Why Cholesterol Spikes in Perimenopause: What Every Woman Over 40 Needs to Know

"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

🥬 Kale, Cardio… and Climbing Cholesterol?

A friend of mine—let’s call her Karen—has lived like a wellness guru for years. She’s the type who starts her mornings with lemon water, logs 10,000 steps by noon, and treats kale like it’s a love language. So imagine her horror when a routine blood test during perimenopause revealed her cholesterol was up—way up.

“I don’t even eat cheese,” she said, eyes wide. “How is this possible?!”

It’s possible. And it’s more common than you might think.

Even for women who eat well, exercise consistently, and do everything right, perimenopause can trigger cholesterol spikes—thanks to one powerful hormonal player: estrogen.

So if you’re scratching your head over rising LDL or a sudden concern about heart health during your 40s or 50s, you’re not alone. Let’s unpack what’s happening and what you can do about it.

🫀 Cholesterol 101: The Good, The Bad, and The Hormonal Twist

Cholesterol often gets a bad rap, but your body needs it—it’s essential for building hormones, supporting brain function, and creating cell membranes. The key is keeping the right balance:

• LDL (Low-Density Lipoprotein) – Known as the "bad" cholesterol. When levels are high, LDL contributes to plaque buildup in your arteries, increasing the risk of heart attacks and strokes.

• HDL (High-Density Lipoprotein) – The "good" cholesterol. HDL helps remove cholesterol from the bloodstream and returns it to the liver for disposal, protecting your heart.

During your reproductive years, estrogen acts as a natural protector—keeping LDL lower and boosting HDL. But as estrogen declines in perimenopause, that protective effect fades. This shift can raise LDL, lower HDL, and trigger inflammation, even if your habits haven’t changed.

“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.”
— Dr. Mary Claire Haver, The New Menopause

🔬 Why Cholesterol Changes in Perimenopause

So what exactly is going on?

💗 Estrogen’s Key Roles in Heart Health:

• Clears Out LDL: Estrogen increases receptors in the liver that help remove LDL cholesterol. When estrogen drops, LDL tends to rise.

• Boosts HDL: Estrogen promotes higher HDL levels, which protect against heart disease.

• Reduces Inflammation: Estrogen has anti-inflammatory properties that keep arteries flexible and strong.

• Regulates Fat Metabolism: Estrogen influences how your body processes and stores fat. Less estrogen often means more belly fat—another heart risk factor.

🔄 Monthly Hormone Fluctuations Matter, Too

Even before menopause, cholesterol shifts throughout your cycle. During the follicular phase (first half), estrogen peaks and cholesterol is more stable. In the luteal phase (second half), estrogen dips, and LDL can spike slightly. Once estrogen consistently declines in perimenopause, the protective rhythm disappears—leaving your heart more vulnerable.

❤️‍🩹 What You Can Do: Practical Tips for a Healthier Heart

This isn’t all bad news—there’s a lot you can do to support your heart during perimenopause, starting today.

1. 🥗 Eat for Heart Health

✔ Load Up on Fiber
Fiber binds to cholesterol and helps flush it from your body. Great sources: oats, lentils, chia seeds, flaxseeds, beans, and vegetables.

✔ Embrace Healthy Fats
Ditch saturated fats (like processed meats and non-organic dairy) and go for unsaturated fats: avocado, olive oil, nuts, and fatty fish like salmon.

✔ Skip the Sugar and Refined Carbs
High sugar and processed carbs spike insulin and contribute to inflammation—both of which worsen cholesterol. Stick with whole foods and balanced meals.

✔ Hydrate Like a Pro
Water supports your liver, digestion, and cholesterol processing. Aim for at least 8 cups daily (more if you’re active).

✔ Add Fermented Foods
Probiotics found in yogurt, kefir, sauerkraut, and kimchi support your gut and may help regulate cholesterol metabolism.

2. 💊 Consider HRT (Hormone Replacement Therapy)

For many women, HRT is a game-changer—especially for heart health. Why?

• Lowers LDL

• Increases HDL

• Reduces inflammation

• Supports blood vessel function

But HRT isn’t one-size-fits-all. If you’re considering it, speak to a provider who specializes in women’s hormones and understands how estrogen impacts cardiovascular health. You might also want to explore the pros and cons of different types of HRT—especially bioidenticals. Check out Are Bioidentical Hormones Right for You? A Perimenopause HRT Guide to help you make an informed decision.

3. 🧘‍♀️ Make Lifestyle Shifts That Stick

✔ Move Your Body
Exercise doesn’t just burn calories—it boosts HDL, lowers LDL, and supports overall heart function. Mix strength training, cardio, and restorative movement like yoga.

✔ Manage Stress
Chronic stress raises cortisol, which contributes to inflammation and cholesterol imbalances. Try breathwork, meditation, or long walks in nature.

✔ Rethink Alcohol
That nightly glass of wine? It may be doing more harm than good. New research shows no amount of alcohol is protective—and it can disrupt hormones and worsen cholesterol. If alcohol has become your go-to for stress relief or sleep, it might be time to re-evaluate.

Check out Alcohol, Anxiety, and Perimenopause: How to Break Free and Feel Better for tips on navigating this tricky midlife trio with more support and self-compassion.

✔ Quit Smoking (if you haven’t already)
Smoking lowers HDL and raises LDL. It’s one of the most powerful ways to protect your heart if you’re still smoking.

✨ Final Thoughts: Knowledge is Power

If you’ve been blindsided by cholesterol changes during perimenopause, you’re not alone—and you’re not doing anything wrong. This isn’t a personal failure. It’s biology.

The good news? With a few intentional changes—through food, movement, and possibly hormone therapy—you can support your heart and feel empowered again.

💡 Take Action:

✅ Book a blood test and check your cholesterol
✅ Add heart-healthy foods to your meals
✅ Prioritize movement and hydration
✅ Talk to your provider about estrogen and HRT
✅ Be kind to yourself—your body is changing, not betraying you

Because when you understand what’s happening inside your body, you can take back control of your health—with confidence and compassion.

Hormonally yours,

Kimberlee Erin

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.