Cholesterol Spikes in Menopause. Here’s How to Lower It

You expect certain hormonal-driven symptoms in menopause. Hot flashes, mood swings, a lack of sex drive. But high cholesterol? That one tends to fly under the radar until your doctor flags it during a routine blood test.

Yet shifts in cholesterol are common in perimenopause and beyond. One 2019 meta-analysis published in Menopause found total cholesterol rises, on average, by around 11 percent during the menopause transition. ¹

Estrogen’s decline is part of the equation. But aging, changing body composition, and reduced physical activity also play a role. Together, these changes during menopause or perimenopause can drive up cholesterol and increase the risk of heart disease.

The good news? You can lower cholesterol in menopause through targeted lifestyle changes, a heart-smart diet, and—in some cases—medication or hormone therapy.

About the Experts

Laura Wyness, Ph.D., is a registered nutritionist who specializes in menopause and the author of Eating Well for Menopause.

Jayne Morgan, M.D., is a cardiologist and an adjunct associate professor of medicine at the Morehouse School of Medicine.

Why Menopause Affects Cholesterol

During menopause, LDL cholesterol tends to rise, while HDL cholesterol may undergo shifts in composition, even if the level stays the same.

• LDL has historically been referred to as “bad” cholesterol because it contributes to cholesterol buildup and blockages in the arteries. One 2019 review article found that on average, LDL rises by 15.5 percent, and triglycerides—fats circulating in the blood—jump by 21 percent. ² Other research found that before menopause, women tend to have healthier cholesterol levels than men, but after menopause, their LDL levels can become just as high—or even higher—than men of the same age. ³
• HDL is commonly known as “good” cholesterol because it helps transport excess cholesterol away from the arteries, and it can become less effective as women go through menopause. The composition of their HDL tends to change, even if the total amount stays the same. According to the 2024 SWAN HDL Ancillary Study, this period is linked to an increase in smaller, triglyceride-rich HDL particles and a decrease in larger, cholesterol-rich ones, which could make HDL less effective at protecting the heart. ⁴

Many women also accumulate fat in their midsection during menopause. ⁵ “Visceral fat—fat around the belly and waistline—also works to increase cholesterol levels,” adds cardiologist Jayne Morgan, M.D.

How estrogen and FSH affect cholesterol in menopause

Estrogen plays a role in regulating cholesterol metabolism in the liver, says Laura Wyness, Ph.D., a registered nutritionist who specializes in menopause. Declining estrogen levels in menopause can raise cholesterol by affecting the liver’s ability to process it. ⁶

Estrogen also helps keep your blood vessels flexible and smooth, making it easier for blood to flow and protecting against plaque buildup and artery stiffness. ⁷

New research suggests that estrogen may not be the only hormone that impacts cholesterol in menopause. FSH (follicle-stimulating hormone) rises in menopause, and higher FSH is linked to more LDL and total cholesterol, even when estrogen levels are similar. Scientists believe FSH may signal the liver to make more cholesterol, while the loss of estrogen makes it harder for the body to clear extra LDL from the blood. ⁸

What are healthy cholesterol numbers?

The optimal cholesterol numbers for adult women who don’t have an increased risk of cardiovascular disease are:

• Total cholesterol: Less than 200 mg/dL
• LDL: Less than 100 mg/dL
• HDL: More than 60 mg/dL

If your LDL is too high, your doctor may prescribe a cholesterol-lowering medication like a statin. “Generally, statins should be strongly considered in any perimenopausal or menopausal woman with an LDL greater than 70 mg/dl, regardless of risk,” says Morgan.

Dietary Changes to Lower Cholesterol During Menopause

Simple adjustments to your diet can help lower cholesterol during menopause and perimenopause.

Increase fiber and whole grains

Eating more soluble fiber can help lower cholesterol in menopause. Found in food including beans, barley, and sweet potatoes, soluble fiber binds to cholesterol in the gut to eliminate it. Research shows eating 5 to 10 grams per day can help lower total and LDL cholesterol by 5 to 11 points. ⁹

One 2020 meta-analysis found that replacing refined grains with whole grains improved LDL and total cholesterol levels ¹⁰.

Minimize processed foods

Ultra-processed foods—think chips, sweetened yogurt, frozen meals—can harm your lipid profile. One study found people who ate more ultra-processed foods had lower HDL and smaller, denser LDL particles, which are more likely to clog arteries. They also had more small HDL particles instead of the larger, heart-protective ones. ¹¹

Favor unsaturated fats

Saturated fats can raise total cholesterol and LDL, so it’s wise to limit them. Women in menopause and perimenopause can potentially lower cholesterol levels by switching out saturated fats like butter for heart-healthy options like olive oil.

In one study of nearly 5,000 middle-aged women, those who ate a healthy, fish- and vegetable-rich diet low in animal fat had lower triglycerides and higher HDL during the menopausal transition, while women eating a more Western diet (high in saturated fats and refined carbs) showed higher triglycerides and lower HDL. ¹²

A 2023 study published in Nutrients advises keeping saturated fat under 10 percent of daily energy; ¹³ others suggest as low as 7 percent for those with high cholesterol.

Heap on the vegetables

A meta-analysis of 95 studies suggests the more produce you eat, the less likely you are to die from cardiovascular disease. ¹⁴ Experts who conducted a recent review of studies about people with high triglyceride levels suspect this is because fruits and vegetables contain fiber and phytochemicals that can improve cholesterol by reducing triglycerides. ¹⁵

According to the USDA, most adult women should eat between 1½ and 2 cups of fruit ¹⁶ and 2 to 3 cups of vegetables daily. And more is better.

Include plant sterols

Phytosterols—which include sterols and stanols—are compounds found in fresh produce, legumes, whole grains, nuts, wheat germ, and vegetable oil. Because their chemical structure resembles that of cholesterol, they trick your body’s intestinal lining into prioritizing their absorption over harmful LDL cholesterol. ^{17 18}

According to a meta-analysis of 41 trials, adding 2 grams of sterols to your daily diet in the form of fortified foods can lower LDL cholesterol by 10 percent. ¹⁹

Lean into plant protein

About two-thirds of protein in most Americans’ diets comes from animals. ²⁰ Shifting to more plant protein is linked with reductions in LDL cholesterol, non-HDL cholesterol, and apolipoprotein B (a marker of cardiovascular risk). ²¹

Women in menopause can lower their cholesterol by incorporating more legumes, lentils, tofu, tempeh, and nuts. “Although nuts are relatively high in calories, they provide beneficial unsaturated fats that help lower cholesterol, as well as heart-healthy fiber and micronutrients—vitamin E, magnesium, and potassium—that benefit heart health,” says Wyness. “One portion [about 1 ounce] of nuts daily has been shown to help reduce total cholesterol and LDL cholesterol without impacting weight gain.”

Be mindful about alcohol

Research suggests even moderate alcohol use might increase cholesterol and raise triglycerides. ²² To make things worse, women in menopause or perimenopause can experience uncomfortable side effects of alcohol intolerance when drinking.

Lifestyle Changes to Lower Cholesterol During Menopause

Lifestyle changes are just as important as dietary changes when it comes to improving cholesterol for women in menopause or perimenopause, say Morgan and Wyness. Emphasize these heart-healthy habits:

Exercise

Cardio exercise like jogging, swimming, and biking can help lower LDL cholesterol and triglyceride levels while increasing HDL cholesterol and improving how well it works in your body. ²³ A small study of exercise in pre- and postmenopausal women found that cardio was actually more effective at improving cholesterol among the latter. ²⁴

Resistance training has also been shown to lower total cholesterol, triglycerides, and LDL in post-menopausal women. ²⁵

Quit smoking

Smoking not only raises LDL but also makes it more likely to oxidize and stick to artery walls. It also lowers HDL and damages your body’s ability to clear cholesterol. ²⁶ What’s more, for women over 44, research shows smoking is associated with a 25 percent greater risk of coronary artery disease than it is for men of the same age. ²⁷ The good news is that once you quit, your HDL may function more effectively again.

Maintain healthy blood pressure

Nearly 74 percent of women over the age of 60 have high blood pressure. ²⁸ While high blood pressure and high cholesterol are technically independent risk factors for cardiovascular disease, together they act synergistically to increase your risk level.

One study of 73,916 Asian men and women, which described the increased risk as “dramatic,” suggests that this may be because the pounding of high blood pressure damages artery walls, making it easier for cholesterol plaque to form on them. ²⁹ Healthy blood pressure is typically below 120/80 mmHg. Morgan recommends monitoring your levels at home. Data reveals that those who used home health devices lowered cholesterol by 67 mg/dl and lost up to 12 pounds in two years. ³⁰

HRT to Lower Cholesterol Levels in Menopause

Hormone replacement therapy (HRT, also called menopause hormone therapy or MHT) that includes estrogen may help lower cholesterol in menopause.

One 2022 meta-analysis of 73 studies suggests transdermal HRT (like patches and cream) may be safest for women in menopause with elevated cholesterol. ³¹ Oral therapy reduced LDL more but also tended to increase triglyceride levels.

While HRT shouldn’t be prescribed just to lower cholesterol, it may be a helpful bonus if you’re taking it for symptoms like hot flashes, insomnia and brain fog. And it appears safe to use alongside statins, per a 2023 JAMA study. ³²

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About the author

Jessica is a writer and editor with a deep interest in health. She has been Content Director/Executive Editor of Weight Watchers, Acting Investigative Food and Health Editor at Consumer Reports, and Health Director at Prevention.

About the reviewer

Tzvi Doron, D.O. is a board-certified family physician, obesity physician, clinical lipidologist, and expert in digital health.