What’s the Connection Between Menopause and High Cholesterol?

With all the other things that can increase around menopause—sweaty hot flashes, jolting sleep disruptions, general weepy-crankiness—your cholesterol levels can bump up as well. So if you've had blood work done and are surprised that your cholesterol numbers have changed, know that you’re definitely not alone.

Before menopause, women generally tend to have lower cholesterol levels than men. But if your levels start to rise during the menopause transition, it can be confusing—especially if you’re taking care of your health, and the higher numbers seem to have come out of nowhere.

While menopause can contribute to cholesterol changes—like higher LDL (“bad”) cholesterol—it's not the only reason your numbers may change. Your age, genetics, and overall health can affect your cholesterol over time, too. 

High cholesterol, though, is usually manageable. Let’s go over the link between menopause and high cholesterol, which numbers to pay attention to, and what you can do to support your heart health for years to come—plus how a Midi clinician can help.

Menopause and High Cholesterol: Why the Connection Matters in Midlife

Cholesterol can creep up into the high zone without you knowing it because unlike such menopause symptoms as hot flashes, you can’t feel it. That's one reason why it's important to know your numbers, especially in midlife. The risk of heart disease increases after menopause because several heart-health markers—including cholesterol—can change during those years.

Some important basics about cholesterol: It’s a waxy, fat-like substance that your body actually needs to build cells and make certain hormones. The two types you may have heard of:

• LDL (low-density lipoprotein), or "bad," cholesterol can build up in your arteries over time and increase the risk of heart attack and stroke. 
• HDL (high-density lipoprotein), or "good" cholesterol, helps remove excess cholesterol from your bloodstream.

Research suggests that LDL cholesterol often starts to rise during the menopause transition—even before you've officially reached menopause. HDL cholesterol levels may stay about the same, but it becomes less protective. Total cholesterol can also rise in this period. Other heart-health markers, like triglycerides (a type of fat in the blood) and blood pressure, may shift as well.

All of this means that midlife is an important time to check your baseline cholesterol numbers and pay close attention to your heart health.

Can Menopause Cause High Cholesterol?

Yes, menopause can contribute to higher cholesterol—but it's rarely the only reason your cholesterol changes. Studies have found that postmenopausal women (compared with premenopausal) tend to have higher total cholesterol, LDL cholesterol, triglycerides, and lipoprotein(a). This is another type of fat in your blood linked to heart disease, and although 80-90% of lipoprotein(a) is genetically determined, menopause is one of the few times where it may increase. 

Along with aging and genetics, other factors that have an effect are body weight and lifestyle factors, such as your eating habits, physical activity, amount of sleep, and stress. 

Even if you eat well and exercise regularly, your cholesterol levels may still increase in midlife. That’s one more reason to get regular cholesterol checks, so you can spot changes early and know whether they need to be addressed.

The Estrogen and Cholesterol Relationship

So, what does estrogen have to do with your cholesterol? Quite a bit, actually. 

Before menopause, estrogen helps your body maintain more favorable cholesterol levels. Here’s how: 

• Estrogen plays an important role in how your liver processes cholesterol. 
• This may keep LDL cholesterol in check while letting HDL cholesterol clear excess cholesterol from your arteries. 
• It also supports healthy blood vessel function, keeping your arteries flexible so blood can flow more easily. 

As estrogen declines during the menopause transition, that balance starts to shift: 

• LDL cholesterol often rises. 
• Blood vessels may become less flexible, which can contribute to higher blood pressure and, eventually, to a build-up of LDL particles. 
• Your body composition also may change, with less muscle and more fat around the midsection. As this visceral fat around your midline increases, cholesterol and triglycerides levels tend to rise.

While hormone therapy may improve cholesterol for some women, it isn't recommended solely to lower cholesterol.

Cholesterol Numbers to Know During Menopause 

A clinician can check your cholesterol with a simple blood test called a lipid panel. It measures several markers, and looking at them together can give you and your healthcare professional a more complete picture of your heart health. Here’s how you can decipher all those numbers:

• Total cholesterol: This is the total amount of cholesterol in your blood. A healthy level is generally below 200 milligrams per deciliter (mg/dL).
• LDL cholesterol: High LDL can increase your risk of heart disease. An LDL level below 100 mg/dL is optimal for most adults, but your personal goal may differ, depending on your overall health and risk factors.
• HDL cholesterol: Higher HDL, or “good,” cholesterol levels, are generally associated with better heart health. For women, an HDL level of 50 mg/dL or higher is typically considered ideal, and levels over 60 mg/dL are associated with lower cardiovascular risk. 
• Triglycerides: Triglycerides are a type of fat in your blood that can increase heart disease risk, especially alongside high LDL or low HDL. A level below 150 mg/dL is considered healthiest. 

Remember, these are general targets. A healthcare professional, like one of the menopause-trained clinicians at Midi, can help you make sense of your cholesterol test results. Depending on your personal or family history, they may also look at non-HDL cholesterol or order an apolipoprotein B (ApoB) test to learn more about your cholesterol levels. 

Your clinician may also keep an eye on your blood pressure, blood sugar, and weight, since changes in these areas also affect your overall cardiovascular health.

High Cholesterol and Menopause: Risk Factors That Can Add Up

Some risk factors for high cholesterol are out of your control, while others you can manage:

• Family history: If your relatives had or have high cholesterol or heart disease, it can up your risk. You can't change your genetics, but knowing your family history can help you know how closely to monitor your cholesterol.
• Smoking or vaping: Smoking damages blood vessels, raises LDL cholesterol, and increases the risk of heart disease.
• High blood pressure: High blood pressure and high cholesterol often occur together, increasing the strain on your arteries over time.
• Diabetes or insulin resistance: High blood sugar can raise bad cholesterol levels and lower good cholesterol levels. 
• Weight gain around your abdomen: During perimenopause and menopause, many women notice more weight around their midsection, even if the number on the scale doesn't change much. This shift in body composition can increase the risk of heart disease, type 2 diabetes, and other cardiovascular issues.
• A history of pregnancy-related conditions: If you experienced preeclampsia or gestational diabetes during a pregnancy, you have a higher risk of heart disease later in life.

These risk factors don’t mean you'll definitely develop heart disease. But in your conversations with your clinician about heart health, it’s best to talk over each one.

How to Lower Cholesterol During Menopause

You may be able to lower your cholesterol during menopause—and at any stage of life—by making some important health shifts. The key is focusing on small, sustainable changes that can add up over time.

1. Eat a heart-healthy diet

Focus on balanced, nutrient-rich meals that emphasize complex carbs, lean proteins, healthy fats, and fiber. Eating foods high in soluble fiber––like oats, beans, lentils, fruits, and vegetables––has been shown to lower LDL cholesterol. 

It also helps to swap out some sources of saturated fat—like red meat, butter, full-fat dairy, and heavily processed foods—for unsaturated fats from foods like olive oil, avocados, nuts, seeds, and fatty fish. These changes can support healthier cholesterol levels over time.

The Mediterranean diet, for example, has been linked to improvements in cholesterol, triglycerides, blood pressure, and insulin resistance.

2. Move your body

Regular exercise helps your heart and blood vessels work more efficiently and can improve cholesterol levels before and after menopause. It can also preserve muscle mass and help you maintain a healthy weight.

Experts recommend aiming for at least 150 minutes of moderate aerobic exercise and 2 strength-training workouts each week. You can work your way up to those goals, and break up the time any way you want to. 

3. Be mindful of smoking and drinking alcohol 

If you smoke, quitting is one of the best things you can do for your heart. In fact, HDL cholesterol may start to improve within just a few weeks. If you drink alcohol, it's a good health move to keep it in moderation (which, for women, is defined as 1 drink or less per day).

4. Prioritize sleep

Getting enough quality sleep supports your cardiovascular health and is linked to a lower risk of high cholesterol. Aim for 7 to 9 hours of sleep per night, try to stick to a regular sleep schedule, keep your bedroom cool and dark, and avoid screens before bed whenever you can.

If menopause symptoms like hot flashes or night sweats are getting in the way of a good night’s sleep, talk with your clinician about options for easing those disruptions.

When Lifestyle Changes Are Not Enough

Lifestyle shifts can go a long way toward managing menopause and high cholesterol, but sometimes they aren’t enough. If your cholesterol stays elevated despite healthy habits like eating well and getting regular exercise, your hormones and individual genetics may be making it harder.

In those cases, medication may be part of the plan. Statins, for example, are the most commonly prescribed medications for high cholesterol. They work by helping your liver make less cholesterol, which can lower LDL cholesterol.

A clinician will review your cholesterol numbers to help guide treatment recommendations. They'll also consider factors such as your age, blood pressure, diabetes, smoking status, and family history to assess your overall risk of heart disease. 

What About HRT and Cholesterol?

If you're considering hormone replacement therapy (HRT, now commonly referred to as menopausal hormonal therapy, or MHT), you may be wondering whether it has an effect on your cholesterol.

HRT restores some of the estrogen—and sometimes progesterone—that declines during the menopause transition. It's available as pills, patches, creams, gels and vaginal rings. It's considered the most effective treatment for menopause symptoms like hot flashes, night sweats, and vaginal dryness, but isn’t typically prescribed as a standalone treatment to lower cholesterol or prevent heart disease. 

That said, hormone therapy can affect cholesterol in different ways. Studies suggest that oral HRT may lower LDL cholesterol more than patches, gels, or sprays. But it may also be more likely to increase triglycerides. 

This underlines the importance of talking about your specific heart risks with a menopause-trained clinician, like experts at Midi. The best treatment plan is one that’s individualized to you. 

Testing, Diagnosis, and Follow-Up

Your clinician can use the results of your lipid panel—along with your medical history and other heart health risk factors—to help you decide on next steps. 

If menopause is also part of the picture, it’s generally diagnosed based on your symptoms and menstrual history. Hormone tests aren't usually necessary for most women—and because hormone levels fluctuate throughout the menopause transition, those tests are often not helpful.

Talk with your clinician about how often you should have your cholesterol checked. For higher-risk patients, a healthcare professional may suggest a referral to a cardiologist.

How Midi Can Support Menopause and Heart Health Conversations

A Midi clinician can be a big help in making sure you have a heart-healthy plan during the menopause transition. They can: 

• review your symptoms, health history, and cholesterol numbers to help you understand the bigger picture
• talk through whether additional lab work or screenings make sense for you 
• discuss hormone therapy and non-hormonal treatment options if menopause symptoms are disrupting your daily life 
• coordinate with your primary care professional or refer you to a specialist if you need additional care

The goal is to help you feel informed, supported, and empowered to keep your cholesterol and heart health in check during menopause and beyond. 

Key Takeaways 

• Menopause can contribute to higher cholesterol, but it's usually only one piece of the puzzle. Aging, genetics, and lifestyle factors all play a role in your cholesterol and heart health.
• Hormonal changes during the menopause transition can affect the way your body processes cholesterol. As estrogen declines, LDL (or “bad”) cholesterol often rises, while HDL (“good”) cholesterol is no longer as protective of your heart as it once was.
• Healthy habits can help support healthy cholesterol levels in midlife. Some women also benefit from cholesterol-lowering medication, like a statin, depending on their overall health and risk of heart disease.
• Hormone therapy may improve some cholesterol markers, but it's prescribed to treat menopause symptoms, not high cholesterol or heart disease.
• A healthcare professional, like one of Midi's clinicians, can help you understand your results, decide how often you should be tested, and create a treatment plan that's right for you.

Frequently Asked Questions

Can perimenopause affect cholesterol before menopause?

Yes, hormonal changes during perimenopause can affect your cholesterol before you reach menopause. As estrogen declines during those years, LDL (“bad”) cholesterol often starts to increase.  

What cholesterol level is considered high after menopause?

The definition of high cholesterol doesn't change after menopause. Generally, an LDL cholesterol level of 100 mg/dL or lower is considered optimal. A healthcare professional can review your results, explain what they mean, and recommend treatment options.

Can menopause increase triglycerides, too?

Yes. Triglycerides can increase during the menopause transition, but hormones aren't the only factor. Diet, alcohol intake, weight, and insulin resistance can all affect your triglyceride levels.

Does belly fat after menopause affect cholesterol?

It can. Many women notice more fat around their midsection during menopause, thanks in part to hormone changes. This shift is linked to higher cholesterol and an increased risk of heart disease.

Should I see a cardiologist for high cholesterol after menopause?

A primary care professional or menopause-trained clinician can help you monitor and manage your cholesterol. But if you have very high cholesterol, a history of heart disease, or other heart disease risk factors, you may be referred to a cardiologist.

Does stress or your mood impact cholesterol levels in menopause?

Stress hormones can have an impact on cholesterol. Chronic stress can boost your levels of cortisol and other stress hormones, and this can increase cholesterol and triglycerides your liver produces. Cortisol can also contribute to both insulin resistance and fat accumulation in the abdomen, both of which can worsen cholesterol levels. So finding ways to lower your stress levels can play a minor role in improving your cholesterol.