Dyslipidemia across the menopause transition: Mechanisms, trajectories, and opportunities for cardiovascular prevention.

The menopause transition is associated with a notable increase in the risk of cardiovascular disease (CVD), making this period a critical window for early prevention and intervention. This heightened CVD risk is driven in part by adverse changes in lipid metabolism. As estrogen levels decline, women experience significant increases in low-density lipoprotein cholesterol (LDL-C) and triglycerides, along with alterations in high-density lipoprotein cholesterol (HDL-C) composition and function that reduce its cardioprotective properties. These lipid changes occur independent of chronological aging, with the most pronounced increases occurring within one year of the final menstrual period. Dyslipidemia is an important modifiable risk factor for CVD during this life stage. Evidence-based lifestyle interventions, such as Mediterranean and Dietary Approaches to Stop Hypertension (DASH) dietary patterns along with regular aerobic or resistance training, can help mitigate these adverse lipid changes. Additional behavioral modifications, including smoking cessation and limiting alcohol intake, further reduce cardiovascular risk. When lifestyle interventions are insufficient, statins remain first-line therapy for dyslipidemia management. While menopausal hormone therapy favorably affects lipid profiles, current guidelines do not recommend its use for dyslipidemia management or CVD prevention due to inconsistent benefits and potential risks. This review evaluates current evidence on dyslipidemia across the menopause transition, distinguishing menopause-related lipid changes from those of chronological aging, and examines the impact of modifiable lifestyle factors and therapeutic interventions on lipid trajectories during this reproductive stage.