Beyond the Hot Flash: What Menopause Does to Cholesterol

Menopause symptoms…hot flashes, night sweats, and that is it, right? No, that is only part of the picture.

Menopause is a decrease in reproductive hormones, mainly estrogen and progesterone for women. But testosterone, the less prevalent of the 3, can also not be forgotten. This hormone level drops, as well. With the drop of these hormones, also brings brain fog, sleep disturbances, mood changes, worsening anxiety, joint pain, decrease libido, vaginal dryness/irritation (which can lead to painful intercourse and frequent UTIs), more difficulty building lean muscle mass, and longer muscle recovery time after exercising. This is not an exhaustive list, but includes some of the most common symptoms.

Especially with the loss of estrogen, Osteoporosis (bone softening which places women at an increased risk of fractures) and heart disease increases as well. Heart disease is the leading cause of death in women, so I think it is very important to examine the relationship between decreased estrogen and cholesterol.

Low density lipoprotein (LDL) or the “bad cholesterol” is made in the liver and then delivered to the cells in the body for use. However, the excess LDL accumulates in the walls of the arteries leading to cardiovascular (CV) disease. The buildup of plaque greatly increases the risk of a heart attack and/or stroke.

The mechanism of estrogen with cholesterol is two fold. Estrogen helps increase LDL receptors, so LDL is pulled out the blood stream. HDL (high density lipoprotein) or the “good cholesterol” is also increased by estrogen. It is evident, then, the negative effects of decreasing estrogen with regards to cholesterol numbers.

I know many of you are probably wondering what steps can I take to decrease my risk of CV disease? The best place to start is a visit with your provider, including a thorough history, a physical exam, and blood work. The traditional cholesterol panel includes total cholesterol, HDL, LDL, and triglycerides (the most common fat in blood), and total cholesterol/HDL ratio. There is also a 10 year risk calculator of heart attack and stroke that can be used. The calculation is based on factors including gender, race, age, other health conditions, blood pressure, and laboratory results.

Besides the traditional panel outlined above, the two newer blood tests I strongly encourage you to ask your provider about are Apo(b) and Lipoprotein(a). While LDL measures the amount of cholesterol on particles, Apo(b) measures the number of these particles. Both numbers are important to obtain a more accurate picture of CV disease risk. Lipoprotein(a) examines inherited risk factors for heart disease, which is also a very important aspect to consider.

Another great screening tool is a calcium CT (computed tomography) scan. This low dose CT scan identifies if there are any calcium deposits in the coronary arteries, which are the vessels that supply the heart with blood. Calcium being present here increases the risks of a blockage in those arteries, which can lead to a heart attack.

Estrogen has a lot of positive features, especially with regards to cholesterol and how our body metabolizes it. However, it is important to note there are different forms of estrogen and not all forms are appropriate for every woman. While estrogen can vastly benefit so many women and often times the benefits far outweigh the risks, it is vital to have a conversation with your health provider to make sure estrogen (and what form) is an appropriate part of your treatment plan.