Perimenopause and menopause are stages of a woman’s life that involve tremendous changes physically, mentally, and emotionally. Fluctuating hormones are at the center of these changes, and they have an impact on virtually every area of the mind and body. The symptoms and severity of the effects of perimenopause and menopause are unique for every woman, and exploring the more than 100 symptoms associated with this time of life may seem overwhelming. Some of the symptoms are more common than others, and one of them is changing cholesterol levels.

During perimenopause and menopause, it is typical for cholesterol levels to change in ways that can have a negative impact on your cardiovascular and overall health. Therefore, it’s important for you to know your cholesterol levels during these stages of your life. This blog is meant to help you understand the different types of cholesterol, why it’s important to keep them in a healthy range, and how you can best achieve that goal through natural means. 

Read about menopause and high cholesterol

Cholesterol basics

When people hear the word “cholesterol,” many think about heart disease and clogged arteries. One reason for this perception is that cholesterol, which is a waxy substance produced by the liver, can build up in your bloodstream and block blood flow. But not all cholesterol is bad. In fact, cholesterol has numerous critical functions in your body.

For example, you need cholesterol to:

• Provide insulin for your nerves cells.
• Make vitamin D. Cholesterol is converted into vitamin D in the presence of sunlight.
• Make bile, the fluid that is necessary for processing and digesting fats.
• Help form and maintain cell membranes and structures. Your cells also use cholesterol to help them adjust to temperatures changes.
• Make essential hormones, such as cortisol, estrogen, testosterone, and progesterone.

However, too much of a good thing can result in a variety of health problems. Here are the kinds of cholesterol and their activities.  

• High-density lipoprotein (HDL) cholesterol, which is often referred to as “good” cholesterol because it performs the good deed of absorbing cholesterol in the blood and transporting it back to the liver. At that point, the liver can flush it from the body. High levels of HDL cholesterol can reduce your risk for cardiovascular disease.
• Low-density lipoprotein (LDL) cholesterol is also known as “bad” cholesterol because high levels raise your risk of cardiovascular disease. It makes up most of the cholesterol in the body.
• Very low-density lipoprotein (VLDL) cholesterol molecules are larger than those of LDL and also contain lots of fat and very low protein levels. VLDL transports triglycerides and cholesterol from the liver throughout the body and can clog your arteries.
• Intermediate density lipoprotein cholesterol is VLDL after some triglycerides have been removed. 
• Chylomicrons are the largest lipoproteins and carry triglycerides from the gut to the liver after you eat where they are reconfigured into other lipoproteins. 
• Triglycerides: We include triglycerides in our cholesterol explanation because this form of fat, when at high levels, has been linked to a greater risk of coronary artery disease. If your triglyceride levels are high, you likely also have low HDL and high LDL, a combination that increases your chances of having a stroke or heart attack. Twenty percent of your triglycerides are included in your total cholesterol figure.
• Total cholesterol is the sum of your HDL, LDL, and 20 percent of your triglyceride total

Healthy vs unhealthy cholesterol levels

The test that measures your cholesterol levels is called a lipid profile. This panel of blood tests measures total cholesterol, HDL, LDL, and triglycerides. Here are the values you should know:

• Optimal total cholesterol: less than 200 mg/dL
• Borderline cholesterol: 220-239 mg/dL
• High cholesterol: 240 mg/dL and greater. It is mainly caused by eating fatty foods, being overweight, not exercising enough, drinking alcohol, and smoking. It can also run in families.
• HDL cholesterol: levels greater than 50 mg/dL for women are ideal
• LDL cholesterol: levels less than 100 mg/dL are ideal
• Triglycerides: levels less than 150 mg/dL are ideal

Physicians also use ratios to determine heart risk. For example, the ratio of total cholesterol to HDL and the ratio of LDL to HDL can predict heart risk accurately, according to a study in Vascular Health and Risk Management. To illustrate: if you have a total cholesterol value of 220 and an HDL value of 60, the resulting value is 3.6. A target value for women is less than 4.0. A ratio of LDL of 100 and HDL of 55 results in a value 1.8. Ideal for women is less than 2.5. 

What is Hypertriglyceridemia?

Hypertriglyceridemia is the presence of excessive triglycerides (fats) in the blood. Triglycerides are used by the body for energy, but this is a case when more is not better. For adults, a fasting level of 150 mg/dL (milligrams per deciliter) is considered normal. Figures greater than 150 mg/dL are considered hypertriglyceridemia, which increases your risk of cardiovascular disease.  

About 20 percent of adults in the United States have hypertriglyceridemia, and this percentage increases with age, as it affects 42 percent of adults age 60 and older. 

Is hypertriglyceridemia the same as high cholesterol? No, but both do involve high levels of lipids in the bloodstream. Many people with hypertriglyceridemia also have high total cholesterol, and this combination puts you at an even greater risk of cardiovascular disease. 

People with hypertriglyceridemia typically don’t have any symptoms, although severe cases may present at skin bumps around the eyelids or on the knees, palms, or knees. 

Triglycerides levels are checked when you have a lipid panel for cholesterol. Treating triglycerides naturally is similar to that for high cholesterol: lifestyle changes as discussed in this blog.

Cholesterol and perimenopause

One of the tasks of estrogen is to regulate lipid metabolism. Therefore, as levels of the hormone decline beginning in perimenopause, women experience changes in their cholesterol levels, including increases in both LDL and triglycerides and a decline in HDL. According to Dr. Samia Mora, a specialist in cardiovascular medicine at Brigham and Women’s Hospital, “it’s especially important to track the numbers [for lipids and cholesterol] in perimenopause and the early years after menopause.” Left unchecked, these changes can lead to greater risk of heart attack and other conditions associated with cardiovascular disease, which is the number one cause of death in postmenopausal women.

High cholesterol in the blood doesn’t typically have noticeable symptoms, which is why it’s important to have your levels checked regularly. Women in perimenopause who notice rising cholesterol levels may have an increased risk for conditions that have symptoms, such as high blood pressure, chest pain associated with heart disease, stroke, and heart palpitations.  

Cholesterol and menopause

Once women reach their day of menopause and pass into postmenopause, estrogen production has nearly stopped. The body still does produce a small amount of estrogen, however, because a hormone called aromatase changes hormones called androgens (made by the adrenal glands) into estrogen. 

In terms of providing protection for the heart, the absence of significant estrogen leaves cholesterol levels at more unhealthy levels and continues to pose a risk of cardiovascular disease. According to a study in the Journal of the American College of Cardiology, a woman’s LDL levels increase about 10 points within two years of her last period. Although this may not seem like a big increase, women who already have elevated LDL are at greater risk of heart issues. 

When it comes to HDL cholesterol, the general consensus has been that this lipoprotein provides protection against heart disease. Because HDL levels drop significantly in menopause, that protection declines as well. In recent years, some researchers have questioned the ability of HDL to protect women against cardiovascular disease in postmenopause. 

According to one recent study, for example, the researchers reported that “HDL subclasses, lipid contents, and function might be better predictors of cardiovascular risk than HDL cholesterol.” This work is still ongoing, so measuring HDL subclasses and their impact on predicting cardiovascular risk in postmenopausal women has not been established for general use. 

However, knowing that the ability of HDL to protect postmenopausal women against cardiovascular risk may not be as helpful as once thought should be kept in mind when looking at a menopausal or postmenopausal woman’s overall chances of experiencing cardiovascular events. In fact, according to the study’s lead author Samar R. El Khoudary, PHD, MPH, FAHA, “This study … suggests that clinicians need to take a closer look at the type of HDL in middle-aged and older women, because higher HDL cholesterol may not always be as protective in postmenopausal women as once thought,” since high HDL may mask an important cardiovascular risk that is not yet understood. 

How to manage cholesterol naturally

Lifestyle modifications can have a significant impact on managing your cholesterol. Several changes can be incorporated into your daily life that will not only improve cholesterol but also other aspects of perimenopause and menopause. For best results, be sure to include as many tips as you can.

Fat intake. Perhaps the most significant dietary change concerns fats. Basically, you need to avoid trans fats, reduce intake of saturated fats, and focus more on monounsaturated and polyunsaturated fats. Trans fats are unsaturated fats that have undergone hydrogenation, resulting in an ability to raise LDL and reduce HDL cholesterol. They are found in vegetable shortening, partially hydrogenated vegetable oils, fried foods, margarine, and some processed and prepackaged foods. 

Saturated fats are found primarily in meat, poultry, fish, dairy foods, and some cooking oils. These fats should make up only about 5 to 6 percent of your daily calorie intake, according to the American Heart Association. For example, if you consume 2,000 calories daily, 120 can be from saturated fat.

Monounsaturated fats are found in foods such as avocados, olives and olive oil, sesame oil, seeds, and nuts. These fats do not raise LDL levels. Polyunsaturated fats, which include omega-3s and omega-6s, are found in fish and shellfish, some nuts (e.g., walnuts), some seeds (e.g., sunflower seeds, flax seeds), and soybean products such as tofu and edamame. These fats have been shown to help reduce LDL cholesterol without affecting HDL. Omega-3s have been shown to be helpful in reducing the risk of cardiovascular events and are used to treat high cholesterol and triglycerides. [Morphus Omega 3-T is an easily absorbed form of healthy omega 3s.]

Modifying fat intake also includes how you prepare your foods. Avoid frying and breading, trim fat and skin before cooking or eating, and focus on baking, poaching, grilling, boiling, and broiling foods. 

Read about menopause and fiber for heart health

Fiber. The beneficial impact of fiber intake on lowering cholesterol has been well researched. Both soluble and insoluble fiber found in a wide variety of foods (whole grains and cereals, vegetables, fruits, seeds, beans and legumes) work to manage LDL cholesterol as well as help with other issues common in perimenopause and menopause, including metabolic syndrome, prediabetes, diabetes, high blood pressure, and digestive disorders. Recommended intake of fiber daily is 25 to 35 grams. Keep track of your dietary fiber intake for several days, and if you are low, consider taking a natural fiber supplement such as Fiberus, a prebiotic supplement that provides 6.5 grams of fiber per serving. 

Vitamin E. Did you know that this vitamin has eight components: four types of tocotrienols and four types of tocopherols. According to the findings of a clinical trial appearing in Atherosclerosis, “tocotrienols are effective in lowering serum total and LDL-cholesterol levels,” which it does by inhibiting the activity of a substance called HMG-CoA. Tocopherols, however, have the opposite effect, so taking tocotrienols is recommended. The effective dose in this study was 100 mg tocotrienols, which resulted in a 20, 25, and 12 percent decrease in serum total cholesterol, LDL cholesterol, and triglycerides, respectively. Toco-E is a highly absorbable vitamin E supplement that provides 150 mg of this potent antioxidant. 

Nicotinic acid (niacin). This B-complex vitamin is available both over-the-counter and by prescription. Niacin reduces LDL cholesterol and triglycerides and raises HDL. Side effects can include flushing of the face and upper body, which can usually be managed by taking the supplement with food. Others that may occur are headache, stomach upset, coughing, and elevated blood sugar. Dosing should be determined by your healthcare provider. 

Exercise. Does exercise help you manage cholesterol levels? Yes, according to experts, including those who published their findings in BMC Public Health. The recommendation is to participate in 150 minutes per week of moderate-intensity aerobic activity (e.g., walking, jogging, tennis, pickleball, swimming, biking) and then two sessions of weight training per week for about 20 minutes per session. Both aerobic and strength training benefit the cardiovascular system. 

If you are new to exercise, are relatively inactive, or are overweight, be sure to check with your doctor before starting an exercise program. You will want to begin at a low level and progressively increase exercise time and intensity over time. 

Stress reduction. When you are stressed or anxious, your brain produces cortisol and adrenaline, which raise glucose levels and in turn creates more triglycerides. Elevated triglycerides result in higher cholesterol levels. Therefore, effectively managing your stress levels can help keep LDL cholesterol levels at bay. It’s also been shown that poor management of stress can result in lower levels of HDL cholesterol. 

Medication for lowering cholesterol

Numerous prescription medications are available that are designed to help lower cholesterol. Here is a list of the types and what you should know about them. You should always discuss any medication with your healthcare provider and thoroughly understand which dose is best for you, as well as learn about side effects, potential benefits, and cost.

• Statins. These work by blocking an enzyme (HMG CoA reductase) that the liver uses to make cholesterol. They may also reduce inflammation and the risk of blood clots. Side effects include headache, constipation, nausea, sore muscles, elevated blood glucose, and liver enzyme abnormalities. Statins do deplete CoQ10 so consider supplementing this nutrient.
• PCSK9 inhibitors. These drugs attach to a specific liver cell protein, which in turn helps lower LDL. Side effects include cold-like symptoms, muscle pain, and back pain.
• Fibric acid derivatives (fibrates). This group of drugs help reduce cholesterol and triglycerides and may also raise HDL levels. Possible side effects include diarrhea, constipation, weight loss, bloating, vomiting, stomachache, headache, muscle pain, and muscle weakness
• Bile acid sequestrants. These medications attach to bile in the intestine, which makes less cholesterol available in the bloodstream. Side effects can include constipation, diarrhea, sore throat, stuffy nose, weight loss, nausea, stomach pain, belching, and vomiting.
• Selective cholesterol absorption inhibitors. These drugs works in the intestinal tract and stops the absorption of cholesterol. It may lower LDL cholesterol as well as triglycerides and also raise HDL cholesterol. Side effects may include diarrhea, joint pain, and fatigue. 
• Adenosine triphosphate-citrate lyase inhibitors. Slower cholesterol production is the effect of this drug group. Some possible side effects include upper respiratory infection, tendon injury, and stomach, muscle, or back pain.

Hormone replacement therapy, cholesterol and cardiovascular disease

The impact of hormone replacement therapy on cardiovascular disease risk and cholesterol has been the topic of research for many years. In 2003, the Women’s Health Initiative (WHI) researchers found no evidence that use of estrogen alone or estrogen plus progestin protected women against cardiovascular disease. 

In 2013, experts reported on their summarization of current analyses of the WHI findings and the effects of hormone replacement therapy on risk factors for CVD. They noted that “although hormone therapy lowers LDL cholesterol and lipoprotein (a) and raises high-density lipoprotein cholesterol, it has adverse effects on triglyceride, lipoprotein composition, and inflammatory and hemostatic markers.” Their conclusion was that use of hormone therapy for cardiovascular disease prevention is not justified in postmenopausal women.

Bottom line

Levels of LDL cholesterol and triglycerides typically rise and those of HDL cholesterol decline among women in perimenopause and menopause. These changes are attributed to declining estrogen levels. The end result is an increased risk of cardiovascular disease, the number one killer of women. All women are encouraged to be proactive in monitoring and managing their cholesterol and consulting with a knowledgeable healthcare provider to establish an effective course of action.