05/02/2026
Estrogen isn’t just a reproductive hormone—it plays a direct role in cardiovascular health.
Before menopause, estradiol helps regulate how your body clears LDL (“bad cholesterol”) by supporting LDL receptor activity in the liver. It also influences pathways like PCSK9, a protein that can reduce the number of receptors available to remove LDL from the bloodstream.
When estrogen levels decline during menopause, this balance shifts. Fewer LDL receptors are available, and LDL particles can remain in circulation longer—contributing to higher cholesterol levels and increased cardiovascular risk.
This is why many women see their LDL rise after menopause, even without changes in diet or lifestyle.
The key point:
This isn’t just about cholesterol. It’s about hormone signaling.
Optimizing estradiol—when appropriate and individualized—can support these pathways and improve lipid metabolism. In some cases, medications like PCSK9 inhibitors may also be used, but they act on a pathway that estrogen previously helped regulate.
Menopause care is cardiovascular care.
Find a PHRT™ provider near you! https://womenshormonenetwork.org/find-a-provider/