When we consider the impacts of menopause, we tend to focus on the acute — symptoms that can impact our day to day functioning like hot flashes, insomnia, and anxiety. And while it’s important to address these symptoms, we also can’t lose sight of the longer-term health changes associated with midlife, including increased risk of heart disease.
One of the key ways this higher risk manifests is through changes in cholesterol levels. We’re taking a look at the science behind cholesterol changes in menopause, and what we can do.
Okay, what is cholesterol?
Blood cholesterol is a waxy substance that exists throughout our body and is used in the production of cells, vitamins, and hormones. As a lipid, cholesterol doesn’t dissolve in water, which means it doesn’t dissolve in our blood. Rather, it circulates throughout our bloodstream, a so-called highway system that allows cholesterol to reach different areas in our body so that it can perform essential functions. Doesn’t sound bad, does it?
Well, yes and no. Cholesterol isn’t inherently bad — in fact, it’s necessary for bodily functioning. However, too-high cholesterol contributes to risk of cardiovascular disease, such as heart disease and stroke. To really understand the nuanced role of this compound, we need to break down the two different types of cholesterol:
1. LDL cholesterol
Also known as “bad” cholesterol, LDL cholesterol refers to low-density lipoproteins — particles that, when combined with other substances circulating in our blood, can coat our artery walls, causing buildup, aka atherosclerosis. Over time, these fatty deposits called “plaques” narrow the width of our arteries, which can reduce blood flow to certain body parts such as our heart, brain, and kidneys. These plaques can also rupture in the artery, causing blood clots and blockages. High levels of LDL cholesterol can increase our risk of heart disease, stroke, and heart attack.
2. HDL cholesterol
You may have heard HDL, conversely, referred to as “good cholesterol.” These high-density lipoproteins remove excess LDL cholesterol from our bloodstream and transport it to the liver, where it’s broken down and removed from the body. High levels of HDL may help protect us from heart disease.
3. Triglycerides
Triglycerides are a type of fat found in your blood. They act as the major source of energy used and stored by our bodies. When we consume more calories than our bodies need, the liver converts excess calories into triglycerides and stores them in fat cells in your body. While we need them, excessively high levels of triglycerides can increase our cardiovascular disease risk.
We often talk about triglycerides in connection with cholesterol because they are both lipids, but cholesterol is not a true fat because of its chemical structure. (Confusing, we know!) Like LDL, having high levels of triglycerides usually does not result in any symptoms — and the only way to know your levels are elevated is by a blood test.
How does menopause impact cholesterol?
While further research is needed (as with many areas of women’s health), studies suggest that there is an association between postmenopause status and total/LDL cholesterol levels. Prior to menopause, LDL is lower and HDL is higher in women compared to men of the same age. After menopause, women have a rise in their LDL cholesterol, often exceeding men of the same age. Why does this occur? Like many things menopause-related, it may come down to estrogen.
This sex hormone — which influences a whole host of menopause symptoms from hot flashes to vaginal dryness — also happens to have heart-protective properties. Specifically, it plays a role in supporting lipid metabolism — the process by which fats are broken down, synthesized, and stored for energy. Or, as we discussed earlier, used as building materials for cells. As estrogen levels decrease throughout the menopause transition, so too do its cardioprotective abilities.
How do I know if I have high cholesterol?
There are typically no symptoms of high cholesterol, which makes preventive screenings super important. The most common cholesterol screening is a “lipoprotein profile” — or lipid profile — which measures for levels of HDL cholesterol and LDL. Clinicians use these measures to get a total-cholesterol-to-HDL ratio, which is used to assess metabolic and cardiovascular risk. Cholesterol is also measured in milligrams per dL, and ideally the HDL measurement stays above 60 mg/dL, and LDL stays below 100 mg/dL.
This profile also measures the amount of triglycerides, or fat, in our blood, which we know poses cardiovascular risk at too high levels. Usually, less than 150 mg/dL is considered healthy.
The American Heart Association (AHA) recommends these tests every five years between the ages of 20-45 for women, then annually with frequencies adjusted based on risk factors.
What can I do to keep my cholesterol levels healthy?
Our cholesterol levels are influenced by several lifestyle factors including diet, exercise, alcohol consumption, and smoking. Family history and ethnic background can also play a role, with certain ethnic groups being predisposed to heart disease risk. The good news is, no matter our family history or menopause status, there are things we can do to maintain healthy cholesterol levels.
No matter our family history or menopause status, there are things we can do to maintain healthy cholesterol levels.
Maintaining a healthy diet
At Elektra, we’re huge fans of the Mediterranean diet, which prioritizes plant-based food sources, whole grains, and healthy fats — with very little if any red meat, fried foods, and high-fat dairy products — making it naturally low-cholesterol and ideal for women’s health during this time.
Prioritizing exercise
Exercise is important for our overall and cardiovascular health, and is shown to increase HDL cholesterol (aka “good cholesterol”), which helps control and offset LDL cholesterol (aka “bad cholesterol”). The AHA recommends at least 150 minutes per week of moderate-intensity physical activity a week. Resistance training for at least 30 minutes twice a week also can help improve cardiovascular health.
Avoiding smoking
Smoking is a major risk factor for heart disease, among other illnesses. Vapors in cigarette smoke are shown to lower HDL and increase LDL cholesterol, damage blood vessels and arteries, and increase chances of blood clots. The CDC can be helpful in finding resources for smoking cessation.
Medication options for high cholesterol
While lifestyle changes are typically the first step in addressing high cholesterol, only about 20% of cholesterol in the bloodstream comes from food — the rest is produced in the body. For this reason, medication treatments can be a good option.
Statins
Statins are a common type of drug used to lower cholesterol that — for people with an increased risk of CVD — can reduce our risk of heart attack or stroke by 20-30%. They work by blocking production of the enzyme HMG-CoA reductase, which reduces the liver’s ability to make LDL cholesterol, thus lowering the amount of lipid circulating in our bloodstream.
What about menopause hormone therapy?
As we mentioned earlier, decreasing estrogen levels may have something to do with increased cholesterol in peri- and postmenopausal women, which can increase our risk of heart disease. So, can estrogen hormone therapy treat high cholesterol?
Menopausal hormone therapy (previously referred to as hormone replacement therapy or HRT) isn’t recommended as a first-line treatment for high cholesterol. However, some research shows that some women who begin MHT within ten years of menopause may experience a reduced risk of cardiovascular disease, meaning it may offer heart health protection as an added benefit.
However, there are important nuances to discuss with a healthcare provider around the type of MHT prescribed — oral estrogens, for example, have beneficial effects on HDL-C and LDL-C cholesterol but can cause an increase in triglyceride levels, while transdermal/topical estrogens do not increase triglycerides but also do not have beneficial effects on HDL-C. There are also differences with progestogens: some reduce the beneficial effects that oral estrogens have on HDL-C while others are more neutral.
What about supplements?
While the research on supplements for cholesterol is limited, we do know that omega-3 fatty acids are important for many aspects of cardiovascular health and may help with high blood pressure and cholesterol levels.
The bottom line
Menopause is associated with increased risk of heart disease, higher cholesterol, and triglyceride levels, due largely to hormone changes — but that doesn’t mean we’re powerless. Dietary changes, exercise, and medication can all be powerful tools for maintaining heart health, and if you’re here educating yourself — you’re already doing some of the important work to take care of yourself.
Book a visit with one of our board-certified menopause-trained clinicians to learn more about your options for preventive health and menopause symptom management.
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