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Cholesterol And The Menopause

We all know that menopause influences many changes in the body, mostly due to the change in hormonal assets. On top of those very well known unpleasant changes, like hot flushes, night sweats, mood swings, and fatigue, it can happen to have various other health related problems. In fact, oestrogens are protective against cardiovascular diseases, and also are able to prevent the onset of osteoporosis.

CardioVascular Diseases (CVD) have always been thought to be more of a male orientated problem. This is, actually, not true. CVD is the leading cause of death in women after the menopause onset, and in fact more women die from heart disease and stroke than from the other of the top five causes of death combined, including breast cancer, which is one of the biggest concerns to women, especially the ones taking HRT. Even though many women perceive that breast cancer is one of biggest threats, statistically women are nine times more likely to die of CVD than of breast cancer.

Statistically women are nine times more likely to die of CVD than of breast cancer

CVD is traditionally seen as a problem in middle-aged men, but in reality CVD affects just as many women as men, if not more. Although this, on average, happens in women around a decade later. This delay in the onset of cardiovascular disease, is thought to be due to the protective effects of oestrogen that is maintained in the years before the menopause. As oestrogen levels drop, often from the mid-40s onwards (the age of menopause being around 50-51 years old), the protective effect is lost, and rapid changes occur that lead to an increased risk of heart disease in the years following menopause. One of the biggest problems, is that women are unaware of this risk, and they are not well informed by health professional. In fact, women usually do not associate menopause with cardiovascular diseases or increase in cholesterol which is one of the risk factors of CVD.

Menopause affects all women and occurs when the ovaries either naturally stop producing oestrogen due to the decline and cessation of oocyte development/production and ovulation, which is essential for the production and level maintenance of both oestrogen and progesterone, or when the ovaries are removed or damaged by other therapies. The average age at natural menopause varies between different countries and is also affected by other factors such as genetics, nutrition, smoking and age of menarche; in Europe it happens around 51 years old. The decrease on oestrogen levels usually starts some years before the menopause begins as oocyte quality decline as well as the numbers.

Oestrogen deficiency can lead to early, intermediate and long-term health problems. There is widespread awareness of the common early menopausal symptoms such as hot flushes, night sweats, insomnia and mood changes. Intermediate symptoms, which appear later, are vaginal dryness, irritation, discomfort and bladder changes. Those are very common and, although discussed less often than hot flushes, are gradually being reported and treated more often than in the past. The long-term effect of menopause includes the symptoms involving bones, with the lack of oestrogen leading to loss of bone strength (and eventually osteoporosis) with an increased risk of fracture. This symptom is fairly known and frequently addressed, or at least a therapy is proposed.

Being overweight for example, is a significant risk factor for CVD and is a problem increasing in the western world.

However, there is incredibly poor information of the important long-term effects that the menopause has on the cardiovascular system. Being overweight for example, is a significant risk factor for CVD and is a problem increasing in the western world. Obesity is reported to be more common in men than in women, but before 45 years of age. After this point the trend actually reverses. During the menopause, or within the first year of the menopause, there is a change in fat distribution and storage in women from the hips to the waist. In fact, menopausal women often say: “ you get thick in the middle”. These are often referred to as ‘apple’ shapes, and the apple shape is the one more associated with an increased risk of CVD. Waist circumference, in fact, reflects this risk. The exact mechanism by which oestrogen deficiency leads to weight gain and change in fat distribution is not clear yet, but is thought to be related to a consequent excess of androgens (post-menopausal ovaries still produce some androgens) together with changes in leptin and thyroid function.


There is no doubt that raised level of cholesterol is a significant risk factor for CVD. Menopause, on the other hand, is associated with a progressive increase in total cholesterol, with an increase in low-density lipoprotein (LDL) (the “bad” cholesterol which helps carry fat molecules around the body) and a decrease in high-density lipoprotein (HDL) (the good cholesterol). Therefore, menopausal women are exposed to a more atherogenic (easier formation of plaques, in other words, fat deposition on blood vessels) lipid profile than pre-menopausal women. Total cholesterol levels peak in women at 55–65 years of age – about 10 years later than the peak in men.

Agents that lower cholesterol levels reduce heart disease risk in both men and women, but it is thought that a larger proportion of women than men are at high risk and are not being effectively treated, because they are unaware and there is not enough information out there, and therefore, no prevention. Basically, not many women associate cholesterol level with menopause, therefore, not many women keep it checked and under control. So, women out there, you need to also keep your cholesterol level under control, because it can be a risk factor of CVD after menopause onset.

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