Cholesterol and menopause

What do they have to do with each other?

"My cholesterol has gone up since my menopause. Yet I eat the same and I exercise."

A familiar question. And actually, it is not strange at all.

Cholesterol is not a "bad" substance in itself. Your body needs cholesterol for, among other things, building cells and producing hormones. The problem lies mainly in how cholesterol is transported through your body.

This is where you often hear about LDL and HDL cholesterol.

LDL: the so-called "bad" cholesterol

LDL transports cholesterol from the liver to the rest of the body. We need that cholesterol, but when too many LDL particles circulate in the blood, they can lodge themselves in the vessel wall. There, an inflammatory reaction can arise and plaques can form.

That is why we often call LDL the "bad" cholesterol.

HDL: the so-called "good" cholesterol

HDL broadly does the opposite. It helps transport cholesterol from the tissues back to the liver, where it can be further processed and excreted.

That is why HDL is often called the "good" cholesterol.

What does "atherogenic" mean?

Atherogenic = promoting the development of hardening of the arteries (atherosclerosis).

A more atherogenic lipid profile therefore means that relatively more lipoproteins are present that can contribute to the development of plaques in the blood vessels. LDL in particular plays an important role in this.

What is the link with menopause?

Due to the decline in estrogen, body composition and fat distribution change, among other things. More abdominal and visceral fat develops more easily and the lipid profile can become less favourable, with an increase in total cholesterol, LDL cholesterol and triglycerides and a decrease in HDL cholesterol (El Khoudary et al., 2020; Bernal et al., 2025).

Estrogen plays an important role in the processing of cholesterol and lipoproteins. When estrogen levels drop during menopause, this metabolism shifts on average towards a more atherogenic lipid profile.

That is relevant, because cardiovascular risk also increases with age.

But there is good news too: exercise can play an important role here.

Strength training and cholesterol

When we think about cholesterol, we often think of nutrition first. But exercise — and strength training in particular — also has important metabolic effects.

A meta-analysis of 12 randomised controlled trials in postmenopausal women showed that strength training lowered total cholesterol and triglycerides and increased HDL cholesterol (Loaiza-Betancur et al., 2022).

Individual studies also show relevant changes. After 12 weeks of strength training in obese postmenopausal women, total cholesterol, LDL cholesterol and non-HDL cholesterol decreased, without any significant change in body weight (Wooten et al., 2011).

And that last point is important.

Your health does not necessarily improve on the scales

You can become stronger, build muscle mass and lose fat mass without the number on the scales changing much. Strength training also increases fat-free mass, which contributes to better metabolic health (Khalafi et al., 2023).

But what about cardio?

Cardio remains important too.

Endurance training is particularly effective for improving your cardiovascular fitness and can also contribute to a reduction in fat mass and visceral fat (Khalafi et al., 2023).

So you do not have to choose between strength training and cardio at all.

They actually complement each other.

Strength training is particularly interesting for muscle mass, muscle strength, waist circumference and various metabolic parameters. Endurance training has strong effects on cardiovascular fitness and fat oxidation.

Combined training therefore delivers a broad package of health benefits. Research indeed shows that no single form of training is superior for all aspects of metabolic health (Khalafi et al., 2023; Zhang et al., 2025).

So how do you best train during menopause?

In practical terms:

Strength training twice a week

Train the large muscle groups and make your workout sufficiently challenging.

You do not have to spend hours in the gym. But your muscles do need a clear training stimulus.

Getting stronger is the goal. Not just burning calories.

Combine this with cardio

As a baseline, aim for 150–300 minutes of moderate-intensity or 75–150 minutes of vigorous aerobic activity per week.

That can be running, cycling, swimming, brisk walking… Above all, choose a form of exercise that suits you and that you can sustain.

Combine both

For most women in perimenopause and postmenopause, a combination of strength and endurance training is probably the most complete strategy for good cardiometabolic health.

And perhaps even more important

Do not look only at your weight.

Also look at your muscle strength, waist circumference, blood pressure, cholesterol, triglycerides, glucose and fitness.

Menopause does not mean that your health will only decline from now on. It is precisely a period in which you may give certain things a little more attention again.

References

• El Khoudary SR, et al. Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention. Circulation. 2020;142(20).
• Bernal E, et al. Physical activity and lipid profile in peri- and postmenopausal women: a systematic review. 2025.
• Loaiza-Betancur AF, et al. Effects of resistance training on body composition and metabolic health in postmenopausal women: a systematic review and meta-analysis. 2022.
• Wooten JS, et al. Resistance exercise and lipoproteins in postmenopausal women. 2011.
• Khalafi M, et al. Resistance training and body composition in postmenopausal women: systematic review and meta-analysis. 2023.

This information is intended solely for educational and informational purposes. It does not replace medical advice, diagnosis or treatment by a doctor or other qualified healthcare provider. Always consult your (family) doctor if you have questions or concerns about your health or treatment.