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Menopause & Heart Disease: What’s the Connection?
Author: Jamie Braithwaite
May 17, 2022
Almost half of women over the age of 55 in the UK suffer from high levels of bad cholesterol. Research has shown that oestrogen, one of the major female sex hormones, has a protective role in keeping cholesterol levels down and preventing heart disease. We take a look at the connection between oestrogen and heart health in menopausal women.
Link Between Menopause & Heart Health
It is the declining levels of oestrogen as women reach menopause that contributed to an increased risk of cardiovascular disease and the risk of heart attacks and strokes for women as they reach menopause and beyond.
Oestrogen is one of the main female sex hormones that controls the menstrual cycle. It plays an important role in women’s health, beyond the reproductive system, such as her musculoskeletal health, neurological health and cardiovascular health.
When it comes to heart health, oestrogen acts on the liver to significantly decrease plasma concentrations of total cholesterol and bad cholesterol, known as low-density lipoprotein (LDL), while increasing concentrations of triglyceride and good cholesterol, known as high-density lipoprotein (HDL). 
The steady declining levels of oestrogen during perimenopause is linked with a progressive rise in total cholesterol and bad cholesterol, and a drop in good cholesterol .
Oestrogen also helps to keep the inner layer of the heart’s artery wall flexible and assists with dilating blood vessels to support blood flow. As oestrogen levels decline through perimenopause and menopause, this protective benefit wanes. With a drop in oestrogen, the development of atherosclerosis increases. This is the build-up of cholesterol on artery walls, which causes them to harden and lose their flexibility, further increasing the risk of heart disease in postmenopausal women.
Can Hormone Replacement Therapy Help?
Research shows that hormone replacement therapy (HRT) can help menopausal women reduce their risk of heart disease. HRT works by replacing the hormones oestrogen and progesterone that decline as a woman transitions through menopause, not only helping to ease symptoms experienced during perimenopause but helping reduce the risk of long term health conditions, such as heart disease. One study of more than 4,200 women found that women using HRT were overall 30% less likely to die of cardiovascular-related conditions than women who were not taking HRT. 
What Lifestyle Changes Can Help?
Leading a healthy lifestyle and adopting healthier habits can help keep your cholesterol levels within safe parameters and lower your risk of cardiovascular disease when progressing through menopause. Some simple lifestyle changes are:
- Diet – eat plenty of colourful plant-based foods and those rich in fibre, and swap saturated fats for healthier alternatives like vegetable-based spreads and oils.
- Exercise – getting active helps to increase the level of HDL cholesterol in your blood, the type that helps to transport excess cholesterol and fat to the liver, where it’s broken down and removed from the body.
- Smoking – smoking increases LDL blood levels and makes it even sticker, so it attaches easier to your artery walls, causing blood flow to become restricted. It also lowers the level of ‘good’ cholesterol in your blood.
Oestrogen is a powerful hormone that helps reduce women’s risk of cardiovascular events prior to menopause. As oestrogen levels decline, women are less protected against heart disease, particularly after menopause and can see an increase in their bad cholesterol levels. Being aware of the impact hormone changes have on their bodies as they get older, will enable women to put the right strategies in place to protect their long term health.
- Flora Pro Activ. (2022). Menopause and Cholesterol. Available at: https://www.pro-activ.com/en-gb/heart-and-cholesterol/high-cholesterol-causes/menopause-and-cholesterol
- Journal of the American College of Cardiology. (2001) Estrogen-induced small low density lipoprotein particles may be atherogenic in postmenopausal women. Available at: https://www.sciencedirect.com/science/article/pii/S0735109700011530#BIB2
- Iorga, A et al. (2017). The Protective Role of Estrogen and Estrogen Receptors in Cardiovascular Disease and The Controversial Use of Estrogen Therapy. Biol Sex Differ: 8(33).
- Harvard Health Publishing. (2020). Take Control of Rising Cholesterol at Menopause. Available at:https://www.health.harvard.edu/womens-health/take-control-of-rising-cholesterol-at-menopause
- British Heart Foundation.Women and Heart Attacks. Available at: www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/women-and-heart-disease
- British Heart Foundation. Bias and Biology Available at: https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/women-and-heart-disease/download-bias-and-biology-briefing
- The British Menopause Society. (2017) Hormone Replacement Therapy can lower risk of early death in women, a new study suggests. Available at: thebms.org.uk/2017/03/hormone-replacement-therapy-can-lower-risk-early-death-women-new-study-suggests
This information has been medically reviewed by Dr Nicky Keay
Nicola has extensive clinical and research experience in the fields of endocrinology and sport and exercise medicine. Nicky is a member of the Royal College of Physicians, Honorary Fellow in the Department of Sport and Exercise Sciences at Durham University and former Research Fellow at St. Thomas' Hospital.
Dr Nicky Keay
BA, MA (Cantab), MB, BChir, MRCP.
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