What… the Menopause?
Each week we spotlight an unexpected and frustrating symptom of menopause that no one warned you about. Because menopause is more than just hot flashes and missed periods.
This week’s spotlight: Cholesterol Changes
What’s going on?
One of the less talked-about yet deeply important shifts many of us experience around menopause is how our cholesterol levels change, and how that affects our heart health. As estrogen levels decline during perimenopause and post-menopause, your body’s usual protective mechanisms against bad cholesterol weaken. Estrogen plays a role in keeping LDL (“bad”) cholesterol lower and HDL (“good”) cholesterol higher and effective. When estrogen drops, LDL and total cholesterol often rise, and HDL can become less protective, increasing your long-term cardiovascular risk.
This shift isn’t just a number on a lab report. It’s a real metabolic change linked to how your liver processes lipids, hormone signalling changes, and broader shifts in your metabolism that accompany midlife. Importantly, many women don’t notice this change until a routine blood test flags it, because high cholesterol usually doesn’t cause obvious symptoms.
You’re not alone
Cholesterol changes during menopause are incredibly common. In fact, studies show that total cholesterol and LDL can rise significantly around the final menstrual period and into the years after. What used to be a health advantage for women before menopause (typically lower cardiovascular risk compared to men) begins to narrow and even reverse as we move further into post-menopause. This means many women in midlife are suddenly dealing with numbers they’ve never had trouble with before, and it’s absolutely not a personal failure or something you’re “supposed to just deal with.”
What can you do?
There are actionable, practical ways to manage cholesterol changes in menopause and you don’t have to wait until a crisis to start.
Prioritize heart healthy eating. Focus on whole foods rich in soluble fiber (like oats, legumes, and vegetables), unsaturated fats (think olive oil, wild caught salmon), and maybe even consider supplements that help reduce LDL absorption.
Get moving. Regular physical activity, even brisk walking 30 minutes most days, improves cholesterol profiles, helps manage weight, and supports heart health overall.
Regular screening and tracking. Ask for lipid panels at least annually once you’re in perimenopause, and track trends over time rather than isolated numbers. Early awareness gives you agency. But don’t get trapped in the standard lipid panel. We need to go deeper. Download the free Lab Test Guide to get the comprehensive list.
Appropriate supplementation*. Speak to your doctor about incorporating a heart health fish oil, bergamot, psyllium husk or other supplement that supports your individual needs.
Discuss medication when appropriate. For some people, lifestyle alone isn’t enough and that’s okay. Cholesterol lowering medications can significantly reduce heart disease risk when indicated and when everything else lifestyle and diet wise doesn’t seem to work.
Support metabolic health broadly. Adequate sleep, stress management, and blood sugar balance all contribute to healthier lipid metabolism. These are bigger levers than you may think.
Consider bioidentical hormone therapy (HRT). Research shows that transdermal estrogen is heart protective and an anti-inflammatory. The benefits may outweigh any risks for most women, but the most benefits occur when started before menopause or within 10 years of menopause. This doesn’t mean you still can’t start, but your heart may already have damage that HRT is unable to reverse. Speak to your doctor if HRT is appropriate for you.
What worked for me?
Over the years as I’ve talked to guests, experts, and women in the Hack My Age community and through my own lens as a gerontologist and biohacker, I’ve learned that shifting your mindset around heart health in midlife is half the battle. Women come into menopause focused on hot flashes, sleep, mood, and weight … but many don’t realize that heart disease is the leading cause of death for women globally unless we take proactive steps.
Personally and professionally, I’ve encouraged tracking metrics like deeper cholesterol markers, waist circumference, bioidentical hormone therapy, and blood pressure, and not just hormone panels, because menopause is a whole-body transition, not just reproductive aging. I’ve seen women make meaningful improvements through diet tweaks, consistent movement habits, managing stress, supplementation and informed discussions with their clinicians about risk and medication when needed. What’s helped the most is treating this as health optimization instead of crisis management, catching small changes early and addressing them before they become big problems.
Menopause doesn’t have to mean surrendering your heart health. Understanding cholesterol changes and acting on them, gives you control over this chapter of your life with evidence-backed strategies and a community cheering you on.
*Recommended Supplements To Explore:
Omega-3 fatty acids (use with taurine to offset oxidation) or choose Puori Omegas: Code HACKMYAGE for 20% off
Curcumin by MitoQ: Code ZORA for 10% of
1-MNA by Endotelio: Code ZORA for 10% off
Nitric Oxide by Berkeley Life: Code ZORA for 10% off
Endocalyx Pro
Omega 15: Fatty15
SPMs (Specialized Pro-resolving Mediators) by Metagenics
Plasmalogens: Code ZORA for 25% off
Niacin (flushing)
Psyllium Husk
Cholesterol Pro by Now Foods (Bergamot and Phytosterol)
Sytrinol + mLNA
COQ10 (CoQGen) or MitoQ+Heart: code ZORA for 10% off
Heart bioregulator peptide by Profound Health: code ZORA-15 for 15% off