Cardiometabolic Health · Perimenopause

Cholesterol & Perimenopause

As estradiol drops, your cholesterol often shifts in a direction that makes your heart work harder — it’s the hormonal transition, not just aging.

What changes during perimenopause

As you move through perimenopause, your natural estradiol levels start to drop. This hormonal shift—not just aging—causes changes in cholesterol that can make your heart work harder. Many women notice increases in total cholesterol, LDL (“bad”) cholesterol, and triglycerides, along with a drop in HDL (“good”) cholesterol.[1-4]

The pattern of change
Total
cholesterol
↑
tends to rise
LDL
“bad”
↑
tends to rise
Triglycerides
blood fats
↑
tend to rise
HDL
“good”
↓
tends to drop
And it’s not just the number.

Estradiol also affects how well HDL works, so when estradiol declines, HDL becomes less protective for your heart.[1][3]

What estradiol therapy can do

Hormone therapy with estradiol can help improve these cholesterol changes. Studies show that estradiol can increase HDL by up to 15% and reduce LDL by up to 20%.[5-6]

HDL (“good”)
up to +15%
can increasethe protective one
LDL (“bad”)
up to −20%
can reducethe one you want lower
Important to understand

Hormone therapy is not prescribed solely for cholesterol or heart protection.[1][5] It’s one tool we may use as part of your overall plan to feel better and stay healthy during the hormonal transition.

In short

Perimenopause naturally shifts your cholesterol in an unhealthy direction because estradiol is declining. Estradiol therapy can partially reverse those changes—but it’s one piece of your overall plan, not a stand-alone treatment for your heart.

Questions about your lipid panel?

If your most recent labs showed changes you want to talk through, send us a message and we’ll fold it into your plan.

Message the clinic

References

  1. Dyslipidemia in Midlife Women: Approach and Considerations During the Menopausal Transition. Torosyan N, Visrodia P, Torbati T, Minissian MB, Shufelt CL. Maturitas. 2022;166:14-20. doi:10.1016/j.maturitas.2022.08.001.
  2. Lipid Metabolism in Women: A Review. van Oortmerssen JAE, Mulder JWCM, Kavousi M, Roeters van Lennep JE. Atherosclerosis. 2025;405:119213. doi:10.1016/j.atherosclerosis.2025.119213.
  3. Menopause: A Cardiometabolic Transition. Nappi RE, Chedraui P, Lambrinoudaki I, Simoncini T. The Lancet. Diabetes & Endocrinology. 2022;10(6):442-456. doi:10.1016/S2213-8587(22)00076-6.
  4. Lipid Changes During the Menopause Transition in Relation to Age and Weight: The Study of Women’s Health Across the Nation. Derby CA, Crawford SL, Pasternak RC, et al. American Journal of Epidemiology. 2009;169(11):1352-61. doi:10.1093/aje/kwp043.
  5. Lipid Management in Patients With Endocrine Disorders: An Endocrine Society Clinical Practice Guideline. Newman CB, Blaha MJ, Boord JB, et al. The Journal of Clinical Endocrinology and Metabolism. 2020;105(12):dgaa674. doi:10.1210/clinem/dgaa674.
  6. Effects of Postmenopausal Estrogen Replacement on the Concentrations and Metabolism of Plasma Lipoproteins. Walsh BW, Schiff I, Rosner B, et al. The New England Journal of Medicine. 1991;325(17):1196-204. doi:10.1056/NEJM199110243251702.
  7. Cholesterol and Atherosclerosis: Modulation by Oestrogen. Barton M. Current Opinion in Lipidology. 2013;24(3):214-20. doi:10.1097/MOL.0b013e3283613a94.