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    How Menopause Affects Cholesterol Levels, and Ways to Manage It

    How Menopause Affects Cholesterol Levels, and Ways to Manage It


    If lifestyle changes aren’t enough to manage your cholesterol, your healthcare provider might recommend medication.

    Statins

    Statins, such as atorvastatin (Lipitor) and simvastatin (Zocor), are the most commonly prescribed cholesterol-lowering medications. They work by slowing down your body’s production of cholesterol and helping your liver remove LDL from your bloodstream.

     Some people may experience side effects like muscle pain, liver damage, or increased blood sugar when taking statins. Increased blood sugar could lead to a higher risk of type 2 diabetes, so it is important to discuss the risks with your doctor before choosing to take statins.

    Klodas notes that for people without a history of heart problems, stroke, or other medical conditions, testing may help determine if cholesterol-lowering medication is necessary.

    “I often use a coronary artery calcium scan [a computer tomography (CT) scan that measures calcium deposits in the heart’s arteries] to determine whether a postmenopausal woman should be placed on a statin,” she explains. “In general, anything but a score of 0 pushes me in the direction of prescribing a statin,” she adds.

    Other Cholesterol Medications

    Other cholesterol-lowering medications include:

    • Selective cholesterol absorption inhibitors, like ezetimibe (Zetia). Side effects include stomach pain, diarrhea, fatigue, and muscle soreness.
    • PCSK9 inhibitors, like evolocumab (Repatha), which are injected into the bloodstream. Side effects are swelling, itching, or pain at the injection site.
    • Fibrates, like fenofibrate (Antara) or gemfibrozil (Lopid). Nausea, stomach pain, and muscle pain are common side effects.
    • Niacin (Niacor or Niaspan) Facial flushing, itching, upset stomach, and blood sugar increase are possible side effects.
    • Bile acid sequestrants, such as cholestyramine (Prevalite). Side effects tend to be gastrointestinal issues, such as constipation.
    PCSK9 inhibitors are used for people who have heart disease and can’t take statins or for treating familial hypercholesterolemia, a genetic disorder that causes high LDL (“bad” cholesterol) levels. Others, such as ezetimibe, are often used in combination with statins to further reduce cholesterol levels.

    Hormone Replacement Therapy

    HRT may have a small impact on cholesterol levels, but it’s unlikely to get those levels back to what they were before menopause, explains Klodas. For this reason, HRT should be primarily considered for managing menopausal symptoms rather than cholesterol levels, she adds.

    Hormone therapy is not intended to prevent heart disease, either, says Dweck, though women who start menopause hormone therapy (MHT) before age 60 and within 10 years of menopause may see some heart health benefits.

    If you’re considering hormone therapy, discuss the potential benefits and risks with your healthcare provider.

    Supplements

    Certain supplements may help support healthy cholesterol levels during menopause, though they’re not a replacement for lifestyle changes or prescribed medications. Adding omega-3 supplements, such as fish oil, to your routine may help lower triglycerides and boost HDL cholesterol, though it may also slightly increase LDL, says Dweck.

    Here are some supplements that may improve cholesterol levels:

    • Plant stanols and sterols: These natural compounds found in plants may reduce LDL cholesterol, but they can cause digestive issues like diarrhea.

    • Ground flaxseed: May help lower LDL cholesterol while providing fiber and omega-3s.
    • Berberine: This natural compound found in plants may reduce LDL cholesterol and triglycerides, but can cause digestive issues like diarrhea and nausea.

    • Green tea extract: May help lower LDL cholesterol.
    • Garlic: May slightly lower cholesterol, though research is mixed. It can cause digestive issues and may interact with blood thinners.

    Always speak with your healthcare provider before starting any supplement, as some supplements can interact with medications or have side effects.

    The Takeaway

    • Decreased estrogen, muscle loss, and weight gain during menopause can affect cholesterol levels.
    • Low-density lipoprotein (LDL), triglycerides, and total cholesterol tend to rise after menopause, while high-density lipoprotein (HDL) levels may decrease, increasing the risk of heart disease and stroke.
    • Heart-healthy habits like Mediterranean-style eating, healthy weight, and regular exercise can help manage cholesterol levels.
    • If lifestyle changes aren’t enough, medications like statins can be used to manage cholesterol. Discuss the benefits and risks with your healthcare provider.



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