Menopause affects cholesterol levels primarily because of the significant hormonal changes that occur during this phase, especially the decline in estrogen production. Estrogen plays a crucial role in regulating cholesterol and protecting cardiovascular health, so when its levels drop during menopause, cholesterol levels tend to rise, increasing the risk of heart disease.
Before menopause, estrogen helps maintain a favorable balance of cholesterol by increasing high-density lipoprotein (HDL), often called “good cholesterol,” and lowering low-density lipoprotein (LDL), known as “bad cholesterol.” HDL cholesterol helps remove LDL cholesterol from the bloodstream, preventing it from building up in the arteries. Estrogen also helps keep blood vessels flexible and promotes healthy blood flow, which protects against plaque formation and narrowing of arteries.
As women transition through perimenopause and into menopause, estrogen levels gradually decline over several years rather than dropping suddenly. This hormonal shift leads to several changes in cholesterol:
– **Increase in LDL cholesterol:** The “bad” cholesterol that can accumulate in artery walls and contribute to heart disease tends to rise after menopause.
– **Decrease in HDL cholesterol:** The protective “good” cholesterol often decreases, reducing the body’s ability to clear harmful cholesterol.
– **Increase in triglycerides:** These blood fats also tend to rise, further contributing to cardiovascular risk.
These changes are not just observed in industrialized populations but appear to be a universal biological response. For example, studies of the Tsimane people, a traditional forager-horticultural community with very low heart disease rates, showed that even in this healthy, active population, post-menopausal women experienced increases in total cholesterol, LDL cholesterol, and triglycerides. This suggests that the rise in cholesterol after menopause is a natural human phenomenon linked to hormonal changes rather than lifestyle alone.
The timing of these cholesterol changes is closely linked to the menopausal transition. Research following women through their 40s and 50s found that total cholesterol and LDL cholesterol levels rise significantly about one year before and one year after the final menstrual period. This period of hormonal fluctuation and decline is when the body’s protective effects from estrogen diminish, leading to less favorable cholesterol profiles.
In addition to cholesterol changes, menopause also affects other cardiovascular risk factors such as blood pressure, body weight, and glucose metabolism. The loss of estrogen’s protective effects can lead to increased blood pressure and changes in body fat distribution, often resulting in more abdominal fat, which is linked to higher heart disease risk.
Because these changes happen gradually over five to ten years during perimenopause and menopause, cholesterol levels and other heart disease risk factors may fluctuate before settling into a new pattern after menopause. This gradual shift means that cholesterol tests taken during perimenopause might not fully reflect the long-term risk, and monitoring over time is important.
In summary, menopause affects cholesterol levels because the decline in estrogen removes its beneficial influence on lipid metabolism and cardiovascular health. This leads to increases in LDL cholesterol and triglycerides, decreases in HDL cholesterol, and a higher overall risk of heart disease. These changes are a natural part of the menopausal transition and occur universally across different populations, regardless of lifestyle or diet. Understanding this connection highlights the importance of monitoring heart health closely during and after menopause.
