Last Updated on February 19, 2026
This episode is bought to you by Quell — to help support rebuilding healthy skin from the outside-in + inside-out!
Take $10 off your next order! Use promo code QUELL10 at check out — Get started HERE!
– – –
High cholesterol in menopause and perimenopause is shockingly common! Blindsided by sudden spikes in cholesterol, blood pressure, or even blood sugar as you hit your 40s has become a rite of passage.
After seeing my own cholesterol shoot up despite a healthy lifestyle, I was stunned. I eat well-balanced meals, lift heavy weights, and stay active, yet within a year, my labs began to tell a very different story. Like many women, I was left wondering: What changed?
The hormonal shifts of perimenopause aren’t just hot flashes and mood swings. What most women don’t realize is how these hormonal changes silently impact your cardiovascular system.
Joining me to dive deeper into this topic is Dr. Eve Henry. Dr. Henry is board-certified in Internal and Integrative Medicine, and is the founder of her own clinic, Eve Henry MD. With extensive experience in personalized medicine and longevity science, she is dedicated to providing innovative care that optimizes healthspan and lifespan.
Let’s unravel the truth about midlife cardiovascular health together — and why your labs are only part of the story.
Or, listen on your favorite app: iTunes (Apple Podcasts) | Spotify | Stitcher | TuneIn | Subscribe on Android
In This Episode:
- Key factor driving high cholesterol in menopause
- Earliest warning signs of metabolic changes in perimenopause
- Estrogen’s effect on cholesterol and blood pressure
- Why your lipid panel isn’t the full story (better tests to ask for)
- Why the Lipoprotein (a) marker is important
- Can HRT for menopause improve cholesterol?
- Effects of oral vs transdermal estrogen
Quotes
“Women have this totally flat line from age 20 to about 40…then their cholesterol starts to rise.”
“There is a strong association between cholesterol being elevated and increased risk of Alzheimer's dementia.”
Links
Find Dr. Henry on Instagram
282: Metabolic Dysfunction Disaster Fueling Skin Problems w/ Dr. Robert Lustig
Menopause and women’s cardiovascular health: is it really an obvious relationship?
The Importance of Apo B and Lipoprotein Little a [Lp(a)]
Oral estrogen therapy for menopause may increase high blood pressure risk
Trajectories of Blood Pressure in Midlife Women: Does Menopause Matter?
Age at Menopause and Risk of Ischemic and Hemorrhagic Stroke
411: Why Do I Suddenly Have High Cholesterol In Menopause? (And How Do You Fix It Naturally?) w/ Dr. Eve Henry
Jennifer Fugo, MS, CNS, LDN (00:24.52)
Dr. Henry, thank you so much for being here on the Healthy Skin Show to talk about high cholesterol in menopause.
Eve Henry MD (00:29.08)
Thank you for having me. I'm really excited to be here.
Jennifer Fugo, MS, CNS, LDN (00:32.828)
Well, I am very appreciative because, and I already told you this, but I'm gonna tell everybody. I selfishly invited you here because, for anybody who is watching this and listening to this going, oh my gosh, I turned a certain age and I'm kind of in this perimenopausal spot, or maybe you're all the way all the way into menopause, this will still apply to you, and suddenly your cholesterol went really high and you suddenly have high cholesterol in menopause, maybe you ended up with high blood pressure, like things seem to be going sideways and you're like, what happened? I was fine last year and now I have high cholesterol in menopause or perimenopause. So that's why I wanted to invite you today, because actually, for those of you who know Dr. Carrie Jones, Dr. Carrie Jones is who connected us and said that you were the best person to talk about this whole thing of like, how is our cardiovascular system impacted by these hormonal shifts that start in perimenopause and then extend into menopause? So thank you so much for being willing to have this conversation.
Eve Henry MD (01:38.859)
You’re welcome.
Jennifer Fugo, MS, CNS, LDN (01:40.686)
So in terms of changes that happen, I think this is maybe a good way to kind of set the stage. What type of cardiovascular or cardio metabolic changes do you typically see in women as they approach this period of perimenopause?
Eve Henry MD (01:59.544)
So, perimenopause, and I just want to define that before we get too far down this road, because there's so many different definitions. But I start to see changes in people's cardiometabolic health about 10 years prior to menopause. So from this standpoint, it's a really long runway. Now, everyone is different, but usually by the time you're in your early 40s, things are starting to change and we can see that in blood work.
Jennifer Fugo, MS, CNS, LDN (02:31.42)
And when you say blood work, do you mean looking at like a hormone panel, or in other markers?
Eve Henry MD (02:38.702)
So the first thing that I actually see start to change, even when your hormones look perfect on paper and you may or may not be having symptoms that you're relating back to perimenopause, the first thing that I see changes is actually people's lipids. The second thing is some of the insulin resistance metrics. So their glucose, their insulin, their hemoglobin A1c, those two things tend to happen around the same time. And again, this is early. This is something that starts to change usually 39, 40, 41.
Jennifer Fugo, MS, CNS, LDN (03:13.224)
Interesting. And is there a difference between, or maybe a different shift, when you hit menopause, then, in terms of these markers?
Eve Henry MD (03:23.566)
Well, let's talk about why this is happening, because then it will make sense of this, why this happens through perimenopause and into menopause.
Jennifer Fugo, MS, CNS, LDN (03:25.982)
Well, that's a good question. That's true. Fair enough.
Eve Henry MD (03:53.71)
So, men and women have different trajectories when it comes to aging and their cardiovascular risk factors. So for men, there's this slow and steady increase in their cholesterol as they age. So when they're 20, it looks better than when they're 25, than when they're 30, et cetera. Women age differently. So if you look at a graph of how women's cholesterol changes as they age, you'll see that women have this totally flat line from age, about 20 to about 40. So their husbands’ are starting to rise, but they go and they get a lipid panel, and they look so much better than their husband at age 30.
Jennifer Fugo, MS, CNS, LDN (04:11.87)
Mm-hmm.
Eve Henry MD (04:23.522)
And the reason why is we get this benefit from estrogen. So when we're in our 20s and 30s and we're at peak procreation, our estrogen levels are very high. That estrogen is putting the brakes on cholesterol rising. And then you hit about 40, and all of a sudden you're not having these regular cycles where there's big peaks of estrogen. You have more cycles where it doesn't happen, and what we start to see is that brake gets lifted. So then, as women start to go through their 40s, their cholesterol starts to rise, and it can rise quickly.
So it's really common for people to come into my office and say, I have no idea what happened. I've always had great cholesterol, and now all of a sudden, my primary care doctor is telling me that I have high cholesterol. And they're racking their brains like, what is it? I changed my coffee creamer, I go to Pilates one day less a week, could it be that? And the short answer is maybe, there's a lot of lifestyle factors that go into cholesterol. But, this is a big elephant in the room. As you start to transition hormonally through perimenopause, we start to see this natural rise in our lipids.
Jennifer Fugo, MS, CNS, LDN (05:31.198)
And I will say, it took me very much off guard when this happened, because I was fine the year before, and all of a sudden this year's panel, I was like, what happened? All of a sudden my triglycerides are high, my LDL is high, my cholesterol went from, normally it would be like 180, 185, which I was fine with, then all the way up to almost 250. And I was like, this doesn't make sense. I lift weights, heavy, three times a week, we eat mostly at home, I barely ever consume alcohol, I make a lot of the food that we eat at home fresh, I garden, I do all these things. Like, I don't know what's happening here.
And the response from my PCP, and I really truly do appreciate her efforts, was just like, hey, so can we cut out eggs? Can we get rid of dairy? Can we do this? And I'm like, there are nutritional benefits to these foods, so I would prefer if we could dig deeper into this. And I had to provide her with studies to actually back up why I was asking for these things. And so I know that women have a deep concern of heart attacks. I don't necessarily worry about that for right now because I'm 45, but I do worry about that down the road. And I recognize that what is happening today could potentially contribute to that.
So I think what would be a good question before we get into the whole lipid panel is just in general, that future kind of pacing of why this is important and why we need to understand this, is there is an increased risk of heart attack, at least from what I've read in research, in women once they get into menopause. Can you explain why, like why does that happen, that suddenly we're at a greater risk for a heart attack?
Eve Henry MD (07:32.11)
So, as we go through perimenopause, all of these risk factors, these things that set people up for developing coronary artery disease, they start to change for the worse. So we start out with this kind of magical benefit compared to men, and so we have this bias of thinking that cardiovascular disease is more common in men. It's more common in younger men compared to younger women, but we catch up, and we catch up very quickly as we transition through menopause. So what happens is these risk factors, and I'm talking about blood pressure, blood sugar, and cholesterol primarily, change as we go through perimenopause, and then about 10 years later, after we've had these kind of new problems, high cholesterol, high blood pressure, blood sugar issues, for 10 years, that's when we start to present with more advanced cardiovascular disease and heart attacks.
Jennifer Fugo, MS, CNS, LDN (08:32.446)
Hmm. So is there something that happens with the drop in estrogen that would contribute to something like the arterial plaque formation?
Eve Henry MD (08:43.206)
Mm-hmm, yep, exactly. So when our estrogen drops, a lot of things happen in our body, but a couple of key things happen. So at the level of the liver, so the liver is in charge of getting rid of our cholesterol when we're done with it. So you've used it, you package it up, and out it should go. As we lose our kind of peaks of estrogen, the receptors whose job it is to grab the cholesterol we're done with and throw it away, they go down in number. So your liver gets less effective at clearing out this cholesterol. The liver is also responsible for making a lot of our cholesterol, and so as our estrogen levels go down, the liver actually ends up making more. So you transition physiologically to having poorer clearance and more production, which is why we see the LDL and Apo B go up as women transition through perimenopause and into menopause.
Jennifer Fugo, MS, CNS, LDN (09:46.59)
And this is just my thinking about this, and you can tell me if this is also magical thinking, and that's totally fine. But I feel like the body is very smart in the way that it does things. And so there's this part of me that wonders, is it possible that the shift, like you're saying, there's poor clearance, there's more production, is it possible that there could be some potential, in terms of high cholesterol in menopause, this sort of like, maybe it's an adaptive shift that could possibly have some potential protective benefit? Like, I'm thinking we have high pools of cholesterol in our brain, and there's increasing risk of Alzheimer's disease and dementia.
Eve Henry MD (10:33.838)
Mm-hmm.
Jennifer Fugo, MS, CNS, LDN (10:35.792)
Especially in women, and my family we've had tons of dementia. So I have lived with this firsthand, growing up, and seen the realities of this. We also need cholesterol to make sex hormones. Because I think a lot of times cholesterol is still being demonized so much, but you know, everything has, a lot of times there's good and there's bad. And that's, you know, I always like to be very cautious in how we talk about things here because I think people latch on to the 10-second snippet and go, it's just bad, that's the core of the message. It's not, it's more complex than that. So, is it possible that there could be some benefit to this shift?
Eve Henry MD (11:20.824)
So when you say it's complex, I completely agree, and I actually think that's the most important. This is very complex. And the complexity of the topic around cholesterol, cardiovascular disease, dementia has really caused just a ton of confusion in those 10-second snippets where people are like, cholesterol causes dementia, cholesterol will prevent dementia. It's very confusing. And that is really born just from the complexity of our physiology. But the short answer is, I have never seen any research saying that this natural rise in cholesterol protects us in any way.
Jennifer Fugo, MS, CNS, LDN (12:05.214)
Okay, fair enough.
Eve Henry MD (12:17.516)
Now, that is not to say that you should push your cholesterol down to zero, you know what I mean? There's not like a flip of like, oh, it's all bad, so therefore we should totally get rid of it. You do need cholesterol in your brain in order for it to function. You do need some cholesterol for healthy hormone production. But there's this kind of second half of life where this becomes more of a problem. After we're finished, from an evolutionary standpoint, of providing for the next generation, we have this uptick in cholesterol. And there is a strong association between cholesterol being elevated and increased risk of Alzheimer's dementia.
Jennifer Fugo, MS, CNS, LDN (12:47.193)
Oh, interesting.
Eve Henry MD (13:15.864)
In part because, so this is probably a little bit more complex than we need to get into, but dementia risk goes up when there's more injury to the small vessels in the brain. So when you have these, what are called like mini, mini, mini micro strokes, they're very hard to see except on very detailed MRIs, you wouldn't know that it was happening, but these tiny vessels in your brain can become damaged. That basically causes an injury in the part of the brain. When you have more plaque in your arteries, just like in your heart, it can cause damage to the vessels in the brain, but in the brain, the vessels are so small, and there's so many of them, that there's this potential for a lot of increased risk around the effects of high cholesterol with dementia.
Jennifer Fugo, MS, CNS, LDN (13:42.886)
And when you say these little mini strokes, are you talking about TIAs?
Eve Henry MD (13:47.438)
So that's actually larger than what I'm talking about.
Jennifer Fugo, MS, CNS, LDN (13:49.118)
Oh, oh, so these are like, miniscule.
Eve Henry MD (13:52.193)
So one of the things that people can get done now is they can go and get brain MRIs. So those full-body cancer screening places also include a brain MRI. What you'll see on the brain MRI are these tiny little white spots that are called T2 hyperintensities. They're just little, little, little focal areas of injury. And they're thought to be, quote unquote, normal with age, right? Meaning that we see them as people age, they get these little white spots in their brain. All those are, are like little injuries, and they have a strong association with cholesterol as well as elevated blood pressure, because they're little microvascular, like I call them boo-boos, but that's exactly what they are. They're little microvascular boo-boos on the brain, and they don't get a lot better, they stay. So as we age, they accumulate with time.
Jennifer Fugo, MS, CNS, LDN (14:47.166)
That is, so first of all, I appreciate you for telling me the truth of what is actually happening because in my head, I wanna try to find a way to justify not doing anything. And I think that happens to a lot of people who are like, I really don't wanna do statins for high cholesterol, I really don't wanna do this, so I'm gonna try to either justify, find an answer that explains away, and do all these other things maybe at the same time. But I appreciate the fact that, and this is why I wanted to have this conversation. Like, it's okay for maybe my, again, I don't think it was magical thinking, but it was more like, is it possible? And I was living in the possibility of that, not knowing whether there was any potential truth to that. So I appreciate you kind of grounding that in actual research and what we know now, because a lot of people and women, especially, wonder this.
And I heard you say multiple times here about hypertension or high blood pressure. And so there was an interesting thing that I noticed when I looked at papers was like, menopause is associated with higher blood pressure. But there was also this interesting study that came out in Hypertension back in 2023, and I found it originally because it was published on the American Heart Association's website about HRT also possibly increasing the risk of blood pressure. And I'm like, what?
Eve Henry MD (16:15.521)
Make it make sense.
Jennifer Fugo, MS, CNS, LDN (16:19.895)
Am I damned if I do, damned if I don't? Like what's happening here? So can you talk to us a little bit about the blood pressure piece? And was this like, I don't know if you're familiar with this paper, like does this make sense with what you've read and what you're aware of? Or maybe we have to look at this from a different perspective?
Eve Henry MD (16:38.563)
Well, I can help explain it to some degree. So one of the reasons why blood pressure increases through perimenopause, and you're 100% right, this is one of the key cardiovascular risk factors that really starts to change, has to do with our declining hormones. So this is more than just estrogen, this is also progesterone, but our vasculature gets stiffer and kind of harder as we go through perimenopause. The hormones have kind of a softening effect. I'm oversimplifying it, but that kind of helps paint a picture.
Jennifer Fugo, MS, CNS, LDN (17:11.752)
Totally fine, yeah.
Eve Henry MD (17:35.565)
So when we do HRT research, we often fall into this pitfall of calling HRT just HRT, when there's a lot of different options of different drugs that were used that could classify as HRT. So a lot of the key large trials actually used an oral estrogen, usually combined equine estrogens, and a compound called a progestin, which is not the same as progesterone. It's a different compound. There are quite a few progestins that have been shown to raise blood pressure.
Jennifer Fugo, MS, CNS, LDN (17:57.555)
Wow.
Eve Henry MD (17:59.747)
So a lot of times that's just kind of like what I would call messy data. Like when we say HRT, what do we mean? What studies are they pulling from? What was actually used? The way that we do HRT most commonly today, which is a transdermal form of estrogen, whether that's a gel or a patch, it's estrogen on the skin, and a oral micronized progesterone, not progestin, I have never seen a rise in blood pressure with that.
Jennifer Fugo, MS, CNS, LDN (18:03.291)
Yeah!
Eve Henry MD (18:04.019)
Like when we say HRT, what do we mean? What studies are they pulling from? What was actually used? The way that we do HRT most commonly today, which is a transdermal form of estrogen, whether that's a gel or a patch, it's estrogen on the skin, and an oral micronized progesterone, not progestin, I have never seen a rise in blood pressure with that. Now, that doesn't mean there isn't someone out there who has experienced a rise in blood pressure, because that can happen to anybody at any time. But I've never seen a correlation or seen a study that shows that our current HRT could do that, but some of the older regimens could.
Jennifer Fugo, MS, CNS, LDN (18:46.034)
You know, what was interesting, and I was gonna ask you this because this paper, I'm gonna cite it, because I think it's worthwhile. We're having this conversation, so I like to share things, because I wonder, people are gonna find this on their own. So it was Canadian women, 120,000, so it's a pretty big pool of people, 45 and older, and you're right, it said estradiol, a synthetic form of estrogen and conjugated equine estrogen, and I have my question here, could it be the form of estrogen? But you actually said it's the form of progesterone, which is progestin, and some of these progestins actually can cause this problem. And I certainly wanna talk about HRT in a little bit, but this is helpful for us to know that us, like me and everybody else who's more on the patient side of things, and even fellow practitioners and healthcare providers, this sounds like you really have to look at the form of the HRT that was used within the study. You can't just go, oh, well, all our HRT is the same.
Eve Henry MD (19:51.225)
That's exactly right. And this is really interesting to me because there's a flip side of this that has to do with cardiovascular health. So, a lot of the larger trials show cardiovascular benefits to HRT. So it shows that if someone starts HRT, they have lower cholesterol, lower risk of plaque, et cetera. So, many times people come to me and say, hey, I'm really excited to start my HRT because I'm expecting my cholesterol to drop like a rock. It's gonna undo this problem that perimenopause caused. And there's a lot of disappointment around that once we start HRT.
Jennifer Fugo, MS, CNS, LDN (20:35.486)
I figured. I figured that much.
Eve Henry MD (20:49.411)
There's a couple reasons why, but the key reason is a lot of these large HRT trials use a form of oral estrogen, whereas today, we primarily use transdermal estrogen. Oral estrogen does lower cholesterol and has more of a significant impact on insulin metrics, glucose, hemoglobin A1c, et cetera. Unfortunately, kind of in the same vein, because it's more active at the level of the liver, it also increases our risk of blood clots.
Jennifer Fugo, MS, CNS, LDN (21:03.122)
Oh!
Eve Henry MD (21:16.207)
So, as we kind of came to a consensus today, like I would say, in modern medicine, we've kind of erred on the side of saying, well, blood clots are really bad, we don't want them, let's use transdermal estrogen. It's safer. But in that transition, we've also lost some of the benefits from a cardiovascular standpoint.
Jennifer Fugo, MS, CNS, LDN (21:36.092)
Interesting.
Eve Henry MD (21:38.568)
So a lot of those older trials really kind of over-promised the cardiovascular benefits compared to the regimens that we're using today.
Jennifer Fugo, MS, CNS, LDN (21:45.682)
Yeah, because stroke is not, that's not something you want.
Eve Henry MD (21:47.401)
No, it's not.
Jennifer Fugo, MS, CNS, LDN (21:49.852)
No. I felt like there was a but in there, and you're like, unfortunately. There was a but. So, question for you, in terms of test for cholesterol, I think it's the most common thing for a PCP, or a GP, is gonna run a lipid panel.
Eve Henry MD (22:09.167)
Right.
Jennifer Fugo, MS, CNS, LDN (22:11.806)
Like that's fairly easy to get. The other things are not so much. You have to fight with them, I had to actually end up paying out of pocket for the entire cost of all the other lipid panels that I had run because the insurance wouldn't cover it. So in terms of that, like say you have this high cholesterol, your triglycerides are elevated, maybe your LDL is high and maybe your HDL has fallen and you're like, oh, that's not in the greatest spot. What else, what could give us an increased perspective of what's actually happening, in terms of testing? What could somebody ask for, what could they consider? What would you recommend?
Eve Henry MD (22:55.727)
So the underlying question that we're trying to answer is like, what do we need to do about this problem, right? Like, do we need to lower our cholesterol? If we need to lower it, how low does it need to go? And I think that is an extremely personalized question and needs an extremely personal answer. So, I'm not someone who thinks everyone's cholesterol should be X. It really matters on your personal risk.
So the things that I think about when I'm trying to decide how much risk someone has is, one, what's their family history? If you have anyone in your family who had a heart attack, or needed a stent, or needed an open heart surgery, especially if they've had that before the age of 65, that's a red flag that you could have genetic risk. And when it comes to genetic risk for cardiovascular disease, our knowledge is like the tip of the iceberg. Like we know some things, but I have seen many cases of families where people have premature cardiovascular disease. So they're having events in their 40s, and their labs look perfect. Like something is going on that we don't know yet. So that's one. If you have a family history, take it seriously.
Two is there's a one-time test that everyone should get called your Lp-little-a. So Lp(a) is a genetic marker basically. You either have a high, elevated level or you don't. You inherit this predisposition from your family. And what an Lp(a) does is it increases your risk of cardiovascular disease. In this iceberg of genetic things we don't know about, we know about this one thing, this Lp(a). So you can get that tested. And if you're elevated, that's just something to know, okay, well I have this one thing that's increasing my risk, I'm gonna take that into consideration. And if it's not elevated, then you know, okay, that's one thing I don't have to worry about.
Jennifer Fugo, MS, CNS, LDN (24:58.738)
And so what you're saying, just I wanna make sure I'm very clear, because obviously a lot of these labs we do over and over, this is a one time thing. It's literally, you just get it once and you don't need, there's nothing you could do to change it.
Eve Henry MD (25:01.549)
Yeah, you don't need to track it. Mm-hmm.
Jennifer Fugo, MS, CNS, LDN (25:13.348)
Okay, okay.
Eve Henry MD (25:09.775)
Yeah, it doesn't change very much at all. It can bop around so you can get an Lp(a) of like 68, 71, 75, but it will hover in a range. Currently, there aren't any pharmaceuticals on the market today that make a big difference in Lp(a). They're coming, there's a lot in kind of, I would say, late stage research trials, but today there's not much. Repatha lowers it a tiny bit, about 20% in some people, but it's an area right now where we don't have a lot of pull in making that go down.
Jennifer Fugo, MS, CNS, LDN (25:48.2)
And then what about Apo B? Do you recommend that marker?
Eve Henry MD (25:50.787)
Mm-hmm. Okay. I do, I do, and let me just explain a little bit like what it is, why it matters. So we're used to thinking about LDL as kind of the cholesterol piece to pay attention to when you're trying to figure out your risk, right? So the way plaque forms is, we basically, you can imagine a little ball floating around in your artery, and just like a ball in a pinball machine, it's bouncing around. Well, if that ball hits the wall of the artery and gets stuck, that's the start of plaque.
Jennifer Fugo, MS, CNS, LDN (26:25.586)
Okay. So it's sticky, this ball is sticky. Okay.
Eve Henry MD (26:50.264)
It's sticky. So when it sticks, it starts to form plaque. Okay, so the number of balls bouncing around really matters. Like you can intuitively think, well, if I have a hundred balls that are more likely to hit the wall and get stuck than if I just have 10, more space in there, less likely to hit, right? So the balls’ number is what we're really trying to figure out. LDL is a weight, so it's a mass measurement. And there's a correlation there where the more balls you have, the heavier the weight. But there's some people where they have really big balls, or their balls are kind of weirdly heavy for whatever reason, where that's not as good of a measurement in terms of figuring out the number of balls. All Apo B is, is they figured out that each ball has one little protein wrapped around it called an Apo B, and every ball just has one Apo B. So if you're naming your game as you're just trying to figure out how many balls you have, Apo B is the most reliable metric.
Jennifer Fugo, MS, CNS, LDN (27:43.702)
Oh, interesting. And can that change? Can that number fluctuate?
Eve Henry MD (27:48.561)
That will fluctuate just like your LDL. So that will go up, that will go down. That's a key target when we try to push people's cholesterol lower to lower their risk. I primarily think about cholesterol risk with Apo B as the forefront of what I'm thinking about. And I honestly think in a few years, hopefully sooner rather than later, our country will transition, actually, instead of using LDL, they'll just use Apo B. That's already changed in a lot of the European guidelines. And now as you see research papers, any research paper that's looking at cardiovascular risk in relationship to cholesterol is really using both Apo B and LDL, and I think LDL will fall by the wayside.
Jennifer Fugo, MS, CNS, LDN (28:34.108)
Yeah, and the paper that I had found, I sent to my primary care doctor and said, I want these test for cholesterol, here's the reason why in case, you know, I didn't want to assume, I don't know what she knows, what she doesn't know, what she's on board with, and I said, if there's a chart. Listen, I value my health, and I just want to put this out there because I know everything costs something, right? And I had a feeling that I was probably going to have to pay for these likely out of pocket. So just be aware of that if you wanna go down this rabbit hole. But I value my health so much because I've had, working for my father's medical practice, and most of his patients were elderly, I saw so many people with health issues. It really was cemented in me that if you don't have your health, you don't have a whole lot. You're really stuck in front of the TV, the quality of life's not great, and I was told repeatedly, the golden years are not golden.
So for me, I really value not only understanding where I am, but what I can do about it. And so this was really helpful because the lipid panel freaked me out, to be honest. And I was like, I don't understand this, I don't want to go off just this, is there anything else we can look at? And that was why I asked for those two. And I also asked for a coronary calcium score, do you have any thoughts on that test?
Eve Henry MD (29:55.057)
Yeah, so the kind of ultimate way to know your personal risk is to figure out are you laying down plaque, right? Because if we have proof that you're laying down plaque, then we know that there's some real risk here. But it's important to understand how plaque is formed because that'll help you decide when and what tests to get. So we talked about the little balls. They're floating around, they hit the wall and they get stuck. That first step in plaque formation, I always think about it like a little bit like pus inside of a pimple. It's like schmutz. It's soft and it smears across the inside of the vessel in a streak. Now, this soft plaque is pretty dangerous.
Jennifer Fugo, MS, CNS, LDN (30:48.574)
Oh.
Eve Henry MD (30:54.638)
It's unstable, and it's more likely to rupture because of this instability. So the body is very smart, and the body knows about this, and it comes and it basically paves over the schmutz with calcium. It hardens it to try to stabilize it and make it safer for us.
Jennifer Fugo, MS, CNS, LDN (31:11.163)
Wow.
Eve Henry MD (31:24.848)
This process of turning schmutz into more of a paved road with calcium on it takes many, many, many years. So when you go and you get a coronary artery calcium scan, they're basically taking a picture and counting how much calcium lights up in this picture. So they're looking at the paved road. What you can't see in that picture is all the schmutz that hasn't been calcified yet. So there's a big piece of the puzzle that could be missing when you look at that test.
Now, age really comes into play here. So if I have a 20-year-old and they're like, should I get a coronary artery calcium test? I say, no, don't bother because if you have any plaque, you simply haven't been alive and around long enough for your body to calcify it. Like it's all gonna be soft if it's there. 40 is a gray zone where depending upon your risk, some people who have a higher risk that they're gonna lay down plaque have already started laying down plaque. But the average woman is just starting, right? Because they had that decades or 20s and 30s where their risk factors looked amazing. Now their cholesterol has gone up, now they have more balls, so now they're just starting to lay down that soft plaque. If you get a coronary artery calcium scan in your early 40s, you may end up with a scan of zero and feel really reassured. But meanwhile, there's soft plaque there that you couldn't see.
Jennifer Fugo, MS, CNS, LDN (32:51.39)
Yeah, mine was zero. So I figured I would do it again in five years.
Eve Henry MD (32:57.4)
Mm-hmm. Doing it again in five years, I think, is a really good idea. I was just gonna say, I usually think about this in late 40s. By late 40s, I'm starting to see people turn positive. By the time you're in your 50s, I'm seeing a fair number of people positive. And I do feel really reassured, my mom, for example, just got a coronary artery calcium scan, and she's in her 80s, and it came back zero.
Jennifer Fugo, MS, CNS, LDN (33:26.002)
Wow.
Eve Henry MD (33:29.466)
And she was like, do I have to worry about my cholesterol? And I was like, I don't think so. I think you're good to go, you just keep on keeping on. So the older you get, the more reassuring that is.
Jennifer Fugo, MS, CNS, LDN (33:36.254)
And it was also such an easy test. It was like, I literally laid down, I was like, are they doing anything? I don't hear anything. And then it was like five minutes and they were done, and I'm like, okay, this was the easiest, and it was like a hundred and, I think I paid $149 for it. So it wasn't like outrageously expensive. It wasn't covered by my insurance, but I just thought I wanted to get a baseline. I didn't know if it was quite the right time, but I thought, you know, gee, maybe for me it couldn't hurt right now, so then in five years I have something to compare it to.
Eve Henry MD (34:10.648)
Mm-hmm, and I do think you're exactly right, it's easy. It's low radiation, it's not that expensive, so it's a great low-hanging fruit to look into. If you're in your early 40s and it comes back positive, that is very concerning. That is someone who I would say, oh, we need to be really aggressive because you're already laying down plaque at a very early age in life, and it's already had the time to calcify, so the trajectory of that is very concerning.
So that is a good reason to do it, to find out if you're kind of like an outlier, a much higher risk person than I would expect for a traditional average woman in their 40s. If you could do it in your early 40s and it's totally zero, which is what I would expect, do it again in five to eight years and just see what's happening, see what that progression turns into. Don't take that as I'm good to go, not an issue. It's just a moment in time, you need another moment in time.
Jennifer Fugo, MS, CNS, LDN (35:06.961)
Yeah. Is it worth it to worry, even though mine was zero, for example, is it worth it to worry about the schmutz that's not calcified in the artery? Or is it just like, listen, you are where you are, and maybe we make some other changes and monitor some other things in the meantime? Or can you figure out if there's schmutz there?
Eve Henry MD (35:31.675)
So yes, first of all, I always worry about the schmutz. We should all be worried about the schmutz because it's the schmutz that turns into plaque over time. Like that is the, from a preventative medicine standpoint, we don't want to wait for the disease to be there and be terrible. We want to act early. And that schmutz is the first step down the road, right? So we're really interested in that. You asked, is there a test that can actually pick that up? The answer is yes.
Jennifer Fugo, MS, CNS, LDN (36:00.198)
Oh!
Eve Henry MD (36:03.323)
A CT angiogram will see soft plaque. So that is not as easy as an experience as what you did for the CAC score. CT angiogram is a test that they have to put in an IV and give you a little bit of dye, and then the dye goes through the coronary arteries and they can actually see, in pretty good clarity these days, the lining of the walls to see if there's schmutz there. But it's much more expensive and it requires more radiation, and there's contrast with it. And I would say it's more challenging for people to get this than it is for them to get a CAC. You can get a CAC a lot of places these days, but the CT angiogram is more challenging.
Jennifer Fugo, MS, CNS, LDN (36:47.518)
So if you care about your health, and I also don't wanna fixate on the schmutz to the point where I'm like terrified of it, because that's also not necessarily productive. I'm gathering from this conversation, number one, monitoring your blood pressure is gonna be a general helpful thing. So that is something I can easily do. Is there anything that you would suggest that one do being that, like this CT angiogram, like I don't think I would wanna go down that rabbit hole at this point. Unless like it came back, I think that becomes like very costly and probably not gonna be easy to get, like you said, and I don't know that I would wanna do that. So what are some better options for us?
Eve Henry MD (37:35.217)
So for you, specifically, in your 40s, this is like the era of risk factor management and prevention, right? So it doesn't matter as much in your 40s whether or not the schmutz is there. Because if it's there, it's gonna be pretty small, it's not gonna cause a problem tomorrow. What we want, though, is to prevent any more schmutz or plaque from forming. We want to be focused on risk factors. So there's three big risk factors that, I would say, where you should put all your kind of focus and energy in, all the eggs in these baskets. That's your Apo B or LDL cholesterol level, your blood pressure, and then all of your glucose metrics. So your hemoglobin A1c, your fasting insulin, fasting glucose, those are the three areas where you have so much power to prevent this disease if you focus in on managing them early.
Jennifer Fugo, MS, CNS, LDN (38:33.416)
So knowing those, and would that be something that you're running like once a year, or do you recommend every six months?
Eve Henry MD (38:41.488)
So it depends on how stable things are and whether or not you're trying to effect change. So bare minimum, once a year when you're in your 40s, because things are naturally changing. When you get closer to perimenopause, menopause, so like as you move through 41 to 48, a lot of times things start to change a bit faster. So that's where I say every six months makes a lot of sense to be checking in and seeing what's happening. Then, if you see something that's concerning. So let's say you get the test result back and, like you were saying, your LDL has gone way up. So now you're like, hmm, I want to try something to fix this. And you do your reading, and you do your research, and there's so many things that you could try. There's supplements, there's dietary interventions, .
Whatever you choose to try, just make sure you check it again in about three months to see if it's working for you. One of the more common things I see is people let a lot of time go by. So they find out that they have high cholesterol, and they're like, okay, I read a bunch of articles, I'm gonna go with this supplement. This article says it's gonna work, I'm all in. So they buy it and they take it, and then it's like three years later they get another lipid panel, and they figure out that that supplement didn't work for them.
Jennifer Fugo, MS, CNS, LDN (40:02.097)
Mm-hmm. Yep.
Eve Henry MD (40:02.948)
But now all this time has gone by where your body has kind of felt the effects of the issue of the high cholesterol or the high blood pressure. So, frequent monitoring, I think, is a really big deal for women to take control of their health.
Jennifer Fugo, MS, CNS, LDN (40:18.108)
And in terms of the HRT for menopause, do you feel like from your research, your experience, your work with patients, that if you get on, so everything I've read is that if you get on HRT within, what is it, the 10-year mark of going into menopause, you have better outcomes on a number of levels, from like bone health, to brain health, to cardiovascular disease, all these different things. Do you feel like that, it might not be a massive change, like you said, I should not, and I didn't expect the estrogen patch and the oral progesterone to make some sizable difference in my LDL and my cholesterol. But do you think overall that is a helpful step for women?
Eve Henry MD (41:04.816)
So personally, and kind of in my practice, I use a lot of HRT because I think it is helpful for a thousand different things in terms of how people feel, how they're sleeping, how they're interacting with their loved ones, and also how their numbers look on paper. So I do think it helps.
Jennifer Fugo, MS, CNS, LDN (41:23.902)
Okay.
Eve Henry MD (41:33.051)
I think it is more, I mean, my experience has been that I've never been like, oh, the solution to your cholesterol problem is going to be HRT. But I have been like, wow, the solution to 99 other problems that you have might be HRT, and then we can see what happens if you have any response. As I mentioned before, with traditional HRT that we use today, I really do not see much change, but sometimes small changes, especially if someone suddenly feels so much better, and now they're exercising more, and their weight has dropped, and their blood sugar is better, well then I will see much more of a significant difference in their lipid panel.
Jennifer Fugo, MS, CNS, LDN (42:10.814)
Okay. And for the woman who's listening to this who’s like, shoot, I missed that 10-year window, I've been in menopause for 12 years or 15 years. Is this worthwhile even considering or asking about, or should you just continue to soldier on without HRT for menopause?
Eve Henry MD (42:30.168)
I always think it's worth a conversation. So after 10 years, I think it's a more complex question based upon how someone is feeling, based upon their labs, their family history, what their goals are. But I think it's always a conversation worth having.
Jennifer Fugo, MS, CNS, LDN (42:50.174)
Fair enough. I like that because I've had a lot of women in my community go, well, I'm too old for that. And I'm like, are you? I don't know. Talk to your doctor. I think it's a worthwhile conversation to have. This has been very illuminating, fascinating. I am going to have to release away my idea, and that's totally fine, that maybe there's this protective reason that the cholesterol is going higher. That's okay, that's okay. It's good to be grounded in things. I just, I think this is such an important area for women because you watch a steady decline in women as we age. They become so, there's this tendency to become frail and, you know, all of these health problems. So I appreciate all the work that you're doing, especially right now, because it feels like this is such a new frontier for many, now that HRT isn't being demonized like it was. So I appreciate you for all the things that you're doing. It's just, thank you. And thank you for being here, I really appreciate your time.
Eve Henry MD (44:02.714)
You're welcome. It was super fun.
Jennifer Fugo, MS, CNS, LDN (44:05.438)
Gosh, I love when people answer questions. I just love it, I love when we can have these conversations. I will make sure, I know your website, you do have a website. You said you're a little hard to find, you're pretty busy, so I'll share that, it is drevehenry.com. And then your social media, I will put that all into the show notes and everything
Eve Henry MD (44:30.906)
It's true. Thank you.
Jennifer Fugo, MS, CNS, LDN (44:31.816)
But thank you so much for sharing all of this. I appreciate all the work that you're doing, and thank you for being a pioneer in this area. It means a lot because my hope is that your work is gonna really transform and hopefully save lives and improve the quality of women's lives moving forward. So thank you.
Eve Henry MD (44:50.97)
I appreciate it. Thank you for having me.
