Cholesterol, Hormones, and Midlife: What Every Woman Should Know
- Ciara Ryan
- Oct 14
- 6 min read
A couple of years ago, after a routine blood test, I was told my cholesterol was high — over seven, if I remember right. The advice? Eat less red meat and get more exercise.
Now, I haven’t eaten meat since my teens, and I already move most days. So that wasn’t exactly helpful.
But I didn’t panic. Because I knew this wasn’t just about what I was eating. It was about what my body had stopped making.
One of the biggest, often-overlooked drivers of cholesterol increases for women in midlife isn’t what you eat — it’s what you stop making: oestrogen.
When the Numbers Don’t Add Up
You might be doing all the right things — eating well, exercising, keeping an eye on your weight — and yet your cholesterol starts to creep up. It feels unfair, doesn’t it? Another thing to deal with.
But the reality is those numbers are changing because your hormones are changing.
During perimenopause, oestrogen levels fluctuate and eventually fall — and that shift affects how your body manages fats and cholesterol. When oestrogen declines, cholesterol tends to linger longer in the bloodstream, even if your diet hasn’t changed much.
When oestrogen declines, that balance shifts. Cholesterol lingers longer in the bloodstream — even if your diet hasn’t changed much.
For years, women have been told that cholesterol is purely about diet and exercise. But that’s only half the story. So if you’re presented with a “high cholesterol” diagnosis out of the blue, take a moment, ask for the full picture, and remember there’s more than one reason those numbers might have changed.
Why Cholesterol Changes Around Menopause
Before menopause, women tend to have lower rates of heart disease than men — partly because oestrogen helps protect the heart and blood vessels.
Once oestrogen declines, that protection fades — and the gap between men and women closes.
Researchers following women through the menopause transition have consistently seen the same pattern: total cholesterol and LDL rise, HDL becomes less efficient, and triglycerides (another blood fat) increase, especially when insulin resistance or midlife weight gain appear.
These shifts can begin years before your final period — which is why so many women are surprised by their blood results in their forties.
Now, none of this means you should panic. For some, the changes are mild. For others, they’re more significant — and worth keeping an eye on. Either way, it’s something to notice and understand, not fear.
This isn’t about chasing perfection or overhauling your life — it’s about working with your changing biology. Midlife is a critical window where your body is incredibly responsive to the right kind of support. What you do now lays the groundwork for decades of heart and hormonal health ahead.
Oestrogen: Your Body’s Traffic Manager for Cholesterol
Cholesterol isn’t the villain it’s often made out to be. Your body needs it — to build cells, make hormones like oestrogen and progesterone, and produce vitamin D.
Because fat and water don’t mix, cholesterol travels through your blood inside carriers called lipoproteins:
LDL (low-density lipoprotein): often nicknamed “bad cholesterol” because high levels can deposit cholesterol in artery walls, contributing to plaque buildup.
HDL (high-density lipoprotein): the “good cholesterol” that carries cholesterol away from arteries and back to the liver for processing.
Triglycerides: another type of blood fat, usually linked to diet, sugar intake, and insulin resistance.
Think of oestrogen as the traffic manager that keeps this flow moving. It helps LDL clear faster, boosts HDL’s clean-up crew, and prevents build-ups.
When oestrogen steps back, that smooth traffic flow becomes stop-start. LDL hangs around longer, HDL slows down, and triglycerides start to pile up. The system hasn’t failed — it’s just lost its manager.
So even women with balanced diets and active lifestyles can see shifts in cholesterol during perimenopause. It’s not a reflection of failure — it’s biology.
(If you’d like to read more about how nutrition influences cholesterol, check out this full article: Managing Cholesterol Through Food.)
The Midlife Metabolic Mix-Up
Of course, hormones aren’t acting alone here. Perimenopause brings a few other players onto the stage.
1. Insulin resistance As oestrogen declines, insulin — the hormone that regulates blood sugar — becomes less effective. That can raise triglycerides and make HDL less protective.
2. Body fat distribution You might notice your shape shifting, with more fat stored around your waist than your hips. This visceral fat sends fatty acids straight to the liver, which can push cholesterol production higher.
3. Inflammation and oxidative stress Both rise with lower oestrogen and can irritate blood vessels, affecting how cholesterol behaves.
4. Genetics Some women’s genes make them more sensitive to these changes. That’s why your cholesterol might spike while your friend’s doesn’t, even if you both eat the same way.
Why the Old Advice Falls Short
The standard “eat better and move more” line doesn’t go far enough. Lifestyle still matters — but how you approach it in perimenopause matters even more.
Your body’s chemistry is shifting. You’re supporting a system that’s lost one of its key regulators. The goal isn’t perfection; it’s protection.
This is the time to be strategic, not restrictive.
How to Lower Cholesterol Naturally in Midlife
If your cholesterol has crept up during perimenopause, the good news is that it responds well to everyday changes — no drastic diets required. Think consistency over extremes.
1. Fibre First
Soluble fibre binds cholesterol in the gut so it leaves the body rather than being reabsorbed. Add oats, beans, lentils, apples, carrots, flaxseed, and chia daily.
2. Fats That Help
Swap butter and processed snacks for olive oil, avocado, nuts, seeds, and oily fish. These support HDL and help calm inflammation.
3. More Plants, Fewer Packets
Plant-based meals bring fibre, antioxidants, and plant sterols that protect heart health. You don’t have to go vegetarian — just crowd your plate with colour and variety.
4. Watch the Waist, Not Just the Scales
Even a modest 5–10% weight reduction (if needed) can improve cholesterol ratios and reduce visceral fat around the middle.
5. Move Daily
Aerobic exercise lowers triglycerides. Strength training builds muscle, reduces belly fat, and supports metabolism. Do what you can — consistency beats intensity.
6. Stress Less, Sleep More
Cortisol (your stress hormone) raises blood sugar and cholesterol. Prioritising rest, routines, and boundaries is as vital as what you eat.
7. Alcohol and Smoking
Both raise triglycerides and damage blood vessels. Keep alcohol within recommended limits, and if you smoke, consider support to stop.
These habits work because they help your liver process cholesterol more efficiently, support hormone balance, and reduce inflammation — all key pieces of the midlife health puzzle.
Supplements Worth Discussing
(Always personalised and guided by a professional.)
Omega-3 (fish or algae oil): can lower triglycerides and ease inflammation.
Plant sterols/stanols: help block cholesterol absorption in the gut.
Psyllium husk or PHGG: soluble fibre that helps lower LDL.
Red yeast rice: acts similarly to a mild statin but should only be used under professional supervision.
Medication and HRT — Where They Fit
If cholesterol remains high despite your best efforts, medication such as statins can be an important tool. They’re not something to feel disheartened about — they’re one more way to protect your heart, especially when risk is higher or genetics play a part.
Research shows that when started around the time of menopause, oestrogen therapy (HRT) can slightly improve cholesterol balance — usually lowering LDL and raising HDL. This is not a reason to start HRT, but it can be a welcome side benefit for some women who are already considering it for symptom relief.
If you’re thinking about HRT, speak with your GP or nutritional therapist to discuss the full picture — your symptoms, medical history, and cardiovascular risk together.
Your Midlife Cholesterol and Hormones Checklist
Book a cholesterol test during perimenopause — don’t wait until after menopause.
Eat high-fibre, plant-rich meals every day.
Prioritise healthy fats — olive oil, nuts, seeds, oily fish.
Move regularly — combine cardio with strength.
Manage waist size and stress levels.
Keep alcohol in check and avoid smoking.
Talk to your doctor about whether medication or HRT could help.
Remember: midlife isn’t a decline — it’s a recalibration.
If you’ve been blaming yourself for high cholesterol or wondering what you could have done differently, take a breath. Your body hasn’t betrayed you — it’s adapting.
Menopause isn’t the end of health; it’s a transition, and like all transitions, it requires understanding and care. When oestrogen steps back, your body asks you to step forward — with awareness, not fear.
And when you do, you’re not just supporting your cholesterol. You’re protecting your energy, your confidence, and the years still ahead.
Ready to Take the Next Step?
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(If you’re worried about your cholesterol or heart health, always seek professional medical advice.)
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