the management of blood cholesterol levels’, Mayo Clin Proc. 78(8):965-78. doi: 10.4065/78.8.965