The hidden heart risk lurking after menopause
Key Takeaways
Industry Buzz
“Estrogen protects cardiovascular health by helping to maintain good cholesterol levels. When women enter menopause and estrogen levels decline, there can be an increase in LDL cholesterol and a decrease in HDL [high-density lipoprotein cholesterol],” or “good cholesterol.” - Megan Miller, MBA, RDN, LD, Telehealth Practice Manager at LifeMD.
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There’s a common association between aging and an increased risk of heart problems.[]
It’s not surprising to see patients experience higher cholesterol and blood pressure as they age. However, for many health-conscious women, a spike in cholesterol during or after menopause can be an unpleasant shock. Although often linked to lifestyle risk factors, cholesterol rises in menopause can be hormone-driven.[] Even patients who watch their diets closely and exercise regularly can experience this change in their lipid profile.
Menopause and the heart
The drop in estrogen levels during menopause has long been linked to higher cholesterol levels.[] This is largely due to estrogen's effect on lipid metabolism. As estrogen levels decline, increases in triglycerides and low-density lipoprotein (LDL) cholesterol, or “bad cholesterol,” often follow.
“Estrogen protects cardiovascular health by helping to maintain good cholesterol levels. When women enter menopause and estrogen levels decline, there can be an increase in LDL cholesterol and a decrease in HDL [high-density lipoprotein cholesterol],” or “good cholesterol,” says Megan Miller, MBA, RDN, LD, Telehealth Practice Manager at LifeMD.
What the research says
Recent studies have also investigated the link between cholesterol levels and anti-Müllerian hormone (AMH) during menopause.[] In a 2023 study published in the Journal of Clinical Lipidology, researchers examined AMH levels in 1,440 midlife women—participants in the Study of Women’s Health Across the Nation (SWAN), a longitudinal study across various sites in the United States—with data from up to nine visits over 16 years. The researchers observed a direct link between AMH levels and HDL levels.
“When women enter menopause and estrogen levels decline, there can be an increase in LDL [low-density lipoprotein] cholesterol and a decrease in HDL [high-density lipoprotein cholesterol],” says Megan Miller, MBA, RDN, LD, Telehealth Practice Manager at LifeMD.
Anti-Müllerian hormone levels typically decrease during menopause. High AMH was observed to lower HDL or good cholesterol. Although higher levels of HDL cholesterol are typically considered optimal, researchers concluded that the association between AMH and HDL levels suggests a strong link between the changes in this hormone and overall lipid profile changes in menopause.
Cortisol levels are also linked to cholesterol levels.[] Stress can cause changes in cortisol at any time, but cortisol levels are known to increase with age and at the onset of menopause. “Increased cortisol levels can stimulate production of LDL cholesterol and increase total cholesterol levels,” Miller confirms.
Taking away the blame
Lifestyle-based guidance on lowering LDL and increasing HDL is often the first step in a lipid profile treatment plan. However, for women who already have healthy lifestyles and experience menopausal changes to their cholesterol, the standard advice may feel more like blame.
Reframing the conversation and addressing the genuine challenges brought on by shifting hormone levels can help.
A treatment plan that reduces the blame might focus on hormones, stress, whole-body menopausal changes, and a complete health picture. Suggestions for known cholesterol-lowering improvements in diet, exercise, and other lifestyle factors can still play a role without the implication that previous implementation of these changes could have completely prevented hormone-based changes.