Estrogen has a heart-protective effect, so when levels of this hormone decrease during menopause, your risk for heart disease and high cholesterol may increase. But lifestyle modifications can help maintain healthy levels.

Menopause is a natural life stage that occurs when a person with ovaries no longer menstruates for 1 year and a day. On average, this occurs at around 51 years of age.

Hormone shifts occur at this stage of life. Markedly, the ovaries produce less estrogen, and the overall levels of this reproductive hormone decline.

After menopause, health risks also change, including an increased risk for heart disease. The increased risk of heart disease is in part due to menopause’s effect on cholesterol levels.

Menopause can cause changes in hormones and metabolism, ultimately altering your lipid profile, which is a panel of blood tests that measure the fats in your blood.

This test can help determine risk factors for heart conditions and includes the following markers:

  • total cholesterol
  • high density lipoprotein (HDL), also known as good cholesterol
  • low density lipoprotein (LDL) cholesterol, also known as bad cholesterol
  • triglycerides

A high level of lipids, namely LDL cholesterol and triglycerides, can increase the risk of developing heart disease.

So, where does menopause fit into this? Turns out, estrogen — the sex hormone that fluctuates during this stage of life — has many heart-protective mechanisms.

What should my LDL level be?

The American Heart Association (AHA) asserts that the lower your LDL level is, the better. They suggest that 100 mg/dL is around optimal.

What the research says

Estrogen can help regulate lipid metabolism in your liver and maintain a healthy lipid profile.

But the beginning of menopause and the estrogen production decrease that follows can affect your body’s ability to maintain a healthy lipid profile. This can lead to increases in cholesterol.

An estrogen deficiency has also been associated with metabolic dysfunction-associated steatotic liver disease (previously nonalcoholic fatty liver disease).

A review of 66 studies found that postmenopausal people had higher LDL, total cholesterol, and triglyceride levels compared to premenopausal people. These higher levels increase the risk of heart disease and stroke.

Another observational study found similar results, except postmenopausal people also had lower HDL cholesterol, which can further elevate the risk of heart complications.

Keep in mind that observational studies can only find associations but can’t explain cause and effect — or why the associations exist. Their findings don’t always tell the full story compared to other types of studies.

Many lifestyle modifications or cholesterol-lowering medications can help you manage your cholesterol levels during menopause (and at any stage of life).

A note on lipoprotein A

While lifestyle largely contributes to your LDL levels, lipoprotein A, a component of LDL, is entirely determined by genetics. It’s an independent risk factor for heart disease but can still increase your risk for it during menopause when estrogen production slows.

Eat a balanced diet

Try to maintain a balanced diet and:

Soy protein may also improve cholesterol and LDL levels in postmenopausal people, and potentially even symptoms of menopause.

Get enough exercise

The AHA recommends at least 150 minutes of moderate-intensity aerobic activity and strength training at least 2 days per week.

Moderate-intensity aerobic activity includes any exercise that you can talk, but not quite sing, during. Brisk walking is a fantastic example.

If you’re new to exercise or can’t find the time to exercise for 150 minutes weekly, that’s OK. Focus on moving your body more in general. You can start parking further away from stores or taking the stairs.

Avoid smoking and alcohol

Smoking tobacco and heavy alcohol consumption (more than two drinks per day for women) are major risk factors for heart disease.

If you smoke and want to quit, speak with your doctor about your smoking cessation options. If you drink, try to limit your alcoholic beverages to no more than one per day or consider avoiding it altogether.

Ask your doctor about cholesterol-lowering medications

Consider speaking with your doctor about cholesterol-lowering medications, such as statins. These medications can help decrease your LDL cholesterol and increase your HDL cholesterol.

But if statins aren’t the best fit for you, you have several other options:

Can menopause cause high cholesterol?

Menopause does not cause high cholesterol, but it can increase your risk for it.

High cholesterol has multiple other risk factors, including:

Does cholesterol go down after menopause?

No, because estrogen levels are lower after menopause. Estrogen helps keep cholesterol low, so when estrogen levels go down, cholesterol levels may go up.

It’s important to focus on managing cholesterol levels through diet, lifestyle, and medications (if you take any or your doctor recommends them).

How can I lower my cholesterol during menopause?

Focus on eating more foods that are high in fiber and healthy fats. Incorporate an exercise routine if you don’t already have one. And if you smoke or drink, try to avoid it altogether.

During menopause, estrogen levels decrease. This is associated with increased cholesterol levels and heart disease because estrogen helps your body regulate cholesterol and other lipids.

Habits that can help lower your risk of heart disease after menopause include enjoying a balanced diet, maintaining an exercise routine, and avoiding smoking or drinking. Also consider asking your doctor about cholesterol-lowering drugs.

Keep in mind that menopause and reduced estrogen are just one of many risk factors for high cholesterol. Try to focus on what you can change.