How to control cholesterol during menopause? Your expert guide

Oct 24, 2025 3 min read •

women's health Healthy Aging Cardiovascular Health

A 2019 meta-analysis published in Menopause found that total cholesterol rises, on average, by around 11 percent during the menopause transition. As estrogen levels decline, cardiovascular risk increases, making it critical to learn how to control cholesterol during menopause and prioritize your heart health for the long term.

Quick Summary

Managing cholesterol during menopause involves strategic lifestyle adjustments, including adopting a heart-healthy diet rich in fiber and unsaturated fats, incorporating regular aerobic and strength-training exercises, maintaining a healthy weight, and effectively managing stress. Medical interventions such as statins or, in some cases, hormone replacement therapy may also be considered in consultation with a healthcare provider.

Key Points

Estrogen Decline: Decreasing estrogen during menopause can lead to a rise in LDL cholesterol and triglycerides, increasing heart disease risk.
Heart-Healthy Diet: A diet rich in soluble fiber, unsaturated fats, and plant-based proteins is crucial for managing cholesterol levels.
Regular Exercise: Aim for at least 150 minutes of moderate aerobic activity and 2 strength-training sessions weekly to boost HDL and lower LDL.
Weight and Stress Management: Maintaining a healthy weight and practicing stress-reducing techniques are vital for supporting a healthy lipid profile.
Medical Options: Medications like statins can be effective, and Hormone Replacement Therapy (HRT) may impact cholesterol but should be discussed with a doctor for individualized assessment.

Understanding the link between menopause and cholesterol

Menopause is a natural biological transition, but the hormonal shifts can have a significant impact on your cardiovascular system. As estrogen declines during this time, it affects cholesterol metabolism, potentially leading to increased LDL ('bad') cholesterol, decreased effectiveness of HDL ('good') cholesterol, and a rise in triglycerides. Other contributing factors include potential weight gain and loss of muscle mass, which further impact cholesterol and heart disease risk.

Optimizing your diet for heart health

Diet is a key strategy for cholesterol control during menopause. A Mediterranean-style diet, focusing on plant-based foods, lean protein, and healthy fats, is recommended.

The Mediterranean-style approach

Prioritize soluble fiber from foods like oats and beans, and choose unsaturated fats found in olive oil and avocados over saturated fats. Aim for plenty of fruits and vegetables daily and incorporate plant-based proteins like legumes. Fatty fish, rich in omega-3s, can help lower triglycerides.

Limit problematic foods

Reduce saturated and trans fats from sources like red meat and processed snacks. Minimize ultra-processed foods and be mindful of alcohol intake, which can raise triglycerides.

Prioritizing regular physical activity

Exercise is vital for managing cholesterol and heart health during menopause. The American Heart Association advises at least 150 minutes of moderate aerobic activity and two days of strength training weekly.

Aerobic exercise: Activities like walking or swimming can improve cholesterol levels.
Strength training: Resistance training helps increase muscle mass, aiding in fat and sugar management.

Maintaining a healthy weight and managing stress

Maintaining a healthy weight is important for heart health as metabolism slows with age; even modest weight loss can benefit cholesterol. Managing stress is also crucial, as high cortisol can negatively affect lipid profiles. Consider relaxation techniques such as mindfulness or yoga.

Considering medical interventions

When lifestyle changes aren't enough, medication may be necessary.

Medications

Statins are common, reducing liver cholesterol production. Other options may be discussed depending on individual needs.

Hormone Replacement Therapy (HRT)

HRT is not a primary treatment for high cholesterol but can positively affect lipid profiles, especially when started early in menopause. Oral estrogen may lower LDL but could increase triglycerides, while transdermal options might have fewer triglyceride effects. Discuss HRT with a healthcare provider to weigh individual risks and benefits.

Comparison: Lifestyle vs. Medication


Feature	Lifestyle Adjustments	Medication (e.g., Statins)
Mechanism	Improve body's natural processes for managing fats	Directly inhibit cholesterol production in the liver
Effects	Raises HDL, lowers LDL and triglycerides (variable)	Significant reduction in LDL, can raise HDL (variable)
Speed	Gradual changes over weeks or months	Often see results more quickly, within weeks
Risks/Side Effects	Very low risk, generally beneficial for overall health	Can have side effects (e.g., muscle pain, liver issues)
Primary Role	Foundational and long-term management strategy	Often used when lifestyle changes are insufficient

Taking a proactive approach

A proactive approach is key to managing cholesterol during menopause. By understanding hormonal changes and focusing on sustainable lifestyle habits, you can significantly protect your heart health. Regular lipid panel screenings with your doctor are important to monitor levels.

For more detailed guidance on making specific dietary changes, consult trusted health resources like the American Heart Association's guide on reducing cholesterol: Top 5 lifestyle changes to improve your cholesterol.

Frequently Asked Questions

During menopause, a woman's estrogen levels decrease. Estrogen helps regulate cholesterol metabolism, so the drop in this hormone can cause an increase in LDL ('bad') cholesterol and triglycerides, while potentially reducing the effectiveness of HDL ('good') cholesterol.

Focus on a diet rich in soluble fiber (oats, beans, apples), healthy unsaturated fats (olive oil, avocados, nuts), and plant proteins. Limiting saturated fats, trans fats, and processed foods is also critical for managing your lipid profile.

The American Heart Association recommends at least 150 minutes of moderate-intensity aerobic exercise, such as brisk walking, and 2 sessions of muscle-strengthening activities each week. This regimen helps lower LDL and raise HDL cholesterol.

HRT can positively affect cholesterol levels, though it is not typically prescribed for this reason alone. Some forms can lower LDL and increase HDL. However, it's essential to discuss the risks and benefits with your doctor to determine if it's right for you.

If significant lifestyle changes are not sufficient to manage your cholesterol, or if you have a high risk of cardiovascular disease, your doctor may recommend medication like statins. This is a personalized decision based on your overall health.

While individual targets vary, a general guideline is total cholesterol below 200 mg/dL, LDL below 100 mg/dL, triglycerides under 150 mg/dL, and HDL above 50 mg/dL. Your doctor will provide specific targets based on your health history.

Yes, stress can negatively impact your cholesterol. Chronic stress elevates cortisol levels, which can contribute to unhealthy lipid profiles. Practicing relaxation techniques like meditation or yoga can help mitigate these effects.

References

Medical Disclaimer

This content is for informational purposes only and should not replace professional medical advice. Always consult a qualified healthcare provider regarding personal health decisions.