Does Menopause Change Cholesterol Levels? 

When you think about menopause, symptoms like hot flashes, poor sleep, night sweats, and mood changes might come to mind. Another complication that frequently occurs around menopause that you might not consider is high cholesterol. High cholesterol is a risk factor for cardiovascular disease, the leading cause of death in women after menopause.¹  

Declining estrogen levels during menopause is the big culprit here. Among its heart-protective benefits, estrogen can help: 

• Relax and widen blood vessels, improving blood flow and reducing the workload on your heart. 
• Maintain a healthy cholesterol profile, reducing the buildup of fatty plaque in your arteries. 
• Neutralize harmful free radicals, which can damage cells and contribute to the development of heart disease.  
• Reduce inflammation in blood vessels and heart tissue. 

Lower estrogen levels, along with other hormonal shifts during menopause such as progesterone and testosterone, can impact your entire lipid profile, leading to high cholesterol and more. 

Your Lipid Profile: Cholesterol, Triglycerides, and More 

When your healthcare practitioner does your bloodwork, they will include a lipid panel. Lipids are fats stored in your body. These fats provide energy, protect your organs, and make sure things work smoothly. Your body maintains a balance of lipids, including cholesterol and triglycerides. Your overall lipid profile determines the levels of these fats in your bloodstream.  

A lipid profile typically includes: 

• Total cholesterol 
• High-density lipoprotein (HDL) 
• Low-density lipoprotein (LDL) 
• Triglycerides 

To understand why these shifts in your lipid profile occur, let’s briefly look at each of these more closely. 

Total Cholesterol 

Total cholesterol refers to the amount of cholesterol in your blood. Cholesterol is a waxy, fat-like substance found in the bloodstream and in every cell of your body. Much of the stigma surrounding cholesterol lingers from decades ago, when a scientist named Ancel Keys argued that too much dietary fat raises cholesterol levels, which leads to heart disease.  

The demonization of cholesterol rests on flawed science. Today, we know that dietary cholesterol doesn't have much impact on blood cholesterol.² In fact, animal foods higher in cholesterol (such as eggs) also provide nutrients like choline, which helps your liver break down cholesterol.  

If you don’t get cholesterol in your diet, your liver will create it. Why? Because your body needs cholesterol to make testosterone, estrogen, progesterone, and other hormones. It helps form the outer layer of your cells.  

Cholesterol helps produce nutrients, including your body’s production of vitamin D from sunlight. Overall low cholesterol is all-around bad news for your health, contributing to PMS, low libido, depression, and more.³ 

Triglycerides 

Triglycerides are a storage form of fat. When you eat, your body takes the extra calories you don’t immediately need and turns them into triglycerides, which then get stored in fat cells.

When your body needs energy—say, after an overnight fast before you’ve had breakfast—it can remove those triglycerides from fat cells, break them down, and use them as fuel. Too many triglycerides, however, can start to build up and make it harder for your blood to flow properly to your heart.  

HDL and LDL Cholesterol  

Just like water and oil don’t mix, fats like cholesterol and triglycerides can't move freely in your bloodstream. They need carrier molecules, called lipoproteins, to transport them safely to cells and other areas where the body needs them. Two primary lipoproteins, called high-density lipoprotein (HDL) and low-density lipoprotein (LDL), are carriers for cholesterol and triglycerides. 

HDL collects extra fats floating around in your blood vessels and takes them back to the liver, where they can be processed and eliminated. LDL, on the other hand, drops fat into your blood vessels. Too many deposits mean that those fats can build up and potentially form blockages, restricting blood flow to your heart.  

Traditionally, LDL was considered “bad” and HDL was “good.” But newer research shows that the size and amount of the cholesterol particles are more important than your overall cholesterol numbers (regardless of whether those particles are found in HDL or LDL cholesterol). 

When it comes to size, there are big, fluffy molecules that don’t do a lot of damage (think of these molecules as cotton candy). Then there are small, dense molecules that create harm (think of those like BB pellets).⁴  

“The large, fluffy subtype of LDL is associated with much lower heart-disease risk than small, dense LDL,” says Jonny Bowden, PhD. “These subtypes of LDL—combined with the total number of LDL particles hanging out in our blood—are far more interesting to us than the total cholesterol content measured by standard cholesterol tests.”⁵  

How do you know which type you have? Ask your healthcare practitioner for a particle size test with your lab work.  

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Why Do Cholesterol Levels Increase Around Menopause? 

When estrogen levels go down, other hormones quickly follow, and your entire lipid profile can shift. Your total cholesterol, LDL, and triglycerides may increase, while HDL can decrease.⁶ To be fair, menopause does not cause high cholesterol, but it can increase your risk of high lipid levels. Along with estrogen and other hormonal shifts, these five factors that occur during menopause contribute to fluctuating lipid levels.  

1. Weight Gain 

Researchers estimate that women gain 5-8% of their baseline body weight during menopause. That means if you weigh 150 pounds, on average you will gain 7.5 pounds in the two years after your final period.⁷ 

Why do many women gain weight during menopause? Because lower estrogen levels mean that fat can more easily be stored in your abdominal area. This dangerous fat, called visceral fat, can increase cholesterol levels and create other metabolic issues. 

2. Insulin Resistance 

One of estrogen’s roles is to maintain healthy blood-sugar levels. When estrogen levels decline during menopause, insulin resistance becomes more common. Insulin is a hormone that helps regulate blood-sugar levels. When the body becomes resistant to insulin, it can lead to higher blood sugar, increasing LDL and triglycerides. 

Research shows that insulin resistance can also contribute to menopausal symptoms like hot flashes.⁸ 

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3. Liver Burden 

Your liver metabolizes cholesterol and other lipids, helping make and eliminate excess amounts. Estrogen protects your liver by promoting the breakdown and removal of LDL from the bloodstream.  

When estrogen levels decrease during menopause, the liver works harder to remove excess LDL cholesterol, which can lead to an imbalance in cholesterol levels. Hormonal changes during menopause can also impact the liver's role in metabolizing triglycerides and other lipids. 

Liver health becomes critical for other reasons, too. After menopause, you have a higher risk for developing non-alcoholic fatty liver disease (NAFLD), where excess fat builds up in your liver. Estrogen deficiency makes you much more susceptible to developing a fatty liver.⁹ 

4. Thyroid Dysfunction 

Thyroid hormones, primarily thyroxine (T4) and triiodothyronine (T3), help regulate your body's metabolism. Those hormones influence cholesterol-managing organs, such as your liver.  

Menopause can trigger or exacerbate hypothyroidism, a condition where the thyroid gland doesn't produce enough thyroid hormones. Because your body's metabolic rate slows down, your body may not clear cholesterol from your bloodstream as easily and LDL levels increase.  

Other issues here, including insulin resistance and weight gain, frequently accompany hypothyroidism. ¹⁰ 

5. Muscle Loss 

Muscle plays a crucial role in regulating various metabolic processes, including how your body handles cholesterol. Muscle is a metabolically active organ, regulating lipid levels. It can utilize fatty acids for energy, for one, helping balance triglyceride levels. Losing muscle, then, can impact your body's cholesterol metabolism.  

One study found that lower muscle mass could adversely impact your lipid profile. Conversely, preventing muscle loss can help your body better manage LDL cholesterol.¹¹  

These and other changes during menopause can impact your lipid profile, increasing LDL cholesterol and triglycerides while lowering HDL cholesterol. 

A Holistic Approach to Navigating Heart Health in Menopause 

I mentioned earlier that high cholesterol is a risk factor for cardiovascular disease. But there are other contributors, including type 2 diabetes, an unhealthy weight, and lack of physical activity.¹² While maintaining a healthy lipid profile is important, the bigger picture includes being mindful about other risk factors, including chronic inflammation and high blood sugar. 

Menopause significantly increases your risk of metabolic syndrome.¹³ This dangerous conglomerate of problems—including weight gain, blood-sugar imbalances, chronic inflammation, and high triglycerides—dramatically increases your risk of heart disease, diabetes, liver problems, and early death. 

Yes, high cholesterol can be a problem around menopause, but metabolic syndrome is the bigger, and ultimately far more damaging, issue. These four strategies can normalize cholesterol levels, reduce your risk of metabolic syndrome, and help manage menopausal symptoms like hot flashes.  

1. Eat by the Plate 

A high-sugar-impact diet with bad fats increases the small, dense, artery-damaging cholesterol particles and lowers the number of big fluffy harmless ones. A low-sugar-impact diet has the opposite effect, supporting healthy cholesterol levels.¹⁴ But it’s not just your lipid profile that falls out of favor; sugar contributes to all the problems of metabolic syndrome, including diabetes and obesity.¹⁵ 

The remedy? Take a protein-first approach to every meal. Optimal protein helps stabilize your lipid profile, balance blood sugar, support your metabolism, and help you stay at your goal weight. 

Eating by the plate with the magic trifecta of protein, healthy fats, and fiber ensures that you’re getting protein along with other lipid-normalizing nutrients, including sufficient fiber.

Fiber acts like a broom through your digestive system, sweeping and eliminating extra cholesterol so less gets absorbed into your bloodstream.

Research shows that getting optimal amounts of fiber—especially soluble fiber—could reduce total and low-density lipoprotein cholesterol levels about 5-10%.¹⁶ 

2. Strength Training 

Low muscle mass is a risk factor for insulin resistance, which can increase LDL cholesterol and triglycerides while lowering HDL cholesterol.¹⁷

Conversely, strength training can improve your overall lipid profile by lowering inflammation, decreasing total cholesterol, triglycerides and LDL, while improving HDL. Strength training can also improve hormones like adiponectin. This hormone’s anti-inflammatory and antioxidant benefits help regulate blood sugar levels and lipid metabolism.¹⁸ 

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3. Quality Sleep 

Poor sleep isn’t doing you any favors around menopause, and your lipid profile isn’t going to look good either. Quality sleep helps manage inflammation, balance hormones, improve insulin sensitivity, and support the body’s stress-management abilities—all of which impact your lipid profile. As a result, sleep deprivation can increase cholesterol levels in your blood, which can eventually burden your liver. ¹⁹ To remedy that, you’ll want to get at least seven and preferably more like nine hours of quality, uninterrupted sleep every single night.  

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4. Stress Management 

Research shows that psychological stress can be a risk factor for lipid disorders, including high cholesterol and triglycerides. (The study noted that regular physical activity, on the other hand, could support healthy lipid levels.)²⁰ You can’t avoid stress, but you can learn to better manage it so that it doesn’t overpower your life.  

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Managing Your Metabolic Health During Menopause  

Healthy lipid levels are important for heart health and so much more around menopause, but other factors—including blood-sugar balance and managing inflammation—can also significantly impact your cardiovascular and overall health. Yes, cholesterol levels are important, but you’ll also want to maintain your overall metabolic health. You have plenty of control over that by the food and lifestyle choices you make daily.  

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References:  

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

2. Harvard: Cholesterol | The Nutrition Source 

3. Blum, Esther. See ya later, Ovulator!: Mastering Menopause with Nutrition, Hormones, and Self-Advocacy (p. 145). Hybrid Global Publishing. Kindle Edition. 

4. Masley M.D, Steven, Bowden, Jonny, PhD. Smart Fat. HarperCollins. Kindle Edition. 

5. Bowden, Jonny; Sears, Barry; Cole, Will. Living Low Carb. Revised & Updated Edition (p. 179). Union Square & Co.. Kindle Edition. 

6. Healthline: How Does Menopause Affect Cholesterol Levels? 

7. Right As Rain by UW Medicine: Weight Gain During Menopause 

8. Tuomikoski P, Ylikorkala O, Mikkola TS. Menopausal hot flashes and insulin resistance. Menopause. 2012 Oct;19(10):1116-20. doi: 10.1097/gme.0b013e3182503d5d. PMID: 22668816. 

9. Blum, Esther. See ya later, Ovulator!: Mastering Menopause with Nutrition, Hormones, and Self-Advocacy (p. 144). Hybrid Global Publishing. Kindle Edition. 

10. Gierach M, Gierach J, Junik R. Insulin resistance and thyroid disorders. Endokrynol Pol. 2014;65(1):70-6. doi: 10.5603/EP.2014.0010. PMID: 24549605. 

11. Lee JH, Lee HS, Cho AR, Lee YJ, Kwon YJ. Relationship between muscle mass index and LDL cholesterol target levels: Analysis of two studies of the Korean population. Atherosclerosis. 2021 May;325:1-7. doi: 10.1016/j.atherosclerosis.2021.01.016. Epub 2021 Jan 31. PMID: 33857762. 

12. Prabakaran S, Schwartz A, Lundberg G. Cardiovascular risk in menopausal women and our evolving understanding of menopausal hormone therapy: risks, benefits, and current guidelines for use. Ther Adv Endocrinol Metab. 2021 Apr 30;12:20420188211013917. doi: 10.1177/20420188211013917. PMID: 34104397; PMCID: PMC8111523. 

13. Jeong HG, Park H. Metabolic Disorders in Menopause. Metabolites. 2022 Oct 8;12(10):954. doi: 10.3390/metabo12100954. PMID: 36295856; PMCID: PMC9606939. 

14. Masley M.D, Steven,Bowden, Jonny, PhD. Smart Fat. HarperCollins. Kindle Edition. 

15. Stanhope KL. Sugar consumption, metabolic disease and obesity: The state of the controversy. Crit Rev Clin Lab Sci. 2016;53(1):52-67. doi: 10.3109/10408363.2015.1084990. Epub 2015 Sep 17. PMID: 26376619; PMCID: PMC4822166. 

16. Surampudi P, Enkhmaa B, Anuurad E, Berglund L. Lipid Lowering with Soluble Dietary Fiber. Curr Atheroscler Rep. 2016 Dec;18(12):75. doi: 10.1007/s11883-016-0624-z. PMID: 27807734. 

17. Blum, Esther. See ya later, Ovulator!: Mastering Menopause with Nutrition, Hormones, and Self-Advocacy (p. 145). Hybrid Global Publishing. Kindle Edition. 

18. Costa RR, Buttelli ACK, Vieira AF, Coconcelli L, Magalhães RL, Delevatti RS, Kruel LFM. Effect of Strength Training on Lipid and Inflammatory Outcomes: Systematic Review With Meta-Analysis and Meta-Regression. J Phys Act Health. 2019 Jun 1;16(6):477-491. doi: 10.1123/jpah.2018-0317. Epub 2019 Apr 25. PMID: 31023184. 

19. Xing C, Huang X, Zhang Y, Zhang C, Wang W, Wu L, Ding M, Zhang M, Song L. Sleep Disturbance Induces Increased Cholesterol Level by NR1D1 Mediated CYP7A1 Inhibition. Front Genet. 2020 Dec 23;11:610496. doi: 10.3389/fgene.2020.610496. PMID: 33424933; PMCID: PMC7793681. 

20. Assadi SN. What are the effects of psychological stress and physical work on blood lipid profiles? Medicine (Baltimore). 2017 May;96(18):e6816. doi: 10.1097/MD.0000000000006816. PMID: 28471984; PMCID: PMC5419930. 

*These statements have not been evaluated by the Food & Drug Administration. Products mentioned are not intended to diagnose, treat, cure, or prevent any disease. The views in this blog by JJ Virgin should never be used as a substitute for professional medical advice. Please work with a healthcare practitioner concerning any medical problem or concern.