Rising cholesterol as you head into menopause?

I talk to a lot of women about their cholesterol as they age, and increasingly I am speaking to women post menopause (or in the transition to menopause) about an appropriateness of a statin (cholesterol-lowering medication). Now, as I’m not a medical doctor, I can’t make any recommendations one way or another. However, whether or not statins should be the first line of defence treatment in the case of increasing cholesterol levels in women does remain debatable. There are studies where there is no benefit on overall mortality nor coronary events. Clinical trials also suggest that overall mortality and coronary heart disease isn’t reduced with the use of a statin. There’s also evidence to suggest that cholesterol has a protective effect on the brain as we age. 

The problem, like many things in health, is that there appears to be evidence to support both sides (statins v no statins) and therefore a different opinion wherever you look. The reason we are so interested in cholesterol is because it is singled out as the main risk factor for cardiovascular disease, despite the growing evidence that low density lipoprotein (LDL) particle size, type and number may be infinitely more important. Apo-B lipoprotein, a molecule attached to the LDL, appears to determine atherosclerosis risk way more than LDL itself, and it isn’t measured in standard laboratory tests. An individual’s triglyceride level, in combination with their high density lipoprotein (HDL) reading is another important ratio, especially if it is considered in light of waist circumference (as a proxy for visceral fat) and insulin level, fasting glucose or overall blood sugar control. These don’t often feature in the conversations relayed back to me between women and their GPs about their cholesterol readings, which makes me wonder if updated cholesterol information is being filtered down to recommendations at the laboratory level. 

At any rate, I have had several panicked women tell me they have been threatened with statin therapy to lower their rising cholesterol if they don’t do something about their diet and exercise patterns. Ironically, these are often women who are currently doing (or have just completed) one of my fat loss programmes and are well on their way to a sustaining an overall healthier state. It makes me think that other considerations need to be highlighted when it comes to increasing cholesterol (putting aside the argument that it isn’t something to worry about). 

First consideration: oestrogen is involved in cholesterol metabolism and clearance, helping maintain levels of HDL cholesterol and lowering LDL cholesterol levels. When oestrogen declines in menopause, this will change baseline cholesterol levels and they will be higher. 

Second consideration: oestrogen and progesterone are both involved in thyroid metabolism. Oestrogen can affect levels of thyroid-binding globulin in the blood, a protein that carries thyroid hormones to where they are required. Changes in oestrogen can increase TBG and reduce free thyroid hormone available to the body. As we age (men and women) we are at greater risk for hypothyroidism anyway. This may exacerbate this. Sub-optimal thyroid function can lead to elevated cholesterol levels. Thyroid hormones help stimulate the liver to break down cholesterol, thus regulating cholesterol in the blood. With insufficient thyroid hormone, the body’s ability to clear cholesterol is compromised, thus leading to elevated cholesterol levels.  

Third consideration: The fluctuating hormones during peri menopause can lead to significantly heavy periods, which reduces iron availability. While indirect, low iron can have implications for cholesterol levels, and this is seen in observational and preclinical studies  in part because of iron’s role in maintaining thyroid function. Conversely, once through the transition, women are no longer losing iron each month through a monthly bleed. This could cause iron overload in the body, increased oxidative stress and inflammation and change how cholesterol is metabolised, potentially increasing LDL cholesterol. 

Fourth consideration: low vitamin D is super common, particularly in the winter months in New Zealand. Research has pointed to a low level of vitamin D and higher levels of cholesterol. Low vitamin D is also associated with greater risk of atherosclerosis, it impacts negatively on nitric oxide production and low levels can increase inflammation, further influencing cholesterol levels in the blood. 

So – all this to say, that if you have been red flagged for your cholesterol level, then investigating other biomarkers to ensure they are optimised could be the answer here. It may not be your cholesterol. It could be oestrogen levels, thyroid function (many menopausal symptoms look like low thyroid function), iron levels and/or vitamin D levels. These warrant a deeper dive before being put on medication for cholesterol, as all are intricately linked to cholesterol metabolism. 

Speaking of women… I’m running a webinar on Sunday 7 April about health and understanding risk of chronic disease as it relates to hormones. I’ll dive into why legitimate experts can have contradicting recommendations and how best to understand how you might support your hormones. If you feel overwhelmed or confused about this (and many women do!) then absolutely is worth registering for this. It is being recorded so if you can’t make it live, you’ll be sent a recording. Click here for more information.