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The Perimenopause Heart Check: Why Your Cholesterol Might Be Climbing—and What to Do About It

"The overlap and increased risk and timing of menopause is not coincidental, as menopause is known to drive up total cholesterol, LDL, and triglycerides, which are established risk factors for heart disease."​ ~ Dr. Mary Clare Haver, The New Menopause

Wait… What Happened to My Cholesterol?!

I nearly fell off my chair when I saw my cholesterol levels in my latest perimenopause blood test. My LDL cholesterol had climbed higher than ever before—not quite in the danger zone, but enough to make me think, “What the hell?!”

Turns out, I wasn’t alone. Many women in perimenopause experience unexpected cholesterol spikes as estrogen levels decline. Since estrogen helps regulate heart health, HDL cholesterol, and fat metabolism, lower levels can lead to higher LDL, increased inflammation, and a greater risk of heart disease—even if your diet hasn’t changed.

So, why exactly does perimenopause affect cholesterol? And what can you do to protect your heart health? Let’s break it down.

The Cholesterol Breakdown: The Good, The Bad, and the Heartbreaker

Cholesterol is often painted as the villain, but it’s actually essential for hormone production, brain function, and even digestion. The trick? Keeping the right balance.

• LDL (The "Bad" One): Think of LDL as the sticky sludge that clogs up your arteries. High LDL levels increase the risk of heart disease by contributing to plaque buildup, which can lead to heart attacks and strokes.

• HDL (The "Good" One): HDL is like a cleanup crew—it helps sweep cholesterol back to the liver for disposal. Higher HDL levels = a healthier heart.

In our reproductive years, estrogen helps keep LDL in check while boosting HDL. But as estrogen levels dip during perimenopause, the balance shifts. LDL creeps up, HDL dips, and suddenly, heart health becomes a much bigger conversation.

“Heart disease remains the number one killer in women, even after a diagnosis of breast cancer, and markers of declining heart health, such as dyslipidemia and increased arterial plaque, can be brought about by the loss of estrogen in menopause”

~ Mary Claire Haver, The New Menopause: Navigating Your Path Through Hormonal Change with Purpose, Power, and Facts

Why Perimenopause Messes with Cholesterol (And Your Heart)

Estrogen does more than regulate your periods—it plays a starring role in heart health. Here’s how:

💗 It Helps the Liver Remove LDL: Estrogen increases LDL receptors in the liver, making it easier for your body to clear out excess cholesterol. When estrogen declines, LDL levels rise.

💗 It Boosts HDL: Higher estrogen levels mean higher HDL. When estrogen drops, so does your body's ability to remove bad cholesterol effectively.

💗 It Reduces Inflammation: Estrogen has anti-inflammatory properties that protect blood vessels. Without it, arteries become more prone to plaque buildup.

💗 It Regulates Fat Metabolism: Estrogen influences how your body processes and stores fats. A drop in estrogen can lead to increased fat storage, particularly around the midsection, which is a risk factor for heart disease.

🚨 The Menstrual Cycle Factor: Even before perimenopause, cholesterol levels naturally fluctuate throughout the menstrual cycle. Estrogen peaks in the follicular phase (the first half), keeping LDL lower. In the luteal phase (the second half), estrogen dips, and LDL rises. But once estrogen levels start declining overall, the protective effect disappears—leaving your heart more vulnerable.

How to Keep Cholesterol in Check During Perimenopause

You’re not powerless here. A few key changes can make a world of difference in protecting your heart health:

1. Eat Smart: The Perimenopause Heart-Healthy Diet

✔ Up Your Fiber Game

• Think oats, beans, lentils, flaxseeds, chia seeds, and loads of veggies. Fiber binds to cholesterol and helps your body flush it out before it can cause trouble.

✔ Choose Healthy Fats

• Swap out saturated fats (red meat that's not grass-fed, processed dairy) for heart-friendly unsaturated fats (olive oil, avocados, nuts, and fatty fish like salmon). These fats support HDL while reducing LDL.

✔ Cut Back on Sugar and Processed Carbs

• Spikes in blood sugar trigger inflammation and worsen cholesterol balance. Reduce refined carbs and added sugars to support stable cholesterol levels.

✔ Stay Hydrated

• Proper hydration helps your liver process and remove excess cholesterol. Aim for plenty of water daily.

✔ Get Your Probiotics In

• Fermented foods like yogurt, kefir, sauerkraut, and kimchi contain probiotics that can support gut health and help regulate cholesterol metabolism.

2. Consider HRT: Is It Right for You?

HRT (Hormone Replacement Therapy) is a game-changer for some women when it comes to cholesterol and cardiovascular health. Here’s why:

✔ Lowers LDL — Estrogen helps remove LDL cholesterol from the bloodstream, reducing plaque buildup.
✔ Increases HDL — Helps maintain high HDL levels, offering continued heart protection.
✔ Reduces Inflammation — Supports blood vessel function and keeps arteries more flexible.

But—and this is important—HRT isn’t for everyone. If you're considering it, talk to a doctor who understands perimenopause and heart health.

3. Lifestyle Upgrades for a Healthy Heart

✔ Move Your Body

• Exercise raises HDL, lowers LDL, and improves overall heart function. Aim for strength training + cardio + flexibility exercises like yoga.

✔ Quit Smoking

• Smoking lowers HDL and raises LDL. The sooner you quit, the better your heart health will be.

✔ Ditch the Alcohol

• Contrary to old advice, there’s no level of alcohol that benefits heart health. It disrupts hormone balance and contributes to cholesterol imbalances.

✔ Manage Stress

• Chronic stress raises cortisol, which can contribute to higher cholesterol and inflammation. Try meditation, breathwork, or anything that helps you unwind.

Final Thoughts: Your Cholesterol Wake-Up Call

If you’ve been feeling blindsided by unexpected cholesterol spikes during perimenopause—welcome to the club. The good news? With the right nutrition, lifestyle shifts, and (for some) HRT, you can take back control of your heart health.

💡 Take Action Today:
✅ Get your cholesterol checked regularly.
✅ Add heart-healthy foods to your diet.
✅ Consider talking to a doctor about HRT if it makes sense for you.
✅ Prioritize movement and stress management.

Because the more you understand your body, the better you can support it. And that’s a power worth holding onto. 💖

Hormonally yours,

Kimberlee Erin

✨ Perimenopause Power Moves: Transform Your Hormones and Health! ✨
Grab your free guide today! Recipes included!
👉 Download Now!

References and Further Reading:

• "Estrogen's Effects on the Liver and Cholesterol Levels," Journal of Women's Health.

• "Dietary Recommendations for Managing Cholesterol," American Heart Association.

Just a heads-up: I’m a Certified Menopause Coaching Specialist and Holistic Nutritionist, and while I love sharing what’s worked for me and my clients, this blog is for informational purposes only. It’s not a substitute for medical advice. Always check in with your healthcare provider before starting new supplements, hormones, or treatments—especially since every woman’s perimenopause journey is different. You deserve personalized care that truly fits you.