As if hot flashes, mood swings, irregular menstrual cycles and possible changes in libido were not enough to put some women on edge as they make the inevitable transition into menopause, many women approaching menopause also have to wrestle with high cholesterol, which increases their risk for developing heart disease and a stroke.

Menopause, also known as the “change of life,” is the time in a woman’s life when her menstrual period ceases. The median age for menopause is 50, but women usually have their final menstrual period between the age of 40 and 60, said Karen A. Matthews, Ph.D, a professor of epidemiology and psychology at the University of Pittsburgh.

“If you never paid attention to your cholesterol level before, it’s a good idea to keep track of your cholesterol when you are going through the menopause phase and after menopause,” said Dr. David Gordon, special assistant for clinical studies at the National Heart, Lung and Blood Institute (NHLBI) Division of Cardiovascular Sciences in Bethesda, Maryland.

A national study, which followed 1,054 menopausal women for nine years, revealed that “the amount of change in LDL cholesterol, or bad cholesterol, goes up strikingly from year to year around the time of a woman’s final menstrual period,” said Matthews, one of the study’s principal investigators. “The increase in cholesterol is thought to be related to the changes in reproductive hormones,” she said. However, obese women are less affected by menopause. Matthews believes this may be because they have higher levels of estrone, a type of estrogen.

The spike in LDL cholesterol, puts menopausal women at a greater risk for strokes, heart attacks and other cardiovascular diseases, Dr. Gordon said. He added that once a woman’s LDL cholesterol level rises, it will remain elevated for the rest of her life unless she makes lifestyle changes or takes cholesterol lowering medication.

Cholesterol is a fat-like substance. High levels of LDL cholesterol in the blood can cause a buildup in the walls of the arteries, the vessels that carry blood from the heart to other parts of the body. Dr. Gordon explained that this buildup of cholesterol, called plaque, “causes inflammation in the artery, which can lead to a clot in the artery that blocks blood flow suddenly, resulting in a heart attack or a stroke.”

Although heart disease is sometimes thought of as a “man’s disease,” the Centers for Disease Control and Prevention (CDC) in Atlanta report that heart disease is the leading cause of death in the United States among men and women, and women account for nearly 50 percent of heart disease deaths. Stroke is the third leading cause of death.

The latest statistics from the American Heart Association (AHA) show that coronary heart disease caused 1 of every 6 deaths in the United States in 2007, and stroke caused 1 of every 18 deaths. AHA statistics also show that someone in the United States has a heart attack every 34 seconds and a stroke every 40 seconds. .

“Around the age of 45, I went to the doctor for a routine physical and I found out that I had high cholesterol,” said Rosita Wheatley, 47, who lives in St. Thomas, Virgin Islands. “I use to feel a little shortness of breath, but I didn’t associate it with high cholesterol.” Wheatley said she tried everything to lower her cholesterol. She changed her diet and began exercising regularly, but her LDL cholesterol remained high, so she reluctantly had to take medication.

Wheatley was fortunate, because high cholesterol can be a silent killer. Many people do not realize that their lives are in danger due to a buildup of cholesterol in their artery until they get a heart attack, Dr. Gordon said. People may experience chest pain or shortness of breath like in Wheatley’s case, but often there are no warning signs.

As a precaution, Matthews said, “As women become irregular in their periods their physicians should monitor their cholesterol levels closely.”

If your LDL cholesterol level is too high, Dr. Gordon suggests that you try lowering your cholesterol through lifestyle changes first, such as reducing the amount of saturated fats in your diet, losing weight, exercising and discontinuing smoking. “If you have done all you can with lifestyle changes, and your LDL is still above the level that is considered desirable for you, then you should consider taking a cholesterol lowering drug like a statin.

“National cholesterol treatment guidelines recommend that people who are at low to moderate cardiovascular risk should aim for an LDL cholesterol below 130 mg/dL, while those who have cardiovascular disease, diabetes or multiple risk factors (like smoking or high blood pressure) should try for an LDL cholesterol below 100 mg/dL,” Dr. Gordon said.

May is National Stroke Awareness Month. For more information about strokes and heart disease, visit http://www.cdc.gov/dhdsp.