{"id":1699,"date":"2026-10-14T13:32:08","date_gmt":"2026-10-14T13:32:08","guid":{"rendered":"https:\/\/flatplanplus.io\/bbc-sciencefocus\/?p=1699"},"modified":"2026-10-14T13:32:09","modified_gmt":"2026-10-14T13:32:09","slug":"the-surprising-real-cause-of-high-cholesterol-in-women-over-50-and-how-to-lower-it","status":"publish","type":"post","link":"https:\/\/flatplanplus.io\/bbc-sciencefocus\/2026\/10\/14\/the-surprising-real-cause-of-high-cholesterol-in-women-over-50-and-how-to-lower-it\/","title":{"rendered":"The surprising real cause of high cholesterol in women over 50 (and how to lower it)"},"content":{"rendered":"\n
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Health<\/p>\n\n\n\n

The surprising real cause of high cholesterol in women over 50 (and how to lower it)<\/h1>\n\n\n\n

It\u2019s one of the biggest killers of women, yet heart health often goes ignored<\/p>\n\n\n\n

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By Hayley Bennett<\/p>\n\n\n\n

–<\/p>\n<\/div>\n<\/div>\n\n\n\n

\"Cholesterol
Picture credit: Getty<\/figcaption><\/figure>\n<\/div>\n<\/div>\n\n\n\n

When it comes to women\u2019s health issues, heart disease isn\u2019t normally one of the first things that comes to mind.<\/p>\n\n\n\n

Yet, cardiovascular disease (CVD) is women\u2019s biggest killer. Over nine million<\/a> women die from heart attacks, strokes and other CVDs every year \u2013 that\u2019s double the number who die from cancer.<\/p>\n\n\n\n

What\u2019s more, CVD causes a higher proportion of women\u2019s deaths, and by the age of 60, women are three times more likely<\/a> than men to have high cholesterol.<\/p>\n\n\n\n

There is a shocking lack of awareness of the problem. In a 2019 survey<\/a>, only 44 per cent of US women correctly named heart disease as the leading cause of death in women. <\/p>\n\n\n\n

Even among doctors, heart attacks are more frequently missed in women<\/a>, and the risk of CVD is more often underestimated<\/a> by the scoring systems doctors use.<\/p>\n\n\n\n

Why the oversight? The reasons are many-layered. Part of the explanation, however, may lie in the poorly recognised surge in cholesterol levels accompanying menopause, which means women see a steeper climb later in life than men.<\/p>\n\n\n\n

This cholesterol hike may be as much a part and parcel of menopause as hot flashes and stiff joints. But it can go unnoticed. And scientists admit that, thanks to chronic underfunding of menopause research, it\u2019s not that well understood.<\/p>\n\n\n\n

So, if your cholesterol shoots up in your fifties, it\u2019s not just because you caved into the odd cake \u2013 and it\u2019s no reason to beat yourself up.<\/p>\n\n\n\n

\"Group
Menopause can cause changes in metabolism and hormones, as well as several other physical changes that can lead cholesterol to skyrocket. Picture credit: Getty<\/figcaption><\/figure>\n\n\n\n

\u201cIf your cholesterol increases after menopause, that doesn\u2019t mean that you don\u2019t look after yourself,\u201d says CVD prevention specialist, Jeanine Roeters van Lennep at Erasmus University Rotterdam, Netherlands, who studies sex differences in CVD. \u201cIt\u2019s a physiological thing.\u201d<\/p>\n\n\n\n

It is<\/em>, however, something to be taken seriously. Asking for a cholesterol check isn\u2019t top of your list when you\u2019re at the doctor\u2019s feeling clammy, on-edge, achy, itchy, bloated and\u2026 was that everything? <\/p>\n\n\n\n

Oh, like you could explode into flames at any moment\u2026 But if you\u2019re this deep into menopause and your doctor isn\u2019t testing your cholesterol, then they\u2019re not doing enough to help.<\/p>\n\n\n\n

So, whether you\u2019re in the thick of it, or just heading into peri, here\u2019s what we know about cholesterol during and after menopause \u2013 and what to do about it.<\/p>\n\n\n\n

1. Women spend much of their lives with higher cholesterol<\/h2>\n\n\n\n

Most women go through menopause in their late forties or early fifties. Long before that, however, our cholesterol trajectories differ from men\u2019s because \u2013 surprise! \u2013 men\u2019s and women\u2019s bodies are different.<\/p>\n\n\n\n

Whilst women\u2019s cholesterol averages lower than men\u2019s through most of our twenties, thirties and forties, it\u2019s actually higher at both ends of the age spectrum.<\/p>\n\n\n\n

\u201cBefore the age of 18, women have higher cholesterol than men,\u201d notes Roeters van Lennep. From at least age eight to around puberty, girls\u2019 total cholesterol tracks just above<\/a> boys. Then, in our twenties, there\u2019s a crossover as men\u2019s steadily rises, overtaking ours. <\/p>\n\n\n\n

The exception is during pregnancy, when cholesterol levels can steeply rise but usually return to normal after birth.<\/p>\n\n\n\n

So, it\u2019s not that menopause sets us on a different path; we follow a different course<\/a> our whole life long. But menopause does push our cholesterol levels to their peak in our fifties, a decade after men. <\/p>\n\n\n\n

Is it hormones dive-bombing that makes our cholesterol soar? Well, as Roeters van Lennep explains, widespread knowledge gaps in female health mean there\u2019s still lots to learn but there\u2019s \u201cconvincing\u201d evidence it\u2019s due to menopause and not just ageing. <\/p>\n\n\n\n

Recent research<\/a> also suggests it\u2019s universal, with similar patterns seen even in indigenous populations renowned for their resistance to heart disease, like the Tsiman\u00e9 in Bolivia.<\/p>\n\n\n\n

\"Tsimane
Heart attacks and strokes are virtually unheard of among the Tsimane people, who live in the Bolivian Amazon. Picture credit: Getty<\/figcaption><\/figure>\n\n\n\n

The post-menopausal peak is at least partly a consequence of falling oestrogen, which reduces clearance of low-density lipoprotein (LDL) cholesterol \u2013 so-called \u2018bad\u2019 cholesterol \u2013 from the blood. Lower oestrogen indirectly causes<\/a> a protein called PCSK9 to break down LDL receptors on the liver, meaning they struggle to do a proper clean-up job.<\/p>\n\n\n\n

Menopausal changes also affect how and where body fat is stored, all of which leads to our CVD risk climbing.<\/p>\n\n\n\n

2. Menopause drives up cholesterol levels<\/h2>\n\n\n\n

Perhaps one of the reasons the post-menopausal cholesterol hike gets missed is that we tend to assume if we\u2019re not overweight and we\u2019ve always had low cholesterol, then we\u2019ll go on having low cholesterol.<\/p>\n\n\n\n

In fact, though, the opposite could be true. One of the largest studies following women through the menopause shows it\u2019s the lightest women below 62kg (137lb) who suffer the biggest cholesterol surges<\/a> with menopause.<\/p>\n\n\n\n

Why? Possibly because thinner women already have lower oestrogen levels \u2013 fat cells produce oestrogen, supplementing the main supply from our ovaries.<\/p>\n\n\n\n

More generally, not every woman\u2019s oestrogen drops off at the same rate, and, as far as cholesterol goes, we enter menopause at different baselines. That\u2019s why getting it checked is vital, particularly if you think you might be at increased risk.<\/p>\n\n\n\n

One important influence on CVD risk is when <\/em>you go through menopause. South Asian women, for example, are often younger (the average age is 45 in Indian women) and a recently published study<\/a> shows this earlier menopause increases CVD risk, though why is debatable.<\/p>\n\n\n\n

\u201cClearly premature menopause finds women exposed to lower oestrogen for a longer duration,\u201d says biostatistician Simone Marschner from the University of Sydney, who led the study. But she thinks there\u2019s \u201cmore to the story\u201d, including changes in visceral (aka \u2018belly\u2019) fat, which affect inflammation and insulin resistance too.<\/p>\n\n\n\n

\"Grandmother,
When it comes to cholesterol, a lot of it is down to your genetics. Picture credit: Getty<\/figcaption><\/figure>\n\n\n\n

Meanwhile, inherited high cholesterol sets a higher baseline, so having family members with high cholesterol or CVD may mean you need to get checked out early. <\/p>\n\n\n\n

Genetic conditions, such as Familial hypercholesterolaemia <\/a>(FH) and elevated Lp(a)<\/a>, can cause high cholesterol, and affect around 1 in 250 and 1 in 5 of us respectively but, crucially, they can be tested for and treated.<\/p>\n\n\n\n

Whilst there\u2019s limited research on how menopause affects cholesterol levels in these conditions, a small study<\/a> that Roeters van Lennep was involved with suggests those with FH will see a 17 per cent rise through menopause if they\u2019re not medicated compared to a 10 per cent rise if they are.<\/p>\n\n\n\n

The team is now looking into whether treatment plans are adapted in these women through menopause.<\/p>\n\n\n\n

\u201cIf their cholesterol goes up, does that mean that their lipid-lowering medication is also adapted to this higher cholesterol?\u201d asks Roeters van Lennep, noting that it might seem \u201cstrange\u201d that we don\u2019t know, but such knowledge gaps are typical of women\u2019s health and menopause research.<\/p>\n\n\n\n

3. HRT decisions are about more than cholesterol<\/h2>\n\n\n\n

If cholesterol rises as oestrogen slumps, then it\u2019s reasonable to think replacing oestrogen would be the route to controlling cholesterol. And hormone replacement therapy (HRT) does help reduce it<\/a>. But experts advise wider conversations around HRT.<\/p>\n\n\n\n

\u201cIt’s important to take a holistic approach,\u201d says Haitham Hamoda, who leads the menopause service at King\u2019s College Hospital, London. \u201cThe discussion often starts with menopause symptoms. And then, in parallel, you can talk about the cardiovascular aspect, bone [health] aspect, breast cancer risk, etc.\u201d<\/p>\n\n\n\n

It\u2019s a complex picture and every woman\u2019s risk profile looks different. Multiple studies show that HRT containing oestrogen helps to slow bone density loss<\/a> whilst increasing the risk of breast cancer<\/a>. <\/p>\n\n\n\n

However, the impact on CVD risk is complex and scientists are still untangling the results<\/a> of trials that were carried out in the 1990s.<\/p>\n\n\n\n

\"Woman
Whether taking HRT is the right decision depends on a huge number of factors, so it is always best to discuss them with your doctor. Picture credit: Getty<\/figcaption><\/figure>\n\n\n\n

Initially, large US trials suggested that old-style pill forms of HRT increased<\/em> heart disease and stroke risk (and breast cancer risk), resulting in women abandoning their prescriptions in droves. <\/p>\n\n\n\n

However, recent reanalysis<\/a> of data from the same trials suggests the increased CVD risk only impacts women over 70 and supports international guidelines<\/a> that state HRT is beneficial for heart health up to age 60.<\/p>\n\n\n\n

Evidence on the risks and benefits of newer, transdermal forms of HRT<\/a> \u2013 including patches and gels \u2013 and on HRT taken during perimenopause (before periods have stopped) is scarcer. <\/p>\n\n\n\n

Transdermal HRT does appear to cause fewer<\/a> dangerous blood clots than pills. But more generally, \u201cthe only way to really know is to have another big trial,\u201d says Samia Mora, a cardiovascular medicine specialist at Brigham and Women\u2019s Hospital in Boston, Massachusetts.<\/p>\n\n\n\n

\u201cIn the absence of that,\u201d Mora adds, \u201cWhat we know is that [HRT] shouldn\u2019t be used for cardiovascular prevention.\u201d In other words, don\u2019t take HRT to reduce your risk of heart disease. <\/p>\n\n\n\n

Take it because you need help with your menopause symptoms, and you\u2019ve weighed up the risks and benefits before deciding it\u2019s the right option for you.<\/p>\n\n\n\n

The British Menopause Society suggests healthy women<\/a> under 60 needn\u2019t worry about the overall safety profile of HRT, whilst a higher risk<\/a> of CVD may warrant a deeper discussion.<\/p>\n\n\n\n

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