KEli Officer, 49, eats a plant-based diet and avoids most processed foods. So, after a recent routine blood test showed she had high cholesterol, “I was shocked and upset,” she says, “because it never happened.” [high] In the past.”
The officer is not alone. as such Women entering menopauseCholesterol levels jump—an average of 10-15%, or about 10 to 20 milligrams per deciliter. (A healthy adult’s cholesterol ranges from 125 to 200 milligrams per deciliter, according to the National Library of Medicine.)
This change often goes unnoticed amidst the physical symptoms and general preoccupation of those years. But, says Dr. Erin Michus, director of women’s cardiovascular health at Johns Hopkins Medicine, “we need to screen women and know their numbers.” High cholesterol is a major risk factor for heart disease, which kills more women in the United States than any other cause, including all forms of cancer combined. The longer a person with high cholesterol lives, the more likely it is to build up in their arteries and cause a heart attack or stroke.
Many factors around middle age conspire to raise cholesterol levels, such as a sedentary lifestyle, less healthy diet, and weight gain. But the factor that stands out as a clear driver of this shift is the sudden and inevitable drop in estrogen levels at menopause. Unlike other problems that begin in perimenopause — mood changes, hot flashes, fatigue — high cholesterol tends to occur fairly suddenly, usually in the year before menopause.
Researchers are learning more about how and why this change occurs, how it is best examined, and the best treatments for women. But the first step is to admit it. “This is a natural transition,” Michus says. Menopause is an essential time for women to check on their health.
Read more: How to lower cholesterol naturally
Big cholesterol change
Before women go through menopause, which typically reaches around age 51 in the United States, they tend to have healthy cholesterol profiles and lower rates of cardiovascular disease than their male counterparts. But with the onset of menopause, this advantage decreases. By the time people reach their 60s and 70s, rates of cardiovascular disease are roughly equal between the sexes, with women outpacing men at this risk by their 80s. Women who go through menopause early have a higher risk sooner.
The protective effect of estrogen on cholesterol is evident even before menopauseCholesterol levels rise and fall slightly with estrogen level fluctuations throughout each menstrual cycle. Researchers are still exploring the details of how estrogen affects cholesterol, but much of it can be traced back to the liver, where estrogen receptors help determine a person’s lipid profile.
The resulting patterns are clear: once the body stops producing as much estrogen, the overall fat profiles become more harmful. Levels of “bad” cholesterol (low-density lipoproteins, or LDL) and triglycerides rise, and “good” cholesterol (high-density lipoproteins, or HDL) falters.
Even residual high-density lipoprotein (HDL) cholesterol may become less protective, says Samar Al-Khodari, associate professor in the University of Pittsburgh School of Public Health. Her research showed that although HDL is a marker of a lower risk of heart disease before menopause, the opposite may be true after menopause. So it’s not just about the amount and balance of these particles, but also that “the quality of these particles changes as women go through menopause,” she says.
test and evaluation
The only way to determine your cholesterol levels around menopause is to test them. But predicting the timing is difficult. Menopause is usually only evident once it’s over and a year has already passed without a period.
Current recommendations suggest that most people at low risk of cardiovascular disease have their cholesterol checked every five years, starting at age 20 (even children and teens should have a baseline cholesterol screening.) Experts recommend additional testing if there is a family history of high cholesterol. cholesterol or there has been a significant health change, such as abdominal weight gain, periods of high stress, or menopause.
Regular exams are important because Heart disease risk High cholesterol rises for longer without treatment. And cholesterol can be a quiet killer: “If you don’t check, you don’t know,” says Dr. Samia Mora, MD, a cardiovascular specialist and director of the Center for Lipid Metabolism at Brigham and Women’s Hospital and associate professor at Harvard Medical School.
Of course, not all women who go through menopause develop high cholesterol. If a person’s base cholesterol is healthy, and if other risk factors for heart disease are low, then average high cholesterol levels are not immediately cause for concern.
But additional testing may be warranted if cholesterol levels or other cardiovascular disease risk factors (such as family history, high blood pressurediabetes, obesity, and smoking) are elevated. Other tests that doctors may recommend include a coronary calcium scan, which measures the amount of plaque buildup in the arteries around the heart, or a lipoprotein(a) test, a form of low-density lipoprotein that can reveal more about cardiovascular risks.
Al-Khodari and others say clinicians should also start looking beyond standard fat panels to get more details about a person’s cholesterol, including the size, shape and composition of the particles. Research has found, for example, that particles smaller than LDL are more harmful than larger ones. Such tests exist—Khodari and others use them in research—but they can hardly pass regular doctor visits. She says incorporating these details into care could be most beneficial for women as they transition through menopause and shape their health for the next decades of life.
The treatment is successful
For women whose cholesterol rises to unhealthy levels during menopauseLifestyle modifications are usually the first recommendation. “We can’t avoid aging, nor can we avoid our genetics, but we can change our lifestyle to counter these effects,” Mora says.
Diet alone can affect cholesterol by 20 to 30 milligrams per deciliter. Even when diet alone can’t get someone into a healthy range, Michos likes to remind patients that their cholesterol is potentially more harmful without the extra effort. She sees a lot of women going through menopause, and even with a vegan diet, they eventually need a cholesterol-lowering medication.
Statins are the standard pharmaceutical treatment for people with high cholesterol, including those in menopause. But women are less likely to take statins, because a group of health care providers are less likely to recommend them, and women are less likely to agree to take them. This trend is unfortunate because women can get more benefit from statins than men, says Dr. Patricia Best, MD, a cardiologist at the Mayo Clinic and Women’s Heart Clinic and an assistant professor in the Mayo Clinic College of Medicine and Science.
It’s better for people to get frustrated when their lifestyle efforts fail to generate healthy cholesterol levels — and then many avoid medications because taking them makes them feel like they’ve failed. “It’s really important to understand that sometimes even if you do everything right, you still need medication,” Best says. She says this is not a failure. Getting started with medication to control high cholesterol is successful: “The most important thing is to stay healthy for the long term.”
Experts also warn that the way many doctors calculate the need for statins or other cholesterol treatments is based on a 10-year risk for a major event such as a heart attack or stroke. But, particularly for middle-aged women, these risk rating systems do not capture the lifetime risk and years of risk accumulation that led up to that point. You don’t want to wait until age 65 to start applying all these precautions [measures] This will help improve the quality of life throughout the rest of her years,” says Mora.
If lower estrogen increases cholesterol, how about adding estrogen back into the body, as with hormone replacement therapy? HRT is usually taken as a synthetic estrogen pill, and is often prescribed for hot flashes and other menopausal symptoms. Many women who take it notice an improvement in their cholesterol levels. However, it’s not recommended as a cholesterol-only drug, in part because estrogen also increases the risk of blood clots.
As with a lot of health, your best bet is prevention, which includes following a healthy lifestyle for as many years as possible. “It’s not just about how high your cholesterol is now, but how long it’s been high,” Mora says. “All years in which high cholesterol is exposed are cumulative. On the positive side, lifestyle interventions are also cumulative.”
How – and Why – Prioritize Cholesterol
Menopause often coincides with a potentially stressful and busy time in women’s lives, when their careers are still in full swing, and they may be caring for their children and parents. Amid these stresses, women often put their health aside, forgoing exercise and healthy food — and missing out on routine health care, including cholesterol checks.
Best says healthy habits during this time are especially important. “A little more exercise, more thinking [about] Diet can really make a big difference — because over the next decade, women are at significantly increased risk of developing heart disease.”
The hard truth is that with the inevitable metabolic shifts during middle age, what used to work to stay healthy may not be cutting it anymore, Best says. “Your body is changing, so you have to adapt.”
When the shift in hormones is combined with weight gain, “that’s one or two punches” that can cause a cholesterol reading to rise — often for the first time in a woman’s life, Best says. This style has become more and more popular in the past couple of years. For example, although the officer used to exercise regularly, since the pandemic disrupted her previous routine, she says the healthy habit has slipped out of the way, and she has now gained additional weight.
To help combat the cholesterol shifts associated with menopause, women don’t need to start running marathons or even go completely vegan, says Mora. She recommends a heart-healthy diet, such as the Mediterranean diet, with plenty of fruits, vegetables, whole grains, and low amounts of processed foods and refined carbohydrates. She says other often-overlooked lifestyle modifications, including getting enough sleep and controlling stress — which can not only help with cholesterol but also cardiovascular and metabolic health, she says.
Mora, who was in menopause herself, tries to follow smart lifestyle habits about 80-90% of the time. This means that she eats a lot of fruit and nuts and goes up the stairs instead of the elevator – but she still occasionally eats the dark chocolate bar. “We’re overwhelmed trying to change everything at once,” Mora says. “All you have to do is adopt a moderate amount of healthy lifestyle behaviors that you do consistently most of the time.”
Best agrees that trying to make healthy decisions all the time can be daunting. The 53-year-old, mother of two, married, holds several positions at the Mayo Clinic as well as other professional groups. “So I totally understand my patients when they are like, ‘Are you kidding me? How am I going to fit in?’”
The best is to introduce healthy activities into her daily life, such as cooking as a family or walking with her husband. It’s not only good for her health, she says, “but it’s good for everyone else in the family.”
Despite these efforts—and her own clinical experience—Best’s cholesterol level rose during menopause. “It’s always disappointing,” she says. She did not lose her resolve though. “You’re expected to gain weight and raise your cholesterol, but you can also fight off all of these things.”
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