Nothing About Your Eating Changed. The Number Did.
Body · The Reading Room · 8 min read · Which numbers move with the menopause transition, which ones just move with age, and the one year the difference shows up in
Based on the published research of Karen A. Matthews, PhD, Distinguished Professor Emerita, Department of Psychiatry, University of Pittsburgh, and on the American Heart Association’s 2020 scientific statement. Faculty profile · Wikipedia · the study on PubMed
Three of your blood results move with the menopause transition. The rest of them just move with getting older. Almost nobody is told which is which.
The letter says your cholesterol has gone up and you should think about diet and exercise.
You read it twice, because the diet has not changed. If anything it is better than it was at forty. You walk more than you used to. You cook most nights. Nothing on the list of things you are supposed to be doing differently is a thing you are actually doing differently.
So why did my cholesterol go up in menopause, when the inputs are the same and the number is not.
There is a specific answer, it was measured in more than a thousand women, and it is not the answer in the letter. Informational, not medical advice, and worth taking to your clinician rather than instead of one.
This is a reading of published research. We are not clinicians; the findings belong to the researchers named below, and the plain-English version is ours.
The short answer: most cardiovascular risk factors drift upwards steadily with age. Three do not. Total cholesterol, LDL cholesterol and apolipoprotein B rise sharply in the twelve months surrounding your final period, in a pattern that does not look like ageing and does look like the transition itself.¹ That single year is doing something the years either side of it are not, and it is the reason the number moved while your life did not.
The skim version
- The study followed 1,054 women from the Study of Women’s Health Across the Nation, a multi-ethnic cohort of 3,302, through to a natural final menstrual period across nine years.¹
- Total cholesterol, LDL cholesterol and apolipoprotein B each showed a distinct increase within the year around the final period, significantly larger than the increases before or after it.¹
- Every other risk factor measured, including glucose, insulin, blood pressure, fibrinogen and C-reactive protein, followed a straight-line ageing pattern instead.¹
- That split is the finding. Two different clocks are running, and only one of them is the menopause transition.¹
- In 2020 the American Heart Association issued a scientific statement on the menopause transition and cardiovascular risk, arguing it is a window where prevention timing matters.²
- The honest gap: the women in this analysis were the ones who reached a natural final period within nine years and who were not using hormone therapy beforehand, and about a quarter of the sample was lost to follow-up. The pattern is well measured. It is not measured in every woman.¹
In this article: The two clocks · Why one year · What moves with what · What to say at the appointment · The one move · FAQ
Why did my cholesterol go up in menopause?
Because you have two clocks running at once and the letter only knows about one of them.
Karen Matthews and her colleagues asked a question that sounds obvious and had not properly been answered: when a midlife woman’s cardiovascular numbers get worse, is that ageing, or is that the menopause transition? Those two happen at the same time in the same person, which is exactly why nobody had cleanly separated them.
The method was to line the data up against the final menstrual period rather than against birthdays. Instead of asking what happens between 48 and 54, they asked what happens in the years before, during and after that one specific event, in 1,054 women drawn from a multi-ethnic cohort of 3,302 followed across nine years.¹
Lined up that way, the picture separates cleanly. Glucose, insulin, blood pressure, fibrinogen, C-reactive protein and the rest climb in a fairly straight line across the whole period, which is what ageing looks like. Total cholesterol, LDL cholesterol and apolipoprotein B do something else entirely. They step up inside the twelve months around the final period, and the authors report that those increases were substantially and significantly greater than the increases before and after that interval.¹
Which means the letter is not wrong so much as it is missing a variable. Diet and exercise are real levers. They are not the lever that moved this particular number in this particular year.
Why would one year do that?
Because that is the year the hormonal environment your lipid metabolism has been operating in for thirty-five years finishes changing.
Oestrogen is not only a reproductive hormone. It has effects across the cardiovascular system, including on how the liver handles cholesterol. When it settles into its post-menopausal level, the system it was influencing settles too, at a new value. What you are reading on the letter is that new value.
The American Heart Association took this seriously enough to make it the subject of a formal scientific statement in 2020, arguing that the menopause transition is a period of accelerating cardiovascular risk in women and that the timing of prevention should reflect it.² That is a notable thing for the AHA to publish. A scientific statement is the mechanism by which a professional body tells clinicians that something in the routine has to change.
What the research found
The study. Matthews and colleagues, “Are changes in cardiovascular disease risk factors in midlife women due to chronological aging or to the menopausal transition?”, Journal of the American College of Cardiology, 2009. 1,054 women from the SWAN cohort, followed to a natural final menstrual period.
The finding. Total cholesterol, LDL-C and apolipoprotein B showed distinct increases within the year surrounding the final period. In the paper’s own terms, those increases were substantial and were significantly greater than the increases before and after that interval. Every other risk factor measured tracked chronological ageing instead.¹
The limitation, as the authors state it: the results rest on women who had a natural final period within the nine years of follow-up, and that group differed from the others, being leaner and more likely to smoke. The analysis was restricted to women not using hormone therapy before the final period. Roughly a quarter of the sample was lost to follow-up, and financial constraints meant blood samples were not assayed in three of the study years.¹ None of that undoes the pattern. It does mean the pattern is best read as what happens on average, in that group, rather than as a prediction about you.
If this is one of several results that have moved in the last two years and nobody has connected them for you, connecting them is worth ten quiet minutes on your own. Start here.
The source for this piece
Karen A. Matthews, PhD
Distinguished Professor Emerita in the Department of Psychiatry at the University of Pittsburgh, with appointments in epidemiology and psychology. Her research covers behavioural and biological contributors to cardiovascular disease, with a particular focus on women at midlife, and she has been among the central investigators on SWAN.
What we read: Matthews, K. A., et al., Journal of the American College of Cardiology, 2009, the analysis separating menopause-related from age-related change in cardiovascular risk factors.¹
Where to follow her work: Pitt Public Health profile · Pitt Psychiatry emeritus faculty · Wikipedia · American Psychosomatic Society honour · INRICH network · PubMed
What moves with the transition, and what just moves with age
This is the table nobody hands you, and it is the whole article in six rows.
| Measure | Which clock it follows | What that means for you |
|---|---|---|
| Total cholesterol | The transition. Steps up around the final period | A rise here around that year is expected, not evidence of a lapse |
| LDL cholesterol | The transition. Same pattern | The number most likely to have triggered the letter |
| Apolipoprotein B | The transition. Same pattern | Rarely tested routinely, and worth asking about |
| Blood pressure | Chronological ageing | Drifts up over the years regardless of the transition |
| Glucose and insulin | Chronological ageing | Same. Steady climb, not a step |
| Inflammatory markers | Chronological ageing | Fibrinogen and C-reactive protein follow the age line |
Read the first three rows against the last three. That is two different processes happening inside one woman in one decade, and the routine annual letter treats all six as the same story about your habits.
Who else has measured this
This is not a single 2009 paper standing on its own. The professional bodies have moved since.
Samar R. El Khoudary, PhD, MPH, FAHA, Chair and Professor of Epidemiology at Virginia Commonwealth University, previously at the University of Pittsburgh, led the American Heart Association’s 2020 scientific statement on the menopause transition and cardiovascular risk. Her research covers sex hormones, lipids, visceral fat and vascular change across the transition.²
VCU Institute for Women’s Health · Pitt profile · Google Scholar · ResearchGate · UPMC expert page · LinkedIn
Nanette K. Wenger, MD, MACC, MACP, FAHA, Professor of Medicine Emeritus in the Division of Cardiology at Emory University School of Medicine, spent a career establishing that women’s cardiovascular disease needed studying in women. The American Heart Association names an annual research award after her.4
Grady Health profile · the AHA award in her name · a conversation with her in Circulation · WomenHeart · Preventive Cardiovascular Nurses Association · oral history, Women in Medicine Legacy Foundation · LinkedIn
The Study of Women’s Health Across the Nation is the cohort underneath all of this: a multi-ethnic, multi-site American study that has followed the same women through the menopause transition since the 1990s, and the reason questions like this one can be answered at all.¹
the 2009 analysis, JACC · free full text, PubMed Central · a later SWAN lipid analysis, Journal of the American Heart Association
The American College of Cardiology summarised the 2020 statement for practising clinicians, which is the document to hand a doctor who has ten minutes and no time to read forty pages.³
ACC, ten points to remember · AHA professional commentary
Two clocks. The letter only knows about one.
What this actually changes
Not the advice, particularly. The advice about eating and moving is good advice and it stays good advice.
What it changes is the sentence you say to yourself while reading the letter. A number that steps up in the year around your final period is doing something documented in a thousand women, and it is not a report card on how well you have been living. The 2020 statement exists precisely because this is a physiological transition with cardiovascular consequences, not a lapse in discipline.²
It also changes what is worth asking. If the rise is transition-related rather than habit-related, then the useful conversation is about where you are in the transition, whether apolipoprotein B has ever been measured, and what your overall risk picture looks like rather than one number in isolation. That is a different appointment from the one where you promise to try harder.
When this belongs with a doctor
Any abnormal lipid result belongs with a clinician, and this article is not a reason to leave one unattended. Go sooner rather than later if you also have chest discomfort on exertion, unusual breathlessness, a family history of early heart disease, or if you had an early or surgical menopause, since that changes the timeline considerably.
The sentence to take with you: “My cholesterol rose around the time of my final period and my diet has not changed. Can we look at this as part of the menopause transition, and can we check apolipoprotein B alongside the standard panel?”
The one move: put the dates side by side
Five minutes, and it needs two pieces of paper you already have.
Write down the approximate date of your last period, if it has happened. Then find your last two or three sets of blood results, which are usually in the patient portal or in a drawer, and write the cholesterol figures next to the dates.
Now look at whether the step, if there is one, sits near that date.
That is all. You are not diagnosing anything and you are not going to act on it tonight. You are building the one piece of information the letter did not have and your clinician almost certainly does not have either, because nobody puts the final period on the lab form. If the two line up, you walk into the appointment with a timeline instead of an apology, and those go very differently.
Common questions
Why did my cholesterol go up in menopause when my diet has not changed?
Because total cholesterol, LDL and apolipoprotein B rise in the twelve months around the final menstrual period in a pattern that does not match ordinary ageing.¹ Diet and exercise still matter. They are simply not what moved that number in that year.
Does everyone’s cholesterol rise at menopause?
The pattern was found on average across 1,054 women, which is not the same as a guarantee for any individual. The analysis also excluded women using hormone therapy before their final period, and about a quarter of the sample was lost to follow-up.¹
Which blood results are just ageing, then?
In this analysis, glucose, insulin, blood pressure, fibrinogen, C-reactive protein and the other measured factors followed a straight-line ageing pattern rather than clustering around the final period.¹ Only the three lipid measures behaved differently.
Does hormone therapy fix it?
That is a genuinely separate question with its own large literature, and it is a decision for you and a clinician who knows your history rather than something an article should answer. What this research establishes is the timing of the change, not its treatment.
Should I be worried?
Worried is the wrong frame. Informed and specific is better. The American Heart Association considers the transition a window where prevention timing matters, which is an argument for having the conversation now rather than for being alarmed by one result.²
The one move
Write the date of your last period next to your last two or three cholesterol results and see whether the step sits near it. Five minutes, two pieces of paper you already have.
If this is one of several things that have quietly shifted while you kept everything else running, seeing them on one page tends to help. Start here.
The number changed because the year changed. You did not stop being careful.
Related reading: what the transition does to the midlife brain, why the body starts filing fat somewhere new, and the bone timetable nobody is shown.
On the researchers. Karen Matthews is an epidemiologist and psychologist studying cardiovascular risk in midlife women, not your clinician; the 2009 analysis describes average patterns in a defined cohort and says nothing about any individual woman’s results. Samar El Khoudary led an American Heart Association scientific statement, which is a synthesis of evidence for clinicians rather than a treatment protocol. Nanette Wenger is a cardiologist cited here for her role in establishing the field, not as a source for any specific figure above.
Sourcing, disclosure and disclaimers
This is not medical advice. Blue Leaf Journal publishes general information for a general readership. Nothing here is a diagnosis, a treatment recommendation, or a substitute for care from a clinician who knows your history. Informational, not medical advice: see your clinician.
We are not clinicians. Blue Leaf Journal is an independent publication and its bylines carry no medical or academic credential. We read published research and translate it. The findings belong to the researchers and institutions named and linked above; the plain-English rendering is ours, and so is any error in it.
No affiliation and no endorsement. Blue Leaf Journal is not affiliated with Karen A. Matthews, Samar R. El Khoudary, Nanette K. Wenger, the University of Pittsburgh, Virginia Commonwealth University, Emory University, the Study of Women’s Health Across the Nation, the American Heart Association or the American College of Cardiology. None of them has reviewed, approved or endorsed this article, and none of them is responsible for it.
No commercial relationship. Nobody named above paid for or was paid for this coverage. There are no affiliate links, no sponsored placements and no product recommendations in this article.
How this was checked. Every figure above was checked against the cited source on 10 September 2026, and each source is linked below. If you find something we have got wrong, write to norawhitfield@blueleafjournal.com and we will correct it and say that we did.
References
1. Matthews, K. A., Crawford, S. L., Chae, C. U., et al. “Are changes in cardiovascular disease risk factors in midlife women due to chronological aging or to the menopausal transition?” Journal of the American College of Cardiology, 2009, 54(25):2366–2373. jacc.org · PubMed · free full text via PubMed Central
2. El Khoudary, S. R., et al. “Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention. A Scientific Statement From the American Heart Association.” Circulation, 2020. PubMed · AHA science news
3. American College of Cardiology, “Menopause Transition and CVD Risk: AHA Scientific Statement, ten points to remember”, December 2020.
4. American Heart Association, the Dr. Nanette K. Wenger Research Goes Red award, 2025. Cited for Wenger’s standing in the field.
Keep reading
Nora Whitfield writes for Blue Leaf Journal, where the working rule is that a mechanism you can name is easier to live with than one you cannot. She reads the limitations section before the conclusion, and passes on what she finds there.
Written by Nora Whitfield for Blue Leaf Journal. Updated: 10 September 2026.
