How menopause affects cholesterol—and how to manage it

Dr Fiona MacRae, pictured, a specialist in integrative women’s health and bioidentical hormone balancing for the Marion Gluck Clinic  discusses how menopause affects cholesterol.

Menopause is a significant life transition for women, typically occurring between the ages of 45 and 55, marked by the end of menstrual cycles and a decline in oestrogen levels. Along with common symptoms like hot flashes, mood swings, and sleep disturbances, menopause also brings notable changes to cardiovascular health—specifically in how it impacts cholesterol levels. Understanding this relationship is crucial for women navigating menopause and healthcare providers aiming to offer effective management strategies.

 

The impact of menopause on cholesterol levels

Before menopause, women typically have lower cholesterol levels than men, largely due to the protective effects of oestrogen. Oestrogen plays a key role in maintaining healthy cholesterol by:

• Increasing high-density lipoprotein (HDL), or “good” cholesterol, which helps remove excess cholesterol from the bloodstream.
• Lowering low-density lipoprotein (LDL), or “bad” cholesterol, which can build up in the walls of arteries and lead to heart disease.

However, during menopause, declining oestrogen levels trigger significant changes in lipid metabolism, leading to:

1. Increased LDL Cholesterol: This build up raises the risk of cardiovascular diseases like heart attacks and strokes.
2. Decreased HDL Cholesterol: Alongside rising LDL, HDL cholesterol levels may decline, reducing the body’s ability to clear excess cholesterol from the blood.
3. Increased Triglycerides: Menopause is also associated with higher levels of triglycerides, another type of fat in the blood, which further heightens the risk of cardiovascular disease.

These changes make postmenopausal women more susceptible to cardiovascular conditions, and managing cholesterol becomes a priority for long-term health.

 

Managing cholesterol during and after menopause

Given the increased risk of heart disease associated with cholesterol changes during menopause, proactive management strategies are essential. Below are some ways this can be managed:

 

1. Healthy diet

Nutrition plays a crucial role in managing cholesterol. Adopting a heart-healthy diet can make a significant difference. Key recommendations include:

• Increase fiber intake: Foods rich in soluble fibre, such as oats, beans, lentils, and fruits, help lower LDL cholesterol.
• Healthy fats: Opt for unsaturated fats from sources like olive oil, avocados, and fatty fish (e.g., salmon, mackerel). These fats can increase HDL cholesterol while lowering LDL.
• Limit saturated and trans fats: Reduce consumption of foods high in saturated fats, such as red meat, full-fat dairy, and processed foods, which can elevate LDL cholesterol. Avoid trans fats entirely, as they raise LDL and lower HDL cholesterol.
• Plant sterols and stanols: These naturally occurring compounds, found in foods like fortified margarine and nuts, can help block the absorption of cholesterol in the gut.

 

2. Regular exercise

Physical activity is essential for maintaining healthy cholesterol levels. Aerobic exercises like walking, cycling, and swimming help lower LDL cholesterol while raising HDL levels. Strength training and flexibility exercises also contribute to overall heart health. The NHS recommends at least 150 minutes of moderate intensity exercise each week for adults.

 

3. Weight management

Weight gain is a common challenge during menopause, and excess weight can further increase LDL cholesterol levels. Maintaining a healthy weight through a balanced diet and regular physical activity is key to keeping cholesterol in check.

 

4. Medications and Hormone Replacement Therapy (BHRT)

For some women, lifestyle changes alone may not be enough to manage cholesterol. In such cases, medications like statins may be suggested to lower cholesterol levels. The decision to commence statins needs to be made only after careful assessment of an extended lipid panel which will assess the type of LDL particle most abundant in the circulation. Absolute LDL level is insufficient. Statins may have considerable adverse effects and are not the solution for everyone.

Bioidentical Hormone Replacement Therapy (BHRT) can be considered to alleviate menopausal symptoms and may have a beneficial effect on cholesterol levels. Studies show that HRT can help increase HDL cholesterol and lower LDL, although it is not specifically recommended for heart disease prevention. The decision to use HRT should be made after careful consultation with a healthcare provider, considering the risks and benefits.

 

5. Smoking cessation

Smoking lowers HDL cholesterol and damages blood vessels, accelerating the buildup of plaque in the arteries. Quitting smoking not only improves cholesterol levels but also significantly reduces the risk of heart disease.

 

6. Limit alcohol intake

Moderate alcohol consumption may have a positive effect on HDL cholesterol, but excessive drinking can raise triglyceride levels and contribute to weight gain. It’s best to limit alcohol to no more than one drink per day for women.

 

Monitoring cholesterol levels

Postmenopausal women should have their cholesterol levels checked regularly to monitor their risk of cardiovascular disease. A lipid panel measures total cholesterol, LDL, HDL, and triglycerides, helping healthcare providers tailor management strategies to each woman’s specific needs.

 

Conclusion

The onset of menopause brings numerous changes to a woman’s body, including a shift in cholesterol levels that increases the risk of cardiovascular disease. Understanding how menopause affects cholesterol and implementing lifestyle changes—such as a healthy diet, regular exercise, and weight management—can significantly improve cholesterol levels and overall heart health. For some women, medications or HRT may be necessary to maintain optimal cholesterol levels. By taking proactive steps and working closely with healthcare providers, women can effectively manage their cholesterol during menopause and protect their heart for years to come.

 

References:

• National Health Service (NHS): Guidelines on Physical Activity
• British Heart Foundation: Understanding Cholesterol and Heart Disease
• National Institutes of Health (NIH): Menopause and women’s cardiovascular health: is it really an obvious relationship?

 

About the Marion Gluck Clinic

https://www.mariongluckclinic.com/

The Marion Gluck Clinic is the UK’s leading medical clinic that pioneered the use of bioidentical hormones to treat menopause, perimenopause and other hormone related issues. Founded by Dr. Marion Gluck herself, the clinic uses her method of bioidentical hormonal treatment to rebalance hormones to improve wellbeing, quality of life and to slow down ageing.