Managing Perimenopause With High Cholesterol
Cholesterol levels often shift during perimenopause. Find out why it happens and how to manage your cardiovascular health through the transition.
Why Cholesterol Changes During Perimenopause
Many women are caught off guard when routine blood tests reveal rising cholesterol in their mid-40s or early 50s, particularly when their levels were previously healthy and their lifestyle has not changed. The cause is largely hormonal. Oestrogen has a direct effect on cholesterol metabolism: it helps raise HDL, the protective form of cholesterol, and keeps LDL at a lower level. As oestrogen declines during perimenopause, LDL tends to climb and HDL may fall, shifting the ratio in a less favourable direction. Triglycerides also tend to rise. This is not a personal failure or a result of poor choices; it is a physiological response to hormonal change that affects a significant proportion of women during this phase.
The Cardiovascular Risk Context
Before menopause, women generally carry a lower risk of heart disease than men of the same age. After menopause, that advantage narrows considerably and within a decade largely disappears. The perimenopausal transition is therefore an important window for establishing habits and, where needed, treatments that protect long-term cardiovascular health. High cholesterol is one piece of a larger picture: overall cardiovascular risk is calculated using blood pressure, smoking status, family history, body weight, blood sugar, and age alongside cholesterol numbers. A full cardiovascular risk assessment with your GP during perimenopause gives you a clearer view of where you stand and what needs attention.
Diet Adjustments That Move the Needle
Reducing saturated fat and replacing it with unsaturated fats from olive oil, nuts, avocado, and oily fish produces meaningful reductions in LDL cholesterol. Increasing soluble fibre from oats, beans, lentils, and vegetables lowers LDL further by reducing how much cholesterol is absorbed from the gut. Ultra-processed foods tend to be high in both saturated fat and refined carbohydrates, and cutting back on them benefits cholesterol, blood sugar, and weight simultaneously. These changes are well-established in the evidence and do not require extreme measures. Consistency over months matters more than perfection on any given day, and the changes also support perimenopausal wellbeing more broadly.
Exercise and Its Cholesterol Benefits
Regular aerobic exercise is one of the most reliable ways to raise HDL cholesterol. Brisk walking, cycling, swimming, and dancing all count and all produce cumulative benefits when done consistently. Resistance training complements aerobic exercise by improving overall metabolic health and helping maintain muscle mass, which declines during perimenopause and contributes to abdominal weight gain and worsening cholesterol profiles. Combining both types of exercise, three to five times per week across the week, produces the best results. Tracking your workouts over time helps you see patterns and stay motivated, especially during weeks when symptoms make it harder to feel like activity is worthwhile.
When Medication Becomes Appropriate
For some women, lifestyle changes alone are not sufficient to bring cholesterol into a healthy range, particularly if there is a strong genetic component or if cardiovascular risk is already elevated due to other factors. Statins are the most widely prescribed cholesterol-lowering medications and are generally well-tolerated. Some women experience muscle aches when starting a statin, which is worth raising with your doctor rather than stopping the medication unilaterally, since dose adjustments or switching to a different statin often resolves the issue. During perimenopause, the threshold for considering statins may be lower than in earlier life, given the overall shift in cardiovascular risk that this phase brings.
HRT and Its Effect on Cholesterol
There is reasonable evidence that HRT, particularly transdermal oestrogen, has a neutral or modestly beneficial effect on cholesterol in perimenopausal women. Oral HRT metabolises differently through the liver and may raise triglycerides in some women, so the route of administration matters. The decision about HRT should be based primarily on your symptom burden and overall health profile rather than on cholesterol management alone. Women with high cholesterol are not automatically excluded from HRT. For some, reducing severe perimenopausal symptoms improves sleep, reduces stress, and enables more consistent exercise, all of which indirectly benefit cardiovascular health in ways that go beyond cholesterol numbers.
Monitoring Progress Over Time
Annual fasting lipid blood tests give you a clear picture of how your cholesterol is responding to dietary changes, exercise, or medication. Keeping your own record of results over time, alongside notes on what you have been doing differently, makes each appointment more productive and helps you see the direction of travel rather than fixating on single data points. Cholesterol management during perimenopause is a long game. The habits built now, consistent movement, a diet that favours unsaturated fats and fibre, regular monitoring, and open communication with your GP, produce cardiovascular benefits that protect you well beyond the menopause transition and into the decades that follow.
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