You might know that you can reduce your risk of cardiovascular disease by keeping your cholesterol levels in check. But does menopause make this harder to do? And can you take HRT if you have high cholesterol? Read on for everything you need to know about menopause and cholesterol.
What is cholesterol and why is it important?
Cholesterol is a type of fat in your body. It has a bad reputation but your body needs some cholesterol to work properly. In fact, the human brain is about 20% cholesterol!
The issue is that when you have too much cholesterol it can cause problems. It can lead to heart attacks, strokes and other kinds of cardiovascular disease if it builds up in your blood vessels. This is why your doctor may recommend a cholesterol blood test.
High cholesterol can be caused by:
- Your genes
- A diet high in fatty foods, such as red meat or fried food
- Being overweight
- Not moving enough
- Smoking
- Drinking too much alcohol
Does cholesterol increase with age?
Your cholesterol levels tend to increase with age until you reach the age of 65. Cholesterol levels then tend to stay the same in women and decrease slightly in men.
When should you check your cholesterol?
It’s a good idea to check your cholesterol at least every five years if:
- You’re aged over 40
- You have a strong family history of high cholesterol or heart disease
- You are overweight
Where can you get your cholesterol checked?
Request a cholesterol test from your doctor. Some pharmacies also provide tests as part of a free NHS Health Check if you’re over 40. They will either take blood from your arm or do a finger-prick test.
What do your cholesterol results mean?
You’ll want to know exactly where you stand if you’re a numbers person. Cholesterol is measured in mmol/L, which stands for millimoles per litre of blood.
You will see a number of different types of cholesterol on your test results, including total cholesterol, LDL and HDL. HDL is sometimes known as ‘good’ cholesterol because of its role in removing other, more harmful types of cholesterol from the body. LDL is the type of cholesterol which can build up in the blood vessels and cause problems.
Adults should aim for a total cholesterol level of 5mmol/L or less. People at high risk of cardiovascular disease should aim for 4mmol/L or less.
However, the cholesterol number alone is not the whole picture. Cholesterol is just one part of your overall cardiovascular risk, and needs to be looked at in the context of your general health.
Your doctor may use your cholesterol results to calculate your risk of heart attack or stroke over the next 10 years using a calculator called QRISK. It checks many risks, such as your family history, to see what treatment is right for you. Your doctor may recommend medication to lower your cholesterol if you have a high QRISK score.
Bear in mind that your cholesterol reading may become raised for a short time if you are actively losing weight, have recently lost weight or if you’re pregnant or breastfeeding.
How does menopause affect cholesterol?
High cholesterol is more common after menopause. It’s typical to see higher levels of ‘bad’ fats in the blood, known as LDL cholesterol and triglycerides, as well as less ‘good’ fats, known as high-density lipids (HDL).
It is thought that this is partly because oestrogen levels fall during this time. Other menopause changes, such as weight gain and lower exercise levels, are also likely to blame.
How can you improve your cholesterol?
Improving your lifestyle and taking medication can help lower your cholesterol levels.
Lifestyle changes that will help include:
- Moving more
- Drinking less alcohol
- Losing some weight if your BMI is over 25
- Eating healthier foods
How to eat to improve your cholesterol
Current advice says that you should get less than 30% of your daily calories from overall fats, and less than 7% of those from saturated fats, which are found in animal products including dairy.
This means that most of the fat you eat should come from wholefoods that are high in ‘good’ fats such as:
- Olive oil
- Fish
- Nuts
- Seeds
- Wholegrain products
- Fruits
- Vegetables – including the trusty avocado!
What medication can help?
Your doctor may recommend medication to reduce your cholesterol if you are at high risk of cardiovascular disease. There are various options, but they will usually prescribe statins. This group of medicines includes atorvastatin, simvastatin, pravastatin and rosuvastatin.
Statins have revolutionised cardiovascular medicine over the past few decades and work very well to both reduce your cholesterol and stabilise plaques of cholesterol buildup in the blood vessels. While statins aren’t suitable for everyone, they may be a useful addition.
HRT has also been shown to reduce cholesterol levels, but it is not usually prescribed for this reason alone because the risks would generally outweigh the benefits. Of course, lower cholesterol might be a welcome side effect if you’re using HRT for menopause relief!
Can you take hormone replacement therapy (HRT) with high cholesterol?
The answer is different for everyone, but HRT may be recommended to people with high cholesterol as the best treatment for their menopause symptoms. It is also safe to take HRT at the same time as cholesterol medication, including statins.
Your doctor will help you weigh up the pros and cons of taking HRT when deciding on the right menopause treatment for you. If you are at higher risk of cardiovascular disease, such as high cholesterol, they may be concerned about the risk of blood clots linked to some types of HRT.
If you have high cholesterol your doctor may recommend:
- Types of HRT that are applied to and absorbed through the skin such as a patch, gel or spray. These come with a lower risk of blood clots and strokes
- Micronized progesterone or dydrogesterone – which is found in Femoston – if you still have a womb as the progesterone part of your HRT. These have less of an impact on your blood lipids
Your doctor will prescribe the lowest dose needed to control your symptoms for the shortest time possible.
Final word
Taking control of your cholesterol is a great way to invest in your future health, especially during and after menopause. You’re just one appointment away from making a real difference to the rest of your life.
Find out more about menopause on our blog or in our symptoms library.
- Ambikairajah A, Walsh E, Cherbuin N 2019, ‘Lipid profile differences during menopause: a review with meta-analysis’, Menopause, vol. 26, no. 11, pp. 1327-1333
- Anagnostis P, Bitzer J, Cano A, Ceausu I, Chedraui P, Durmusoglu F, Erkkola R, Goulis DG, Hirschberg AL, Kiesel L, Lopes P, Pines A, van Trotsenburg M, Lambrinoudaki I, Rees M 2020, ‘Menopause symptom management in women with dyslipidemias: An EMAS clinical guide’, Maturitas, vol. 135, pp. 82-88
- Beckett N, Nunes M, Bulpitt C 2000. Is it advantageous to lower cholesterol in the elderly hypertensive? Cardiovasc Drugs Ther. 2000;14(4), pp397-405
- National Institute for Health and Care Excellence (NICE) 2023, Hypertension in adults: diagnosis and management [Clinical Guideline 181]
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