Whether your cholesterol levels have always been healthy or you’ve had high readings in the past, your next blood work results may surprise you. Declining estrogen during menopause can raise cholesterol levels. Some women have seen increases of 20 points or more. While elevated cholesterol is common during midlife, you shouldn’t ignore increases, even if they’re small. “Knowing your cholesterol levels can help you take meaningful action to improve your health,” says gynecologist Ghazaleh Moayedi, D.O. And the sooner you take steps to curb the rise, the lower your risk of a future heart attack or stroke will be.

High cholesterol is a key risk factor for heart disease, the leading killer of women. While cholesterol levels tend to rise as you get older, menopause can accelerate the increase. The incidence of high cholesterol in women is more than three times greater in those over 40 than in younger women. This spike coincides with menopause and declining estrogen levels that impact cholesterol. Men’s increase during this stage of life is only about 50 percent.

Why cholesterol increases at menopause

As with many menopause symptoms and side effects, hormones are part of the reason. “Estrogen is generally considered to have a cardioprotective effect, which means it can be beneficial to the heart and cardiovascular system,” says Dr. Moayedi. This is one of the reasons younger women are less likely to have heart attacks and develop heart disease later in life than men.

As estrogen starts to decline in perimenopause, women lose that protection. “The drop in estrogen from menopause leads to an increase in LDL cholesterol, a decrease in HDL cholesterol, and an increase in triglycerides,” says Dr. Moayedi. The longer your body is subjected to high levels of cholesterol, the more damage it can do to your arteries, increasing your risk of a heart attack or stroke. High triglycerides and low HDL cholesterol are also some of the hallmarks of poor metabolic health, which also increases your risk for diabetes. That’s why it’s essential to monitor your cholesterol levels regularly and take action as soon as your numbers start to go up.

How to lower cholesterol

While you can’t stop the effects of menopause on your body, or change your genetics, high cholesterol is treatable. “Lifestyle can strongly influence your cholesterol levels,” says Gennev health coach Monika Jacobson, a registered dietitian nutritionist. “Both nutrition and exercise can play a role in improving cholesterol with consistency over time.” Here are proven strategies to lower cholesterol, improve your metabolic health, and reduce your risk for heart disease, stroke, and diabetes.

Adopt a Mediterranean way of eating. “A diet primarily composed of fiber-rich carbohydrates, lean protein, and inclusive of healthy fats may help reduce cholesterol levels,” says Monika. “This balance of nutrients is best compared to the well-researched Mediterranean Diet, which is known to prevent cardiovascular disease. Many of the nutrition tips that follow align with the Mediterranean diet.

Up your soluble fiber intake. Soluble fiber latches onto cholesterol in your small intestines and escorts it out your body before being absorbed into your bloodstream, where it builds up as plaque in your arteries. Aim for at least 25 grams of fiber a day, but gradually increase your intake while drinking lots of water so it’s easier to digest. Foods high in soluble fiber include raspberries (8 grams in 1 cup), black beans (8 grams in ½ cup), a medium-sized apple with skin (5 grams), chopped broccoli (5 grams in 1 cup), and brown rice (4 grams in 1 cup).

Reduce saturated fats. Foods high in saturated fat include red meat, processed meats (hot dogs, bacon, and lunchmeat), butter, cheese, and ice cream. Too much saturated fat impairs your liver’s ability to process cholesterol, which builds up in your bloodstream and clogs your arteries. Instead, eat more fish, poultry, and low-fat dairy.

Choose healthy fats. Monounsaturated fats, found in olive oil, nuts, seeds, and avocados, lower the bad LDL cholesterol, and omega 3 fats are known to raise “good” HDL cholesterol levels. While healthy fats are key in heart health and help you to feel full faster, be mindful of portion size because they pack a lot of calories.

Cut back on refined carbohydrates. These include sweetened drinks, baked goods, candy, juice, white bread, pasta, and alcohol. When digested, these foods quickly break down into sugar, raising blood sugar and insulin levels which may adversely affect triglyceride and HDL levels.

Add soy protein. If you’re not already eating tofu, soybeans, soy nuts, or soy milk, add some to your diet. You can also try replacing more high saturated fat protein foods with plant-based soy foods. Soy foods contain isoflavones, a type of phytoestrogens, that have been shown to reduce cholesterol. They may also help ease other menopause symptoms like hot flashes.

Get moving. You can walk, run, swim, cycle, use the elliptical, take a Zumba class, play pickleball, or do any activity that gets your heart beating faster. Any cardio exercise can improve your cholesterol levels. The key is to do it most days of the week and accumulate at least 150 minutes (30 minutes five days a week or about 21 minutes daily). You don’t have to push yourself too hard. However, an hour a day of activity or higher intensity activities like fast walking or jogging, may provide better results.

Find a way to relax. One of the many detrimental effects stress has on your body is elevated cholesterol levels. Experts aren’t sure how stress increases cholesterol, but reducing stress can minimize the damage. Common relaxation strategies include meditation, yoga, and deep breathing, but they’re not the only ways to relax. For some, watching a movie, going out with friends, reading a book, working out, petting your dog or cat, or even cooking can reduce stress. Find what works for you and make it a regular part of your life.

Consider supplements. Omega 3 fatty acids are healthy fats found in fish, such as fatty fish like salmon, mackerel, and sardines, walnuts, and seeds like flax seeds and chia seeds. Research shows that they can lower triglycerides and raise good HDL cholesterol. If you’re not eating foods high in Omega 3s, you should talk to your doctor or a Gennev Dietitian to see if supplements might be right for you. Another supplement to speak with your doctor or healthcare provider about, especially if you have diabetes, is coenzyme Q10. CoQ10 is an antioxidant made in your body; however, levels decline as you age. Some research suggests that CoQ10 supplements may help lower LDL and total cholesterol in people with diabetes.

Start with as many strategies as you can manage. Even implementing one or two of them can have an impact as long as you do them consistently. Then retest your cholesterol in six months, or as soon as your doctor suggests.  

If your numbers aren’t improving as much or as quickly as you’d like, talk to your doctor or healthcare provider about other options, such as medication. Lifestyle changes aren’t always enough to lower cholesterol, especially if you have a family history of high cholesterol, certain medical conditions, or very high numbers. It’s worth the effort to find a way to bring down your cholesterol so you can live a longer, healthier life.

When you make some key lifestyle choices in menopause, it can have a lasting effect on your health as well as help to relieve symptoms. Gennev's integrated care provides access to experts in menopause lifestyle change management. They will help you to thrive through nutrition, fitness and mindfulness practices. Schedule a one-on-one virtual visit to get started with your personalized wellness plan.

The information on the Gennev site is never meant to replace the care of a qualified medical professional.  Hormonal shifts throughout menopause can prompt a lot of changes in your body, and simply assuming something is “just menopause” can leave you vulnerable to other possible causes. Always consult with your physician or schedule an appointment with one of Gennev's telemedicine doctors before beginning any new treatment or therapy.


Michele Stanten

February 1, 2023

Medically Reviewed By

Dr. Ghazaleh Moayedi

Dr. Moayedi is a Board Certified OB/GYN and subspecialist in Complex Family Planning.

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