Cholesterol went up after menopause. What should I do?

A rise in cholesterol after menopause is a common change, and it is worth acting on calmly rather than ignoring. Studies that followed women through menopause, such as the US SWAN study, found that total and LDL cholesterol rise sharply in the year or so either side of the last period. Start by having a doctor read your result together with your earlier results, age and family history, and ask when to test again. Then look at the everyday habits that affect blood fats: the kind of fat you eat, how much you move, alcohol and smoking.

Why can cholesterol go up around menopause?

What counts as menopause

England's NHS describes menopause as not having had a period for 12 months when you are not using hormonal contraception. It usually happens between the ages of 45 and 55, but can happen earlier. Perimenopause is the time before that, when periods become irregular.

Hormone levels and age both change

The US National Heart, Lung, and Blood Institute (NHLBI) explains that menopause lowers levels of female hormones, and that a woman's chance of having higher cholesterol goes up after menopause. It also notes that as we get older, the liver does not remove LDL cholesterol as well as it did when we were young.

So two things are happening in the same years: the change in hormones, and ordinary ageing. Research that follows the same women over time helps tell them apart.

What did studies that followed women through menopause find?

Three analyses, two from the US SWAN study and one from Japan, measured the same women again and again, before and after their last period.

What the SWAN results add

In the Derby SWAN analysis, the change linked to menopause was similar in size to the change linked to ageing. Early after menopause, the odds of having LDL of 130 mg/dL or more were 2.1 times those before menopause. The increases were smallest in women who were heaviest at the start.

What these studies cannot tell you

These are averages from women in the US and Japan, not Thailand, and individual women vary. They show when the change tends to happen, not what your own numbers will do, which is why your own results over time matter most.

What are cholesterol levels like in Thai women?

Thailand has its own national data. A 2025 analysis by Ganokroj and colleagues, using the 6th National Health Examination Survey, looked at blood fats in 17,018 adults aged 20 and over (7,244 men and 9,774 women) who were not taking cholesterol medicine and did not have heart or blood vessel problems.

In this survey, median LDL was highest in women aged 55 to 59 and in men aged 45 to 49. The researchers also noted that LDL levels in Thai adults were notably high compared with other populations. This survey is a snapshot of different people at different ages, not the same women followed over time, and it did not look directly at how these values relate to menopause.

For comparison, MedlinePlus uses LDL below 100 mg/dL as the healthy level for adults in the US. That is a US example, not a Thai standard, so ask your doctor which level applies to you.

What should I do first after a higher result?

Have a doctor read it with your history

One number does not tell the whole story. MedlinePlus says a healthy level for you may depend on your age, family history, lifestyle and other risk factors. Take your earlier results so the doctor can see the trend, and mention roughly when your periods stopped.

Ask when to test again

MedlinePlus suggests testing every 1 to 2 years for women aged 55 to 65 and every year over 65, and more often for some people. Ask the doctor what suits you. If you need to fast before the test, MedlinePlus says it is usually for 9 to 12 hours, but follow what your clinic tells you.

Leave medicine decisions to you and your doctor together

Whether you need medicine is a decision to make with a doctor who knows your full picture. Do not start, change or stop medicines on your own.

For reading each value on a blood fat report, see I'm in my early 30s. Should I start watching my blood fats?

Which everyday habits are worth looking at now?

The kind of fat you eat

England's NHS advises eating less saturated fat and replacing some of it with unsaturated fat. Foods high in saturated fat include fatty cuts of meat, butter, lard, palm oil, coconut oil, coconut milk and coconut cream, cheese, cream, cakes, biscuits and pastries. The NHS also suggests grilling, baking, poaching or steaming rather than frying. The Thai Reference Daily Intake (Thai RDI) used on nutrition labels is 20 g of saturated fat and 300 mg of cholesterol a day.

For how cooking oils differ, see How do cooking oils differ, and what fats do they contain?

Moving your body

WHO's 2020 guidelines advise adults to do 150 to 300 minutes of moderate activity, such as brisk walking, or 75 to 150 minutes of vigorous activity a week, plus muscle-strengthening on 2 or more days. The NHLBI notes that lack of physical activity is linked to a higher chance of unhealthy cholesterol levels. Brisk walking and strength work also suit the years after menopause for other reasons, as covered in How do bones change after menopause? Which habits matter?

Smoking and alcohol

The NHLBI says smoking lowers HDL, particularly in women, and raises LDL, and that drinking too much alcohol, more than one drink a day for women, can raise total cholesterol. The NHS advises no more than 14 units a week (1 unit is 8 g of pure alcohol), spread over 3 or more days if you regularly drink that much. For more on drinking and blood fats, see I drink alcohol often. What should I know about blood fats?

Sleep

Menopause can also disturb sleep, which makes it harder to keep up the habits above. For night sweats and sleep, see Menopause night sweats keep me awake. How can I cope?

What should I bring and ask at the appointment?

What to bring

• your earlier blood fat results, if you have them
• roughly when your periods became irregular and when they stopped
• family history, such as close family with heart or blood vessel problems
• a list of every medicine you take regularly, including vitamins and herbal products
• how much you smoke, drink and move in a typical week

What to ask

• which of your values matters most and how it compares with before
• when to test again
• whether anything else should be checked

If you take regular medicines, keep taking them as your doctor has told you.