It can be surprising to get blood test results back and see that your cholesterol levels are high, especially if they’ve always been in a healthy range. But for women in midlife, increases in cholesterol are common.

Cholesterol levels can shift during perimenopause and menopause, even when your diet and exercise habits stay the same. Fortunately, there are steps you can take to lower your cholesterol and protect your heart health during this stage of life.

What Is Cholesterol?

Cholesterol is a waxy substance your body needs to build cells and make hormones, vitamin D, and substances that help you digest food. About 80 percent of the cholesterol in your body is made by your liver. The food you eat provides the rest.

Cholesterol is often labeled as “good” or “bad,” but your body needs it to function. It only becomes a problem when there’s too much of it in the blood.

There are two main types of cholesterol:

• HDL (high-density lipoprotein) — Considered good cholesterol because it helps remove excess cholesterol from the bloodstream
• LDL (low-density lipoprotein) — Considered bad cholesterol because it contributes to plaque buildup in arterial walls, leading to a condition called atherosclerosis

You may see triglycerides listed on your lipid profile. Triglycerides are not cholesterol. They’re a type of fat in the blood. But high triglycerides are a risk factor for heart disease, so it’s important to pay attention to them, too.

When LDL cholesterol and triglycerides are high, or when HDL cholesterol is too low, cardiovascular risk increases.

Health problems linked to high cholesterol include:

• Stroke
• Heart attack
• High blood pressure
• Coronary heart disease
• Sudden cardiac arrest

High cholesterol doesn’t usually cause symptoms in the beginning, so it’s important to get regular checkups and blood tests, especially if you have a family history of heart disease.

Why Does Cholesterol Rise During Menopause?

Women in midlife are about three times more likely to have high cholesterol than women under 40. Much of this shift is linked to hormonal changes.

Estrogen is a hormone that helps protect the heart and blood vessels. As estrogen levels decline during perimenopause, cholesterol levels often change as well. LDL (bad) cholesterol tends to rise, HDL (good) cholesterol may drop, and triglyceride levels often increase. Together, these shifts can lead to an increased risk of cardiovascular disease.

If you’re already coping with hot flashes, sleep disruptions, and other menopause symptoms, adding high cholesterol to the list can feel discouraging. But you do have options. Here are eight ways to lower cholesterol during perimenopause and menopause.

1. Eat a Heart-Healthy Diet

Eating a heart-healthy diet means focusing on whole, minimally processed foods, like vegetables, fruits, whole grains, lean proteins like fish and poultry, and healthy fats from nuts, seeds, and olive oil.

As you add nutrient-rich foods, try to cut back on refined carbohydrates. Highly processed foods such as white bread, pastries, soda, and candy can raise triglycerides and LDL levels. When choosing ingredients, opt for unsaturated fats over saturated fats.

For meal-plan ideas, explore the Mediterranean diet, which has been shown to help prevent cardiovascular disease. If you need help creating a heart-healthy eating plan, ask your healthcare provider for tips or consult a dietitian.

2. Increase Your Soluble Fiber Intake

Soluble fiber is a type of dietary fiber that can help lower LDL (bad) cholesterol levels. Good sources of soluble fiber include oats, legumes, apples, raspberries, citrus fruits, carrots, broccoli, and barley. Try adding a few servings of these foods to your daily meals. For example, you might start your day with a bowl of oatmeal topped with fruit or enjoy a bean-based soup for lunch.

Remember to drink plenty of water and increase your soluble fiber intake gradually to give your body time to adjust. If you’re not sure how much fiber you need, ask your healthcare provider.

3. Get Regular Exercise

Any physical activity that raises your heart rate contributes to healthy cholesterol levels. You don’t have to run a marathon or climb a mountain to see results. You just need to be consistent.

After checking with your doctor, aim to move your body most days of the week. A good target is at least 30 minutes a day on five days of the week, or about 150 minutes per week.

If you don’t already have a favorite activity, try walking, biking, or playing any sport that you enjoy. Even small changes, like taking the stairs or taking short walks throughout the day, add up.

4. Aim for a Healthy Weight

A high body weight can raise LDL (bad) cholesterol and triglycerides, while lowering HDL (good) cholesterol. The good news is that losing even a small amount of weight can make a difference.

To support weight loss and improve cholesterol, focus on a balanced, heart-healthy diet, and make movement a priority. Aerobic activity and strength training can both help burn calories and maintain muscle. Weight-bearing and resistance exercises can also help preserve bone density and reduce the risk of fractures in postmenopausal women.

While weight gain is common during menopause, it doesn’t have to be inevitable. If you’re struggling to lose weight, talk to your doctor or a weight-loss specialist for guidance.

5. Manage Stress

Menopause often coincides with other stressful times in a woman’s life, like caring for aging parents or seeing children reach important milestones. This can make stress harder to manage. However, it’s important to do so because chronic stress can raise cholesterol.

To manage stress, experiment with different relaxation techniques. Tried-and-true methods include deep breathing, yoga, and meditation. Quiet activities like reading a book, taking a walk in nature, or spending time with a loved one or pet may also help. You can also speak to a therapist to help with stress.

Getting enough sleep is important, too. Aim for seven to nine hours of sleep per night. If you struggle with insomnia, talk to your doctor. Sleep disruptions are a common symptom of menopause that can affect your health, wellness, and quality of life.

6. Limit Alcohol

While some studies have suggested that light or moderate alcohol intake may have health benefits, the American Heart Association says there’s no clear evidence that alcohol directly improves heart health. In fact, drinking can cause serious health problems.

Drinking alcohol increases the risk of cardiovascular problems, including high blood pressure, stroke, and heart failure. It can also trigger hot flashes or disrupt sleep during menopause.

If you don’t currently drink, there’s no reason to start. If you do drink, consider cutting back or eliminating alcohol altogether. The American Heart Association recommends that women have no more than one drink per day.

7. Avoid Smoking

Smoking increases the risk of heart disease, lung cancer, and other serious health problems. It also damages blood vessels, lowers HDL cholesterol, and contributes to plaque buildup. During menopause, smoking can also increase the risk of osteoporosis and stroke.

Quitting smoking has immediate benefits, including lower heart rate and blood pressure, and long-term benefits such as improved cholesterol levels and overall cardiovascular health. Quitting may be challenging, but there are resources to help. Talk to your doctor for help with quitting smoking.

8. Ask About Supplements and Medications

If healthy lifestyle changes aren’t enough to lower your cholesterol, ask your healthcare provider whether supplements or prescription medications might help.

Even though many supplements are available over the counter, they aren’t risk-free. Despite marketing claims, research shows they are far less effective at lowering cholesterol than statin therapy and lifestyle changes like diet and exercise.

Supplements are not regulated as closely as medications, so there are also safety concerns to consider. Some can interact with medications or cause side effects, so it’s important to discuss them with your doctor first.

Some supplements that may help lower cholesterol include:

• Omega-3 fatty acids
• Flaxseed
• Plant sterols or stanols
• Niacin
• Green tea extract
• Coenzyme Q10 (CoQ10)

Your medical provider may recommend prescription medications, such as statins or other cholesterol-lowering medications, depending on your overall health and individual risk factors. Statin therapy is an effective and safe treatment for lowering the risk of heart attack and stroke by around 20 percent. No supplement has been shown to be as effective as statin therapy in reducing cardiovascular disease.

Your doctor can help determine which options are right for you and explain the potential benefits, risks, and side effects. If needed, they can also refer you to a cardiologist for additional guidance and support.