Menopause marks a significant physiological transition in a woman's life, characterized by the cessation of menstruation and a decline in ovarian hormone production, notably estrogen [1]. This hormonal shift leads to various metabolic changes, including alterations in lipid metabolism, which can influence cardiovascular health. Understanding these changes is crucial, as cardiovascular disease (CVD) becomes a leading health concern for postmenopausal women [2-4].

Research indicates that menopause is associated with unfavorable changes in lipid profiles. A study by El Khoudary et al. (2020) highlighted that during the menopausal transition, women experience adverse lipid changes, including increased total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C), and decreased high-density lipoprotein cholesterol (HDL-C), contributing to heightened cardiovascular risk [5]. Similarly, a meta-analysis by van Oortmerssen (2025) reported that postmenopausal women exhibit elevated TC and LDL-C levels, along with reduced HDL-C, compared to premenopausal women, suggesting a shift towards a more atherogenic lipid profile [6].

These lipid alterations are not solely attributable to aging but are significantly influenced by the loss of estrogen. Warjukar P et al. found that postmenopausal women had significantly higher serum cholesterol, LDL-C, and triglycerides, with significantly lower HDL-C levels compared to premenopausal women, underscoring the impact of estrogen decline on lipid metabolism [7].

The implications of these lipid changes are profound, as they contribute to an increased risk of cardiovascular events in postmenopausal women. A study by Zhang et al. (2024) emphasized that postmenopausal women are particularly vulnerable to increased cardiovascular disease risk due to significant alterations in lipid metabolism following estrogen decline [8]. Therefore, monitoring and managing lipid profiles in postmenopausal women is essential for cardiovascular risk assessment and prevention.

The primary objective of this systematic review is to comprehensively evaluate the lipid profile patterns in postmenopausal women, focusing on total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG). This review aims to synthesize evidence from recent cross-sectional, comparative, and interventional studies to elucidate the influence of menopause, age, duration since menopause, comorbid conditions, and lifestyle interventions on lipid metabolism. By consolidating current knowledge, the review seeks to highlight potential cardiovascular risks and inform strategies for effective lipid monitoring and management in postmenopausal women.

Search Strategy and Data Sources: A systematic literature search was conducted across PubMed, Scopus, Web of Science, and Embase databases, covering recent studies. The search strategy combined Boolean operators and relevant keywords, including (“post-menopause” OR “postmenopausal women”) AND (“lipid profile” OR “cholesterol” OR “triglycerides” OR “HDL” OR “LDL”) AND (“dyslipidemia” OR “cardiovascular risk”). The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for study selection and reporting [9].

Inclusion and Exclusion Criteria: Studies were included if they:

• Investigated lipid profile parameters in post-menopausal women.
• Reported quantitative data on serum cholesterol, triglycerides, HDL, LDL, or other lipid fractions.
• Were published in peer-reviewed journals in English.

Studies were excluded if they:

• Included pre-menopausal women without separate analysis for post-menopausal subjects.
• Were case reports, reviews, conference abstracts, or editorials.
• Focused exclusively on experimental models or non-human subjects.

Study Selection Process: Two independent reviewers screened titles and abstracts of identified articles. Full texts of potentially eligible studies were retrieved for detailed assessment. Any disagreements were resolved through discussion or consultation with a third reviewer. The study selection process adhered to PRISMA’s four-phase approach: Identification of records, Screening for relevance, Full-text eligibility assessment, Final inclusion of studies.

Data Extraction and Quality Assessment: A standardized data extraction sheet was used to collect information on study design, sample size, participants’ age, duration of menopause, lipid parameters measured, and key outcomes. Study quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist, with studies categorized as low, moderate, or high quality [10].

Data Synthesis: Due to heterogeneity in study populations, lipid parameters reported, and study designs, a narrative synthesis was performed. Meta-analysis was not conducted because of variations in methodology and outcome measures among the included studies.

Study Selection and Screening Process: The systematic search initially identified a total of 1,245 records from PubMed (480), Scopus (320), Web of Science (310), and Embase (135). Following the removal of 371 duplicates, 895 records remained for title and abstract screening. Screening resulted in the exclusion of 710 articles that did not meet the inclusion criteria, leaving 185 full-text articles for detailed assessment. Of these, 163 full-text articles were further excluded for specific reasons: 66 studies included populations not specific to post-menopausal women, 51 studies lacked quantitative lipid profile data, 26 studies were non-human or experimental, and 20 studies were reviews, case reports, or editorials. Ultimately, 22 studies met all eligibility criteria and were included in the systematic review for qualitative synthesis.

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The systematic search and selection process yielded 23 studies that met the inclusion criteria for this review. The included studies comprised cross-sectional, comparative, and interventional designs, focusing on lipid profile changes in postmenopausal women.

Eight studies evaluated lipid profiles in general postmenopausal populations (Table 1). Across these studies, elevated total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) were frequently observed, with 50% or more participants exhibiting increased levels in several cohorts. High triglyceride (TG) levels were reported in 39–40% of participants in some studies. Age-related differences were apparent, with older postmenopausal women generally demonstrating higher TC and LDL-C. Variations in high-density lipoprotein cholesterol (HDL-C) were less consistent, though decreased levels were reported in multiple studies. Geographic differences were also noted; for instance, Okpara et al. reported increased TC and LDL-C alongside decreased HDL-C in Nigerian women, while Rustagi et al. observed similar trends in an Indian cohort.

Two studies assessed lipid profiles in specific populations, including diabetic and rural postmenopausal women (Table 2). Diabetic postmenopausal women exhibited significantly worsened lipid profiles, with elevated TC, LDL-C, and TG. Similarly, rural populations demonstrated a correlation between higher body mass index (BMI) and increased TC and LDL-C, indicating the influence of both metabolic and anthropometric factors on lipid parameters.

Two studies explored the relationship between lipid profile variations and either years since menopause or longitudinal lipid trajectories (Table 3C). Longer duration since menopause was associated with higher TC and LDL-C levels. Longitudinal data revealed an inverse U-shaped trajectory for lipid indices, with TC, LDL-C, and apolipoprotein B (ApoB) increasing before menopause and declining afterward, highlighting the dynamic nature of lipid changes across the menopausal transition.

Three studies compared lipid profiles between pre- and postmenopausal women (Table 4). Consistently, postmenopausal women exhibited higher TC and LDL-C levels, with lower HDL-C. One study further demonstrated that lower estrogen levels in postmenopausal women were associated with altered lipid profiles, suggesting increased atherosclerotic risk. Overall, these studies confirmed that menopause is associated with a dysregulated lipid profile compared to premenopausal status.

Seven interventional studies investigated the effects of lifestyle modifications, dietary supplementation, or hormone therapy on lipid parameters (Table 5). Resistance training significantly reduced TC, LDL-C, and TG, particularly in obese individuals. Phytosterol, phytostanol, vitamin D, plant-derived supplements, resveratrol, and omega-3 fatty acids demonstrated beneficial effects on TC, LDL-C, and TG, with modest increases in HDL-C in some interventions. Menopause hormone therapy positively influenced lipid profiles, especially in women with hypertriglyceridemia. These findings suggest that targeted interventions can partially mitigate the adverse lipid changes associated with postmenopause.

Across all study types, postmenopausal women consistently exhibited elevated TC and LDL-C, variable TG, and generally lower HDL-C. Factors influencing lipid alterations included age, duration since menopause, BMI, comorbidities (e.g., diabetes), and lifestyle interventions. Interventional studies highlight that both pharmacologic and non-pharmacologic strategies can improve lipid profiles, underscoring their potential role in cardiovascular risk reduction for postmenopausal women.

Table 1: Cross-sectional Studies – General Postmenopausal Women

Table 2: Cross-sectional Studies – Special Populations (Diabetic or Rural)

Table 3: Cross-sectional Studies – Duration since Menopause / Age-related Changes

Table 4: Comparative Studies Between Pre- and Postmenopausal Women

Table 5: Interventional Studies on Lipid Profile in Postmenopausal Women

This systematic review emphasizes the substantial modifications in lipid profiles observed in postmenopausal women, underscoring the heightened cardiovascular risk associated with these changes. Multiple studies consistently report increased levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG), alongside decreased high-density lipoprotein cholesterol (HDL-C) levels in postmenopausal women compared to their premenopausal counterparts. These lipid profile alterations are primarily attributed to the decline in estrogen levels during menopause, which is known to influence lipid metabolism and increase cardiovascular risk [33-36].

Recent studies have further elucidated the impact of menopause on lipid metabolism. A study by Mou et al. (2025) involving 1,511 perimenopausal and postmenopausal women found that the decrease in estrogen levels leads to an increase in TC, TG, and LDL-C levels, while HDL-C levels decrease, contributing to a more atherogenic lipid profile [37,28]. Similarly, Vallée (2025) reported that menopause is independently associated with an increased 10-year incidence of atherosclerotic cardiovascular disease in women, emphasizing the long-term cardiovascular risks associated with menopausal lipid changes [39].

The association between menopause and cardiovascular risk is further supported by Uddenberg et al. (2024), who highlighted that the risk of cardiovascular disease notably increases in the fifth decade of a woman's life, coinciding with the onset of menopause [40-42]. Moreover, Anagnostis et al. (2024) discussed how estrogen depletion following menopause predisposes to increased risk of cardiovascular disease, mainly due to ischemic heart disease, and emphasized the importance of early intervention and monitoring [43].

These findings underscore the critical need for healthcare providers to monitor lipid profiles in postmenopausal women closely. Early identification of dyslipidemia can facilitate timely interventions, such as lifestyle modifications and pharmacological treatments, to mitigate the increased cardiovascular risk associated with menopause. Furthermore, personalized approaches considering individual risk factors and comorbidities are essential in managing the cardiovascular health of postmenopausal women effectively.

Despite providing comprehensive insights into lipid profile alterations and associated cardiovascular risk in postmenopausal women, this systematic review has several limitations. First, the included studies exhibit heterogeneity in terms of study design, sample size, population demographics, and methods of lipid measurement, which may affect the comparability of results. Second, most studies are observational, limiting the ability to infer causality between menopause-related estrogen decline and dyslipidemia. Third, variations in the definition of menopause and menopausal status across studies could introduce bias in the interpretation of lipid changes. Fourth, the majority of studies focus on short-term or cross-sectional assessments, and longitudinal data examining long-term cardiovascular outcomes remain limited. Fifth, potential confounding factors such as dietary habits, physical activity, genetic predisposition, and use of hormone replacement therapy were inconsistently reported, which may influence lipid profiles and cardiovascular risk estimates. Finally, publication bias may exist, as studies reporting significant findings are more likely to be published, potentially overestimating the observed associations.

Future research should aim to include larger, longitudinal, and multi-ethnic cohorts with standardized definitions and measurements to provide more robust evidence on the interplay between menopause, lipid metabolism, and cardiovascular risk.

This systematic review demonstrates that postmenopausal women are at a higher risk of adverse lipid profile changes, characterized by elevated TC and LDL-C, variable TG, and generally reduced HDL-C. Age, duration since menopause, BMI, and comorbid conditions such as diabetes significantly influence these lipid alterations. Comparative studies confirm that menopause is associated with a dysregulated lipid profile compared to premenopausal status. Importantly, interventional strategies, including lifestyle modifications, dietary supplementation, and menopause hormone therapy, show consistent benefits in improving lipid parameters, highlighting their role in cardiovascular risk reduction. These findings underscore the need for regular lipid monitoring and tailored interventions in postmenopausal women to mitigate long-term cardiovascular morbidity.

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