Category: Women’s health · Menopause · Blood lipids
LDL of 147 at Menopause but Cannot Take Hormones: How Much Normal Triglycerides Help, and Evidence-Based Ways to Lower LDL Without Medication
AI Overview / Quick Answer (BLUF)
An LDL of 147 mg/dL is borderline high and often rises at menopause as estrogen falls. Normal triglycerides are a good sign but do not make LDL harmless. Check 10-year heart risk; a portfolio diet of psyllium, oats, nuts, and plant sterols lowers LDL about 17–28%.
why LDL rises at menopause (SWAN) ·
what normal triglycerides mean · LDL pattern A versus B · psyllium, oats, nuts, plant sterols, and swapping fats · exercise · when to discuss medication.
Background on LDL cholesterol and menopause from MedlinePlus ·
When to see a doctor ·
Why LDL rises ·
Triglycerides and LDL ·
4 non-drug methods ·
Evidence table ·
FAQ
Reader question: cannot take hormones, LDL rose to 147, wants to lower it without medicine
A member of a women’s health group wrote: “I can’t take hormones because I react badly to them… my LDL jumped to 147. Any advice? How can I lower LDL without medication?”
The question has three parts: why LDL rises after menopause, how worrying 147 is when triglycerides are normal, and which non-drug methods really work, and by how much.
This guide answers all three with numbers from research and explains when to discuss medicine with a doctor.
When to see a doctor soon (Red Flags)
- Chest pain or pressure lasting more than 5 minutes, spreading to the arm, jaw, or back, with sweating or breathlessness — call emergency services now (1669 in Thailand). Women may have subtler signs such as unusual fatigue, nausea, or upper-abdominal pressure
- Sudden facial droop, one-sided weakness, or slurred speech — possible stroke; go to the emergency room
- New breathlessness or chest tightness on exertion that eases with rest — get a heart check within days
- LDL of 190 mg/dL or higher, or a parent or sibling with heart disease before 55 (men) or 65 (women) — possible inherited high cholesterol
- Yellow fatty deposits on the eyelids or Achilles tendons — needs a detailed lipid assessment
- Menopause or removal of both ovaries before age 40–45 — higher heart risk; review risk with a doctor
- Severe muscle pain, dark urine, or yellow skin after starting red yeast rice or a cholesterol medicine — stop and see a doctor
If any of these apply, do not wait for diet changes to work, and do not start or stop medicines without a doctor.
1. Why LDL rises when hormones fall, and where 147 sits
Estrogen helps the liver make more LDL receptors, so the liver pulls LDL out of the blood quickly. When the ovaries stop working, naturally or after surgery, LDL clearance slows and blood levels rise.
The SWAN study (Matthews 2009) followed 3,302 women and found that among 1,054 with natural menopause,
LDL, total cholesterol, and apoB rose sharply within 1 year before and after the final period — an effect of menopause itself, not just getting older.
Early or surgical menopause calls for closer heart attention
A meta-analysis of 310,329 women (Muka 2016) found that menopause before age 45 carried 1.50 times the risk of coronary heart disease compared with menopause at 45 or later.
The 2018 AHA/ACC guideline therefore counts menopause before 40 as a risk-enhancing factor when deciding about medicine.
The American Heart Association (El Khoudary 2020) calls the menopause transition a key window for starting heart-disease prevention.
LDL levels under NCEP ATP III
| LDL (mg/dL) | Category | What it means in practice |
|---|---|---|
| Below 100 | Optimal | Keep current habits; routine checks |
| 100–129 | Near optimal | Adjust diet and exercise |
| 130–159 (147 is here) | Borderline high | Serious lifestyle changes and a 10-year heart-risk assessment |
| 160–189 | High | If persistent, a risk-enhancing factor; medicine is often discussed |
| 190 or higher | Very high | Guidelines advise cholesterol medicine without risk calculation, plus screening for inherited high cholesterol |
Categories from NCEP ATP III and the 2018 AHA/ACC guideline. Individual targets depend on overall risk.
Not taking hormones does not mean losing a heart-protection tool
The USPSTF 2022 recommends against hormone therapy to prevent chronic disease, including heart disease, in postmenopausal women.
Hormone therapy mainly relieves menopause symptoms; it is not a cholesterol treatment. People who cannot use hormones still have every heart-protection tool others have: diet, exercise, blood pressure and blood sugar control, and cholesterol medicine when needed.
2. How much do normal triglycerides reduce the concern about an LDL of 147?
The direct answer: it is partly good news, but it does not make an LDL of 147 safe. The LDL number and the years of exposure remain the main drivers of plaque build-up in artery walls.
What LDL pattern A and pattern B mean
Pattern A LDL particles are large and buoyant; pattern B particles are small and dense. Austin 1988 compared 109 heart-attack patients with 121 controls
and found pattern B linked to about 3 times the risk, together with high triglycerides and low HDL. People with normal triglycerides and good HDL therefore tend to have more large LDL particles, reflecting lower metabolic risk — genuinely good news.
But particle size is not the deciding factor
The MESA study (Mora 2007) of 5,538 people found that when both particle counts were considered together, both large and small LDL particles were linked to thicker neck artery walls,
and particle size added no predictive value. The European Atherosclerosis Society (Ference 2017) concluded from genetic, epidemiologic, and trial evidence that LDL causes atherosclerosis, with the effect depending on the level and duration of exposure.
Comparison of LDL pattern A and pattern B
| Feature | Pattern A (large particles) | Pattern B (small dense particles) | What the evidence says |
|---|---|---|---|
| Usual lipid companions | Low triglycerides, good HDL | High triglycerides, low HDL, belly fat | Normal triglycerides reflect lower metabolic risk |
| Link with heart disease | Still linked to atherosclerosis when particle numbers are high | Higher risk in early studies | Once particle numbers are counted, size adds no predictive value |
| Numbers to watch | LDL, non-HDL, apoB | LDL, non-HDL, apoB, triglycerides | apoB reflects the number of plaque-forming particles more directly |
| Meaning for an LDL of 147 | Less worrying than with metabolic syndrome | More worrying | Both should lower LDL and assess 10-year risk |
LDL particle-size testing is not a standard test. The 2019 ESC/EAS guideline advises apoB or non-HDL as supporting numbers and an Lp(a) test at least once in a lifetime.
How strong are your menopause symptoms, and what should not wait?
This score helps you see how your hot flashes, sleep, mood, abnormal bleeding, and risk factors fit menopause patterns, how severe they are, and when not to wait.
Get a severity analysis and personalized guidance from our Advisory team.
Take the Menopause Symptom Score (free)
The score grades symptoms only; it is not a diagnostic test.
3. Four ways to lower LDL without medicine, and how much each helps
The direct answer: each method alone lowers LDL by roughly 3–12%, but combined as a portfolio diet they lower it by about 17–28%, which could bring 147 down toward 110–120 for many people.
1) Soluble fiber: psyllium husk and oat beta-glucan
Soluble fiber binds bile acids in the gut and carries them out in stool, so the liver pulls LDL from the blood to make new bile.
A meta-analysis of 28 trials in 1,924 people (Jovanovski 2018) found that a median of about 10.2 grams of psyllium a day lowered LDL by 0.33 mmol/L, about 13 mg/dL.
Oat beta-glucan at 3.5 grams a day (Ho 2016, 58 trials, 3,974 people) lowered it by about 7 mg/dL.
2) Swap fats: less saturated fat, more unsaturated fat
Saturated fat reduces LDL-receptor activity in the liver. A Cochrane review (Hooper 2020) of 15 trials with about 59,000 people found that cutting saturated fat lowered cardiovascular events by 21%.
Cut back on poultry skin, lard, fatty meat, butter, pastries, coconut milk, and coconut oil, which raises LDL by about 10.47 mg/dL compared with common vegetable oils (Neelakantan 2020).
Use olive oil, rice bran oil, soybean oil, avocado, nuts, and fish instead.
3) Tree nuts and plant sterols
Plant sterols resemble cholesterol and compete with its absorption in the gut. A meta-analysis of 124 studies (Ras 2014) found that 0.6–3.3 grams a day lowered LDL by 6–12%,
but ordinary food provides far less, so sterol-fortified foods or supplements are usually needed, taken with main meals.
Tree nuts such as almonds, walnuts, and pistachios, a handful (28 grams) a day, lowered LDL by about 4.8 mg/dL (Del Gobbo 2015, 61 trials, 2,582 people). Choose unsalted, uncoated nuts.
4) Aerobic exercise and strength training
Exercise is excellent for the heart but lowers the LDL number only a little. A meta-analysis of 25 studies (Kodama 2007) found HDL rose by about 2.53 mg/dL with at least 120 minutes a week.
The STRRIDE trial (Kraus 2002) of 111 people found that the high-amount group (equal to jogging 32 km a week) had fewer small LDL particles and larger particle size; amount mattered more than intensity.
Aim for moderate aerobic exercise (Zone 2: you can talk in sentences but not sing) for 150 minutes a week plus strength training 2 days a week, which also protects muscle and bone after menopause.
Combining everything as a portfolio diet came close to a statin in a short trial
In Jenkins 2003, 46 adults with high cholesterol (21 of them postmenopausal women) followed a diet combining plant sterols, soy protein, soluble fiber, and almonds for 1 month. LDL fell 28.6%,
close to the lovastatin group (30.9%), while a low-saturated-fat diet alone lowered it 8.0%. A meta-analysis of 7 trials in 439 people (Chiavaroli 2018) confirmed about a 17% reduction.
Real-life results are usually smaller than in trials where food is provided, because the diet is hard to sustain.
4. Comparison of LDL-lowering options: diet, supplements, exercise, and medicine
| Option | Mechanism | LDL effect in research | How to use and what to know |
|---|---|---|---|
| Psyllium husk | Binds bile acids; liver pulls LDL to make new bile | About 13 mg/dL at about 10 g/day | Start low, drink water, 2 hours apart from other medicines |
| Oat beta-glucan | Viscous fiber that binds bile acids | About 7 mg/dL at 3.5 g/day | Oats or oat bran daily, unsweetened |
| Plant sterols and stanols | Compete with cholesterol absorption in the gut | 6–12% at 0.6–3.3 g/day | Needs fortified foods or supplements; take with main meals |
| Tree nuts | Unsaturated fat, fiber, and sterols | About 4.8 mg/dL per 28 g/day | Unsalted, uncoated; replace snacks rather than add calories |
| Cut saturated fat, replace with unsaturated fat | Improves liver LDL-receptor activity | 21% fewer cardiovascular events (Cochrane) | Less poultry skin, lard, coconut milk, coconut oil, butter, pastries |
| Portfolio diet | Combines the mechanisms above plus soy protein | 17% (meta-analysis) to 28.6% (1-month trial) | The strongest non-drug option; needs consistency |
| Aerobic + strength training | Raises HDL, reduces small LDL particles, lowers triglycerides | Little change in total LDL; HDL up about 2.5 mg/dL | 150 minutes/week + strength 2 days; good for heart and bone |
| Red yeast rice | Contains monacolin K, the same compound as the drug lovastatin | Varies by product | Not a safer alternative to medicine; content varies widely between products; ask a doctor first |
| Cholesterol medicine: statins (e.g., atorvastatin, rosuvastatin) or ezetimibe | Reduce liver cholesterol production / reduce gut absorption | Moderate-intensity statins lower LDL about 30–49% | With high 10-year risk, diabetes, or LDL of 190 or higher, as a doctor decides |
Drug classes and generic names only. Starting or stopping medicines must go through your own doctor.
5. When non-drug steps are enough, and when to discuss medicine
Assess 10-year heart risk before deciding
The 2018 AHA/ACC guideline advises adults aged 40–75 with LDL of 70–189 mg/dL to calculate 10-year cardiovascular risk from age, blood pressure, diabetes, smoking, total cholesterol, and HDL.
Below 5% risk, lifestyle is usually the focus; at 7.5% or higher, statins are usually discussed together, with risk enhancers such as menopause before 40, family history, or high Lp(a) helping the decision.
What to recheck and what to add
- Recheck lipids 4–12 weeks after consistent diet and exercise changes
- Test Lp(a) at least once in a lifetime; it is genetic and barely changes with diet
- apoB or non-HDL (total cholesterol minus HDL) shows the number of plaque-forming particles
- If risk is borderline, a doctor may order a coronary artery calcium (CAC) scan
- Check thyroid, blood sugar, and liver and kidney function, which can raise LDL
Common beliefs versus the evidence
“Normal triglycerides mean an LDL of 147 is nothing to worry about”
Partly good news, but both large and small LDL particles can build up in artery walls, and particle size adds no predictive value once particle numbers are counted. LDL should still be lowered and 10-year risk assessed.
“The liver and brain make fluffy, harmless LDL when triglycerides are low”
LDL comes from the liver via VLDL, not from the brain. Particle size does track triglycerides, but it is a tendency, not a promise of safety.
“Zone 2 exercise turns LDL into a safe type”
A high amount of exercise reduces small LDL particles somewhat, but total LDL changes little. Exercise supports the heart; it is not the main LDL-lowering tool.
“Without hormones, I can’t protect my heart”
Hormone therapy is not recommended for heart-disease prevention in the first place. The main tools are diet, exercise, blood pressure and blood sugar control, and cholesterol medicine when needed.
“Fruit and vegetables already give me 2 grams of plant sterols a day”
Ordinary food provides far less than the effective dose. To get the sterol effect, sterol-fortified foods or supplements are usually needed.
Frequently asked questions (FAQ)
Why does LDL rise after menopause or ovary removal, even with regular exercise?
Estrogen helps the liver make more LDL receptors, which pull LDL out of the blood quickly. When the ovaries stop working, LDL clearance slows. The SWAN study of 3,302 women found that LDL and apoB rose sharply within 1 year before and after the final period, an effect of menopause itself, not just age. Exercise helps the heart a great deal but lowers the LDL number only a little.
Do normal triglycerides really make an LDL of 147 less worrying?
Partly. Low triglycerides and good HDL tend to come with larger LDL particles and lower metabolic risk, but it does not make LDL safe. The MESA study of 5,538 people found that both small and large LDL particles were linked to thicker neck artery walls, and particle size added no predictive value once particle numbers were counted. What matters is the LDL level and the years of exposure.
How risky is an LDL of 147, and do I need cholesterol medicine?
An LDL of 130–159 mg/dL is borderline high, not an emergency. Whether to use medicine depends on 10-year cardiovascular risk, calculated from age, blood pressure, diabetes, smoking, total cholesterol, and HDL under the 2018 AHA/ACC guideline. People at low risk can usually start with diet and exercise, but with high risk, diabetes, or LDL of 190 or higher, doctors usually advise medicine as well.
If I cannot take hormones, have I lost a way to prevent heart disease?
No. The US Preventive Services Task Force in 2022 recommends against hormone therapy to prevent chronic disease, including heart disease, in postmenopausal women. Hormone therapy is mainly for menopause symptoms. Managing cholesterol, blood pressure, blood sugar, weight, and not smoking are the main heart-protection tools, and none of them need hormones.
How much psyllium husk should I take, and how much does it lower LDL?
A meta-analysis of 28 trials in 1,924 people found that a median of about 10 grams of psyllium a day lowered LDL by about 13 mg/dL, roughly 9 percent of an LDL of 147. Start low and build up, drink plenty of water with it, and take it at least 2 hours apart from other medicines. People with swallowing problems or past bowel obstruction should ask a doctor first.
Can I get enough plant sterols from ordinary fruit and vegetables?
Ordinary food provides far less plant sterol than the effective dose. A meta-analysis of 124 studies found that about 0.6–3.3 grams a day is needed to lower LDL by 6–12 percent, which usually requires sterol-fortified foods or supplements. A daily handful of tree nuts (about 28 grams) lowers LDL by roughly another 5 mg/dL.
How much do Zone 2 exercise and strength training lower LDL?
Not much for the LDL number, but a lot for overall heart health. A meta-analysis of 25 studies found that aerobic exercise raised HDL by about 2.5 mg/dL with at least 120 minutes a week, and the STRRIDE trial found that a high amount of exercise reduced small LDL particles while total LDL changed little. Aim for 150 minutes of aerobic exercise a week plus strength training 2 days a week, alongside diet changes.
When should I recheck my blood, and what else should be tested?
After consistent diet and exercise changes, recheck lipids in 4–12 weeks to see the effect. Test Lp(a) at least once in a lifetime as the 2019 ESC/EAS guideline advises, and consider apoB or calculated non-HDL cholesterol. If risk is still borderline, a doctor may order a coronary artery calcium scan to help decide about medicine.
Scientific mechanism: estrogen, LDL receptors, and drug-free ways to pull LDL out of the blood
Summary by Asst. Prof. Dr. Norawit Raatpiboon:
the liver makes VLDL, which is broken down into LDL in the bloodstream, and takes LDL back through LDL receptors on liver cells. Estrogen increases these receptors; when estrogen falls, receptors fall and LDL stays in the blood longer.
ApoB-containing particles of every size cross the artery wall, become oxidized, and trigger inflammation that forms plaque. The more particles and the more years of exposure, the more plaque builds.
Soluble fiber pulls bile acids out of the gut–liver cycle, so the liver adds LDL receptors to make new bile from cholesterol. Plant sterols take space in micelles, so less cholesterol is absorbed.
Cutting saturated fat improves LDL-receptor activity, and exercise raises lipoprotein lipase, which clears triglyceride-rich particles and reduces small LDL.
All of these widen LDL’s exit routes without estrogen, and together they work better than any one alone.
E-E-A-T and academic citations
Written and reviewed by Asst. Prof. Dr. Norawit Raatpiboon (ผศ.ดร.นรวิชญ์ ราษฎร์พิบูลย์)
from research and clinical guidelines indexed in PubMed.
- Matthews KA, et al. Are changes in CVD risk factors in midlife women due to chronological aging or to the menopausal transition? (SWAN) J Am Coll Cardiol. 2009. PubMed 20082925
- Muka T, et al. Age at onset of menopause and cardiovascular outcomes: systematic review and meta-analysis. JAMA Cardiol. 2016. PubMed 27627190
- NCEP Expert Panel. Third Report on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III). Circulation. 2002. PubMed 12485966
- US Preventive Services Task Force. Hormone therapy for the primary prevention of chronic conditions in postmenopausal persons. JAMA. 2022. PubMed 36318127
- Austin MA, et al. Low-density lipoprotein subclass patterns and risk of myocardial infarction. JAMA. 1988. PubMed 3418853
- Mora S, et al. LDL particle subclasses, LDL particle size, and carotid atherosclerosis in MESA. Atherosclerosis. 2007. PubMed 16765964
- Ference BA, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease: EAS Consensus Panel. Eur Heart J. 2017. PubMed 28444290
- Mach F, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias. Eur Heart J. 2020. PubMed 31504418
- Grundy SM, et al. 2018 AHA/ACC Guideline on the Management of Blood Cholesterol. Circulation. 2019. PubMed 30586774
- Jovanovski E, et al. Effect of psyllium fiber on LDL cholesterol, non-HDL cholesterol and apoB: meta-analysis of RCTs. Am J Clin Nutr. 2018. PubMed 30239559
- Ho HV, et al. The effect of oat beta-glucan on LDL-cholesterol, non-HDL-cholesterol and apoB: meta-analysis. Br J Nutr. 2016. PubMed 27724985
- Ras RT, et al. LDL-cholesterol-lowering effect of plant sterols and stanols across different dose ranges. Br J Nutr. 2014. PubMed 24780090
- Del Gobbo LC, et al. Effects of tree nuts on blood lipids, apolipoproteins, and blood pressure: 61 controlled trials. Am J Clin Nutr. 2015. PubMed 26561616
- Hooper L, et al. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev. 2020. PubMed 32428300
- Neelakantan N, et al. The effect of coconut oil consumption on cardiovascular risk factors. Circulation. 2020. PubMed 31928080
- Kodama S, et al. Effect of aerobic exercise training on serum levels of HDL cholesterol: a meta-analysis. Arch Intern Med. 2007. PubMed 17533202
- Kraus WE, et al. Effects of the amount and intensity of exercise on plasma lipoproteins (STRRIDE). N Engl J Med. 2002. PubMed 12421890
- Jenkins DJ, et al. Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and CRP. JAMA. 2003. PubMed 12876093
- Chiavaroli L, et al. Portfolio dietary pattern and cardiovascular disease: meta-analysis of controlled trials. Prog Cardiovasc Dis. 2018. PubMed 29807048
- El Khoudary SR, et al. Menopause transition and cardiovascular disease risk: AHA Scientific Statement. Circulation. 2020. PubMed 33251828
Medical disclaimer
This guide is general education, not a diagnosis, prescription, or individual medical advice.
LDL targets and decisions about medicine depend on each person’s overall risk. Consult your own doctor before starting supplements such as psyllium, plant sterols, or red yeast rice, especially if you take other medicines.
Do not start or stop medicines on your own. If you have any symptom under when to see a doctor soon, seek care promptly.