How does the lipid profile change after menopause, and what can you do about it?

After menopause, LDL cholesterol (the 'bad' cholesterol) rises measurably, and this is not simply a consequence of ageing: the effect remains visible even after correcting for age. At the same time, HDL cholesterol (the 'good' cholesterol) falls, and the longer the menopause lasts, the lower HDL turns out to be. In addition, triglycerides and lipid-rich lipoproteins rise. Lipoprotein(a), an extra risk factor that few people have heard of, also increases in women after menopause. All these changes together make cardiovascular risk after menopause considerably greater.

The decline in oestrogen is the primary driver of these shifts. Women die from cardiovascular disease more often than men, and that risk increases substantially after menopause. Yet in practice, high cholesterol in women is more often recognised too late and treated insufficiently.

On the lifestyle side, a review analysis shows that moderately eating less and exercising aerobically on a regular basis can counteract the unfavourable lipid changes. There are no separate randomised trials in these sources that quantify this precisely, but the direction is clear enough to take exercise and diet seriously as a first step.

The herbal preparation black cohosh (160 mg per day, three months) showed no demonstrable effect whatsoever on cholesterol or triglycerides in a double-blind randomised study involving 310 peri- and postmenopausal women. This product therefore offers no added value for the lipid profile.

Menopausal hormone therapy showed a more favourable lipid profile in a prospective cohort study: more large HDL particles and fewer small LDL particles. Because this concerns observational research, caution in interpretation is appropriate. Actively lowering high cholesterol after menopause, preferably in consultation with your doctor, can help prevent cardiovascular disease.