Menopause and Cholesterol: Your Questions Answered
I'd always had good, healthy cholesterol numbers. That is, until menopause hit. An expert breaks down the whys and hows.
Cholesterol is not just a number. It’s responsible for many important bodily functions, among them providing stability and structure to cell walls and regulating what enters and what leaves. But you can have too much of a good thing. Or too little of a bad one.
Last week, the shouting began: Get your cholesterol even lower..and start younger!
According to new guidelines of eleven medical organizations, this suggestion (plea?) was made to help prevent or reduce heart attacks and stroke.
Medical advice can be confusing, as can medical guidelines, because they always seem to change. Just when we thought it was safe to drink wine, we were cautioned against it. And then, we were told it was okay…then, not okay…then maybe okay. It can be frustrating to know what the h*ll to do!
To help clarify things, I reached out with some important questions to cardiologist Dr. Nathaniel Lebowitz at Hackensack University Medical Center. As luck would have it, Dr. Lebowitz has long been focused on the silent threat of lipoprotein.
1. Why does cholesterol (and is it specifically LDL) increase after menopause? What is the exact role of estrogen in this equation? And when does that precipitous climb typically occur?
“The shift in cholesterol levels around menopause is significant, and it is indeed the “bad” cholesterol, or LDL, that we watch closely.
Before menopause, estrogen plays a crucial protective role in your cardiovascular health. It effectively helps your liver clear LDL cholesterol from the bloodstream by increasing special receptors on liver cells that grab and break down LDL.
Estrogen also helps to maintain levels of HDL, the “good” cholesterol.
As you enter menopause, estrogen levels decline, and this protective mechanism weakens.
Consequently, the liver’s ability to remove LDL cholesterol is reduced, causing its levels in the blood to rise.
This change isn’t just a postmenopausal issue; the increase in cholesterol often begins during the perimenopausal transition.
Studies show a notable climb can start around three years before the final menstrual period and continue in the year that follows. This timeframe represents a critical window to be proactive about your heart health.”
2. What should menopausal (and postmenopausal) women know about managing their cholesterol?
“The menopausal transition is the perfect time to take charge of your cardiovascular health. Management is a partnership between you and your doctor, focusing on lifestyle as the first line of defense.
A heart-healthy diet, such as the Mediterranean style, is highly recommended. This involves increasing your intake of soluble fiber from foods like oats and barley, eating healthy fats found in nuts and olive oil, and reducing saturated fats.
Regular physical activity is non-negotiable; a combination of aerobic exercise like brisk walking and resistance training is ideal for improving cholesterol levels.
It is also vital to maintain a healthy weight, quit smoking, and limit alcohol consumption.”
I’ll chime in here to say this: despite my healthy diet, my regular physical activity and my careful and limited alcohol consumption, my LDL levels were too high. And now I understand why:
“Lifestyle efforts are not always enough, as genetics can play a strong role. It is essential to have your cholesterol levels checked regularly. If your LDL remains high despite your best efforts with diet and exercise, please do not feel discouraged. We have very effective and safe medications, primarily statins, that can lower your cholesterol and significantly reduce your risk of heart attack and stroke.”
It’s me again: I recently began a statin, as my doctor advised. And my last blood test? I wanted to frame it. The LDL numbers were so so much improved.
3. What numbers should we aim for?
“For menopausal and postmenopausal women, the target cholesterol numbers are generally the same as for the broader adult population, but it’s important to remember these are part of a larger picture of your overall heart disease risk.
Total Cholesterol: The goal is to keep this number below 200 mg/dL.
LDL (”bad”) Cholesterol: For most healthy women, the target is less than 100 mg/dL. If you have other risk factors for heart disease, such as diabetes or a history of heart attack, we will aim for a more aggressive target of 70 mg/dL or lower.
HDL (”good”) Cholesterol: For women, a higher number is better. We like to see this at 50 mg/dL or higher, with 60 mg/dL or more being the ideal goal.
Triglycerides: This is another type of fat in your blood that should be kept below 150 mg/dL.”
Remember, high cholesterol has no symptoms - until a severe cardiovascular event happens. That is why it’s so important to get regularly screened.
Remember, too, that the older you get and the more risk factors you have, the more often you should get screened. As always, work together with your doctor to come up with the best, most individualized, plan of action.
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The information provided on the site is for educational purposes only, and does not substitute for professional medical advice, diagnosis or treatment.