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 perimenopause and 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’ (LDL) cholesterol in your blood. This is a type of cholesterol that can clog your arteries and increase your risk of heart attack, heart disease and stroke. During perimenopause, oestrogen levels fluctuate and during menopause, levels fall. The LDL cholesterol in your blood often rises during menopause and this can continue into old age, with 65% of women aged 65 and over having raised cholesterol compared to 48% of men [2].

RELATED: menopause and your heart

Understanding your cholesterol

There are usually no symptoms of raised cholesterol. You may have had your cholesterol checked as part of a health check or because of a medical indication.

When you get your cholesterol tested, you should be told the figure for your total cholesterol and also your HDL (“good”) cholesterol and LDL (“bad”) cholesterol – a healthy total level is often considered to be 5mmol/L or below. However, levels depend on your risk of heart disease and if you have had any heart problems before.

Your cholesterol may have increased since being perimenopausal or menopausal – as menopause is associated with an increase in total cholesterol and also an increase in LDL and a decrease in HDL cholesterol [3].

What else causes high cholesterol?

Lifestyle can play a role in cholesterol levels and is something that can be modified. For example, dietary choices can influence cholesterol, as can how much exercise you do, smoking, alcohol and maintaining a healthy weight.

However, even if you eat well, exercise and are a healthy weight, you can still have raised cholesterol. Your family history or your 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 developing raised cholesterol.

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

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, can 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 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 lead to LDL cholesterol lowering by 4.2% [4]. 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% [5].

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 [6].

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 [7]. Testosterone can also lower cholesterol levels [8]. By correcting the hormone deficiency and replacing the missing hormones, HRT also helps to lower your risk of heart disease in future.

Statins can reduce your LDL cholesterol [9]. Your clinician will be able to discuss the most suitable approach based on your personal situation.

Resources
Heart UK
British Heart Foundation

References

NHS health survey for England 2021
NHS health survey for England 2021
Ambikairajah A., Walsh E., Cherbuin N. (2019), ‘Lipid profile differences during menopause: a review with meta-analysis’, Menopause 26(11), p1327-1333. DOI: 10.1097/GME.0000000000001403
Amerizadeh A., Ghaheh H.S., Vaseghi G., Farajzadegan Z., Asgary S. (2023), ‘Effect of Oat (Avena sativa L.) Consumption on Lipid Profile With Focus on Triglycerides and High-density Lipoprotein Cholesterol (HDL-C): An Updated Systematic Review’, Curr Probl Cardiol, 48(7):101153. DOI: 10.1016/j.cpcardiol.2022.101153
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
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
Beazer J.D., Freeman D.J. (2022), ‘Estradiol and HDL Function in Women – A Partnership for Life’, J Clin Endocrinol Metab, 107(5):e2192-e2194. DOI: 10.1210/clinem/dgab811
Davis S.R., Azene Z.N., Tonkin A.M., Woods R.L., McNeil J.J., Islam R.M. (2024), ‘Higher testosterone is associated with higher HDL-cholesterol and lower triglyceride concentrations in older women: an observational study’, Climacteric. 27(3):282-288 DOI: 10.1080/13697137.2024.2310530
Feingold K.R. Cholesterol Lowering Drugs. [Updated 2024 Feb 12]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000. https://www.ncbi.nlm.nih.gov/books/NBK395573/