Why Do Cholesterol Levels Rise in Women After Menopause?

Menopause is a significant psychological and physiological transition in a woman’s life. As women go through perimenopause, they can experience hot flashes, night sweats, weight gain, mood swings and insomnia. And while many women expect the typical signs and symptoms of perimenopause, they don’t anticipate higher cholesterol levels, especially when they’re eating healthy and exercising regularly.

A healthy cholesterol range for women is between 125 and 200 milligrams per deciliter. But as a woman enters menopause, cholesterol levels tend to jump between 10 and 20 deciliters. Bad cholesterol, or LDL cholesterol, usually has the greatest increase.

Women with a history of premature menopause (before age 40) or early menopause (between the ages of 40 and 45) have a higher risk of heart disease because they live more years without protective hormones.

“No one wants to hear they need a medication, but unfortunately, it’s common for post-menopausal women to need a statin,” says endocrinologist Dr. Andrea Klemes, chief medical officer, MDVIP.

Menopause is associated with rising levels of total cholesterol, low-density lipoprotein, known as LDLs or bad cholesterol, Klemes says. Increased levels of lipoprotein-a, a more dangerous variation of LDLs, and triglycerides (TG), a blood fat, are also higher risks for post-menopausal women. High-density lipoproteins or HDLs, which are good cholesterol, tend to go down as well.

What Causes the Rise?

The primary problem is related to hormones estrogen (specifically estradiol 2) and anti-Müllerian hormone (AMH). In women, both hormones begin waning between early- and mid-30s and are depleted by the time a woman reaches menopause.  

• Estradiol protects women’s heart health by relaxing arteries. It also regulates liver metabolism, including cholesterol and triglycerides, promoting healthy blood fat levels. When estradiol levels drop during menopause, it leads to higher levels of LDLs and triglycerides.
• AMH isn’t fully understood, but its levels can predict a woman’s final menstrual period, potentially warning women of an earlier menopause. It’s thought that lower circulating AMH levels may be involved in poor cholesterol profiles and heart disease risk among women who underwent an earlier menopause. Another study found women with an unhealthy body mass index (BMI) had lower AMH levels and association with the cardiometabolic index, a relatively new predictor of obesity-related diseases, including heart disease, that’s based on distribution of body fat, waist-to-height ratio and the TG to HDL cholesterol ratio.

Another piece of the puzzle is weight gain. Extra weight raises your chances of an unhealthy cholesterol profile. In fact, for every 10 pounds you're overweight, your body produces up to 10 milligrams of additional cholesterol on a daily basis, according to the Obesity Action Coalition. Generally, women gain five pounds during perimenopause and continue gaining an average 1.5 pounds every year during their 50s. A number of variables influence menopausal weight gain, such as genetics and hormones. The drop in estrogen causes fat to shift from the thighs and hips to the abdomen, plus lower estrogen and progesterone cause a loss of muscle mass and a slower metabolism, making it easier to gain weight. Poor sleep, also associated with menopause, also contributes to weight gain.

Finally, a lack of physical activity causes your body to produce less HDL cholesterol. Many women become less active as they approach menopause, affecting their cholesterol profile and their weight. “Post-menopausal cholesterol management requires a multi-prong approach that usually involves lifestyle changes and medication,” Klemes says.

Controlling Cholesterol

Here are a handful of tactics you can take to help control your cholesterol.

• Work with your primary care doctor. 
• Begin a walking program. Walking is credited with raising HDL, while lowering LDL and triglycerides. It’s easier than you think. And there’s a good chance you don’t need 10,000 steps a day to reap the benefits.  
• Eat a heart-healthy diet. This includes cutting out ultra-processed foods that can lead to weight gain. 
• Manage your weight. This can be very difficult once you hit perimenopause, so make sure you partner with your doctor. 
• Improve sleep habits. 
• Take medications as directed.

“The most important step to take is working with your PCP,” says Klemes. “You should always talk to them before beginning or changing your workout routine and adjusting your dietary habits.”

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