Why Does LDL ("Bad") Cholesterol Increase in Perimenopause & Menopause?

As women transition through perimenopause, menopause and into post menopause, it's common to see changes in cholesterol levels—especially an increase in LDL cholesterol, often called “bad” cholesterol. This shift isn’t just about aging. There is a hormone connection……..estrogen!! 

What's Happening in the Body?

Estrogen Protects Your Heart: Estrogen helps your liver clear LDL cholesterol from the blood. When estrogen declines during menopause, the liver becomes less efficient, and LDL builds up.

Fat Shifts to the Belly: Hormonal changes increase visceral (belly) fat, which contributes to insulin resistance and higher cholesterol and triglycerides.

More Small, Dense LDL Particles: These particles are more damaging to arteries and more common after menopause.

Overall Heart Risk Increases: In addition to higher LDL, HDL ("good" cholesterol) may drop, and triglycerides may rise—raising heart disease risk.

LDL Cholesterol Is Not Always Bad: LDL has been villainized but did you know that LDL can increase when you increase healthy fat intake or even when you have inflammation in the body? The goal would be to look for the inflammation.

Look To The Thyroid: Cholesterol levels often rise with a low functioning thyroid and is often overlooked especially if only TSH and Free T4 lab markers are checked.

Natural Ways to Support Healthy Cholesterol During Menopause

These lifestyle strategies can make a big difference in keeping you healthy without immediately turning to medications:

1. Food as Medicine

• Fiber-Rich Foods: Oats, flaxseeds, chia, legumes, fruits, and veggies help sweep LDL from the body.

• Healthy Fats: Use olive oil, avocado, nuts, and fatty fish (like salmon) to raise HDL and lower LDL.

• Green Tea: Contains antioxidants that may support healthy lipid levels.

• Dark Chocolate: Rich in flavonoids (in moderation!).

2. Key Supplements (Talk with your provider first)

• Omega-3 Fatty Acids (from fish oil or algae): Help reduce LDL and triglycerides.

• Red Yeast Rice: A natural statin-like compound (best used under supervision).

• Berberine: Supports lipid metabolism and insulin sensitivity.

• Plant Sterols/Stanols: Block cholesterol absorption in the gut.

3. Movement Matters

• Prioritize strength training - I am not talking about the pink weights, or boot camps that use dumb bells and bands, but weight that makes you say oh SH”T, this is heavy I probably can crank out 4 reps with good form.  If you never lifted weights, hire a trainer for a few weeks to get comfortable with weight training and executing good form to minimize injuries (try the grounds app for your personal trainer, if you can’t find one locally).

• Cardio - Aim for 150 minutes/week of exercise that includes a couple of sessions of sprint interval training (usually only about 5-10 minutes), a couple of sessions of high intensity interval training (20 minutes), jump box training or other plyometrics training (5-10 minutes) and outdoor walking.

• Include stress-reducing activities like yoga, tai chi, or Pilates.

4. Stress & Sleep

• Chronic stress and poor sleep increase cortisol, which can elevate LDL.

• Prioritize 7–8 hours of sleep and find calming routines to unwind (journaling, deep breathing, screen-free evenings).

5. Hormone Balance

• In some cases, bioidentical hormone therapy (BHRT) or herbal hormone support (like black cohosh or maca) may help. Work with a qualified practitioner to explore this safely.

Final Thoughts

Menopause brings natural changes, but high cholesterol doesn't have to be one of them. With the right nutrition, movement, and lifestyle support, you can stay heart-healthy and vibrant through this next phase of life.