Cholesterol and menopause: why levels can rise and what helps

Something I hear quite often from women in midlife is that their cholesterol levels have increased, sometimes quite unexpectedly, despite feeling that they eat reasonably well and haven't made any significant changes to their diet.

It's understandably concerning, particularly when you've been making an effort to look after your health.

But there's something important that isn't always discussed enough: the hormonal changes of perimenopause and menopause can have a significant influence on cholesterol levels.

And while nutrition remains important, understanding what's happening in your body can help you make more informed decisions about how to look after your heart health.

Why can cholesterol rise during menopause?

Oestrogen plays an important role in cardiovascular and metabolic health, including how the body regulates cholesterol.

As oestrogen levels fluctuate and decline during the menopause transition, changes in lipid metabolism can lead to an increase in LDL cholesterol, often referred to as 'bad' cholesterol.

LDL cholesterol is particularly important because elevated levels contribute to the development of fatty deposits in the arteries, increasing cardiovascular risk over time.

Research following women through the menopause transition has identified changes in blood lipids associated with declining oestrogen, suggesting that menopause itself contributes to changes in cholesterol beyond the effects of ageing alone.

This doesn't mean every woman will experience a significant increase, or that menopause is the only explanation for raised cholesterol. Genetics, dietary habits, other health conditions and lifestyle factors can also contribute.

But it does mean that paying attention to cholesterol and cardiovascular health becomes increasingly important during midlife.

What can you do to support healthy cholesterol levels through food?

The encouraging thing is that there are some well-established dietary changes that can help lower LDL cholesterol and support long-term heart health.

And none of them require you to follow a highly restrictive diet.

1. Eat more soluble fibre

Fibre is something I talk about regularly, and for good reason.

Certain types of soluble fibre can help lower LDL cholesterol by reducing the reabsorption of bile acids in the digestive tract. The liver then uses cholesterol to produce more bile acids, contributing to lower circulating cholesterol levels. Oats and barley contain a type of soluble fibre called beta-glucan, which has been shown in randomised controlled trials to reduce LDL cholesterol. Beans, lentils and other pulses can also make a useful contribution to cholesterol management.

In practical terms, this might mean enjoying porridge for breakfast, adding lentils to soups or curries, or including beans in a salad or traybake.

You don't need to change everything you're eating. It's often about making a few useful additions to meals you already enjoy.

2. Look at the types of fat you're eating

One of the most effective dietary approaches to lowering LDL cholesterol is replacing some saturated fat with unsaturated fat. This isn't about avoiding fat altogether. Fats are an important part of a balanced diet, and they contribute flavour, texture and satisfaction to meals. But the type of fat matters. Replacing some butter, cream, fatty processed meats and other sources of saturated fat with foods containing more unsaturated fats can help improve your cholesterol profile.

Think olive oil or rapeseed oil for cooking, nuts and seeds, avocado and oily fish.

And remember, we're talking about substitutions rather than simply adding unlimited amounts of additional fat to your diet.

3. Include more plant foods

A varied, plant-rich eating pattern can help you increase your intake of fibre, unsaturated fats and other nutrients that support cardiovascular health. Vegetables, fruit, pulses, wholegrains, nuts and seeds all have a place here. I'm a big advocate of thinking about what you can add to your meals rather than focusing entirely on what you need to remove.

For example, you might add chickpeas to a chicken curry, stir some beans through a soup, or sprinkle ground flaxseed and nuts over your breakfast.  Small changes like these can help improve the overall nutritional quality of your diet without making eating feel complicated.

4. Think about your overall eating pattern

Individual foods can be useful, but it's your overall dietary pattern that matters most. 

A Mediterranean-style approach, rich in vegetables, pulses, wholegrains, olive oil, nuts and fish, is consistent with established recommendations for cardiovascular health. It also fits beautifully with the way I encourage women to build their meals: combining protein, fibre-rich foods, healthy fats and plenty of plant variety.

And you can still enjoy pasta, potatoes, bread and the other foods you love. The objective isn't dietary perfection. It's developing an approach that supports your health and that you can comfortably maintain.

What else matters for heart health during menopause?

Nutrition is an important part of the picture, but it isn't the whole picture. Regular movement, including aerobic activity and resistance training, supports cardiovascular health. Maintaining muscle mass, managing blood pressure, getting adequate sleep and avoiding smoking also matter.

And if your cholesterol levels have increased, I'd encourage you to discuss them with your GP rather than assuming it's simply part of menopause.  For some women, dietary and lifestyle changes may be sufficient. Others may benefit from cholesterol-lowering medication alongside those changes.

Looking after your heart health doesn't have to be complicated

One of the things I really want women to understand is that eating for long-term health doesn't need to involve another set of restrictive food rules. You can enjoy satisfying, delicious meals while making choices that support your cardiovascular health, muscle maintenance and overall wellbeing.

That's the approach behind my Nourished Metabolism meal plans, where I've brought together protein, fibre, healthy fats and plenty of variety in meals that are practical for everyday life.

If you'd like to see how that works, my free Meal Plan Taster gives you a full day of balanced recipes to try at home.

Explore my free Nourished Metabolism Meal Plan Taster

Josie Jones
Nutrition and eating psych