Menopause and Heart Disease

How a change in hormones can affect your cholesterol.

We know that estrogen plays a role in helping women maintain healthy levels of cholesterol before menopause. After menopause, as estrogen levels plummet, LDL (low-density lipoprotein) tends to rise, HDL (high-density lipoprotein) drops, and triglycerides increase.

In theory, hormone replacement therapy (HRT) should solve those problems. And when researchers looked back on large populations of women who chose to take HRT, the numbers seemed to support this theory. But the story isn't so simple after all.

In 2002 the government halted part of a major trial, the Women's Health Initiative, after realizing that Prempro, a brand of pill that combines estrogen and another hormone, progestin, not only failed to protect women from heart disease, it actually increased the incidence slightly. The drug also slightly raised the incidence of breast cancer, stroke, and blood clots in postmenopausal women.

Researchers don't know if it was the form of the estrogen used, the form of progestin, or the combination that caused the problems. Many suspect that another form of HRT would yield different results. Meanwhile, doctors no longer prescribe HRT just for heart protection.

So what's a menopausal woman to do? Lifestyle changes, such as exercise and diet adjustments, will help bring HDL and LDL levels back in line. Some studies suggest a high intake of foods (such as soy) that contain estrogen-like compounds called phytoestrogens can lower cholesterol. Whether phytoestrogens directly protect against heart disease is still under study, but soy offers valuable nutrients without the saturated fat of meat, and thus is a good addition to a heart-healthy diet.

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