Menopause Estrogen and Cholesterol: As Women Age Cholesterol Levels and Bad LDL Rise, Good HDL Falls

Generally women have higher good HDL levels than men, especially during childbearing years when estrogen production is highest, and even after menopause. According to the FDA, estrogen appears to help younger women maintain a healthy balance between LDL and HDL cholesterol, making them six times less likely to experience a heart attack than men age 50 and younger.

After menopause, when estrogen is no longer present, a woman’s risk for heart disease is about the same as a man’s, as bad LDL levels rise, accompanied by atherosclerosis (narrowing of the arteries). According to the National Institute on Aging, it is probably advancing age—not menopause itself—that is the likely cause of a woman’s rising cholesterol.

Postmenopausal hormone therapy: heart-friendly or harmful?

The American Heart Association (AHA) recommends against postmenopausal estrogen-progestin hormone replacement therapy (PHT) solely to prevent cardiovascular disease in women who have or have not had a heart attack or stroke. According to the Heart and Estrogen/Progestin Replacement Study (HERS), a clinical trial of 2800 women with known coronary disease conducted by Dr. Deborah Grady at the University of California San Francisco, there was no reduction in the risk of heart attack or stroke among the women who took the hormones for 4 years.

Subsequently, another similar large clinical trial was conducted, the Women’s Health Initiative (WHI). This major 15-year research program sponsored by the National Institutes of Health (NIH), National Heart, Lung, and Blood Institute (NHLBI) addressed the most common causes of death, disability and poor quality of life in postmenopausal women. The study confirmed that hormones do not reduce risk of coronary heart disease. Indeed, the trial was halted after investigators found the health risks of the combination hormone therapy outweighed the benefits and such therapy may even increase the risk of coronary heart disease.

Preventive cholesterol-lowering measures

  • Awareness—according to Lori Mosca, MD, PhD, director of preventive cardiology at New York-Presbyterian Hospital, a majority of women over 50 have high cholesterol but are unaware of it. Even though heart disease and stroke kill almost 500,000 women a year, they are less likely than men to be treated for the condition. Although many women visit gynecologists for pap and breast exams, these are no substitute for annual wellness physicals and blood work through a family practice or internal medicine doctor. Dr. Mosca recommends women should know their HDL, LDL and triglyceride levels and ask their physicians if and how they could be improved.
  • Diet—According to the Cleveland Clinic Information Center, menopausal women should get sufficient quantities of calcium, iron, fiber, fruits and vegetables and water, and limit intakes of salty and fatty foods, especially those high in trans and saturated fats found in meat and dairy products. Read food labels, substitute low fat dairy products and limit cholesterol intake to 300 milligrams daily.
  • Supplements—The AHA recommends eating oily fish at least twice a week, and consider taking an omega-3 capsule supplement of 850–1000 mg of EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) in women with heart disease, two to four grams for women with high triglycerides.
  • Lifestyle Changes—a healthy diet, along with exercise, weight control, not smoking and limiting alcohol, can collectively improve cholesterol in lower risk women as much as medication can.

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