Menopause and cholesterol: Why your numbers may change

For many women, menopause arrives with a host of symptoms.

Hot flashes, night sweats, sleep disturbances and weight gain are due to declining estrogen, a hormone that’s essential for reproductive health. 

But low estrogen doesn’t just manifest in these noticeable forms. It can also be responsible for silent changes in the body, such as elevated cholesterol levels.

During National Cholesterol Education Month, Sundermurthy Yamini, MD, a cardiologist at Trinity Health Mid-Atlantic Medical Group’s Cardiology Holme, explains the impact of menopause and hormones on cholesterol, how the natural effects of aging also play a role and steps women can take to protect their heart health at this stage of life.

Drops in estrogen can begin impacting cholesterol up to three years before menopause. This is due to the hormone’s important role in helping the body clear LDL (low density lipoprotein), or “bad” cholesterol, and triglycerides from the bloodstream. Estrogen also helps the body maintain higher levels of HDL (high density lipoprotein), or “good” cholesterol.

When estrogen begins to drop in perimenopause and, eventually, menopause, LDL stays in the blood longer, leading to increased cholesterol levels and risk for heart attack, stroke and other serious events.

“It changes your cholesterol profile unfavorably,” says Dr. Yamini. “Part of it is because the female hormone goes down. The other part is because of the aging process itself.”

The average age of menopause is 51-52, which coincides with cellular changes in the body that can trigger a low-grade form of inflammation, known as inflammaging. Since estrogen also acts as an anti-inflammatory, the drop in this hormone coupled with the inflammaging that naturally comes with age is a recipe for elevated cholesterol levels and increased risk for cardiovascular issues.

Additionally, the combination of low estrogen and aging slows metabolism and alters how the body stores fat, which can result in central obesity and further raise cholesterol.

“That’s not to say if you don’t have central obesity, that you won’t get abnormal cholesterol,” says Dr. Yamini. “It’s not just the estrogen, but the aging, the inflammation, the rise in blood pressure. All these things are happening, which can influence your cholesterol in a bad way.”

For perimenopausal and menopausal women, annual primary care visits are essential in navigating these changes. It’s important to have cholesterol numbers checked so that action can be taken, if necessary, before a stroke, artery blockage or heart attack has the chance to occur. If LDL and/or triglycerides are too high, a provider can advise about medication and lifestyle changes, such as better sleep, limiting alcohol and avoiding smoking.

“If your levels are significantly raised, you’re at risk for not just heart problems, but also issues in the brain, pancreas and more,” says Dr. Yamini. “If you have abnormal cholesterol and let nature take its course with no medications or medical guidance, it will keep going in an unfavorable direction throughout your post-menopausal years.”

Visit Heart and Vascular Care for more information and to make an appointment.