What's really happening
During and after menopause, your body’s cholesterol balance can shift dramatically—often without warning. Estrogen helps regulate fat metabolism and cholesterol transport. When estrogen drops, LDL (“bad” cholesterol) tends to rise, HDL (“good” cholesterol) may fall, and triglycerides often increase. That combination raises your risk for heart disease—even if your lifestyle hasn’t changed.
But why?
Estrogen helps regulate cholesterol production and removal. Less estrogen = more cholesterol circulating in your bloodstream.
Scientific Breakdown
Estrogen plays a critical role in lipid metabolism. It promotes the expression of LDL receptors in the liver—helping clear bad cholesterol from your bloodstream. When estrogen declines, your liver becomes less efficient at filtering LDL, and your risk of plaque buildup increases. Simultaneously, HDL cholesterol may drop, removing less plaque, and triglycerides often rise due to changes in metabolism and insulin sensitivity.
• ↓ Estrogen = ↑ LDL (bad cholesterol)
• ↓ Estrogen = ↓ HDL (good cholesterol)
• Liver loses some of its estrogen-regulated filtering power
• Changes in fat storage + insulin resistance may also play a role
Essentially…
Estrogen used to be your heart’s helper. Without it, cholesterol builds up faster—even if you haven’t changed your habits.
See a doctor if …
• Total cholesterol over 200 mg/dL
• LDL over 130 mg/dL (or 100 if you have other risk factors)
• Triglycerides over 150 mg/dL
• Genetic conditions like familial hypercholesterolemia
• Thyroid dysfunction
• Poor liver or kidney function
Frequently Asked Questions (FAQs) about
High Cholesterol
Q: Can I lower my cholesterol naturally?
Yes—diet, movement, and even small weight changes can help.
Q: Does HT lower cholesterol?
Sometimes—especially transdermal estrogen in early menopause.
Q: Do I have to take statins forever?
Not always. Some women use them short-term or alongside lifestyle changes.
“I didn’t want to go on statins right away. With a plant-based diet, movement, and a low-dose patch, my LDL dropped 40 points in 6 months.”
— FLUXX community member, age 50
FLUXX Recommendations
1. Get baseline cholesterol numbers in early perimenopause
2. Consider HT if you’re a good candidate and in the right timing window
3. Adopt a heart-supportive eating pattern (e.g., Mediterranean or Portfolio diet)
Non-Hormonal Medications
• Statins (most commonly prescribed)
• Ezetimibe (Zetia), PCSK9 inhibitors, bempedoic acid
• Bile acid sequestrants
• Soluble fiber (e.g., oats, beans, chia)
• Plant sterols/stanols (found in fortified foods or supplements)
• Red yeast rice (with medical supervision)
• Omega-3s (flaxseed, fish oil, walnuts)
Lifestyle Suggestions
• Mediterranean diet
• Weight-bearing exercise (supports metabolic health and heart)
• Alcohol in moderation or none
• Quit smoking (boosts HDL, reduces inflammation)
Myth-Busting
Heart disease kills more women than all cancers combined—yet it’s still under-screened and undertreated.
Modern Guidance
HT may improve cholesterol levels when started early in menopause. Lifestyle changes—like cutting processed foods, increasing fiber, and exercising—also make a big impact. Statins may be recommended if levels remain high.
Ask yourself
• “Am I in the early window for HT?”
• “Do I want to try lifestyle changes first?”
• “Does my family have a history of heart disease?”
Ask your doctor
• “Are these cholesterol changes hormonal?”
• “Can I try lifestyle changes or HT first?”
• “What’s my cardiovascular risk score?”
Uncontrolled high cholesterol increases your risk of heart disease, stroke, and atherosclerosis.
