Cholesterol levels spike in men and women with advancing age. For women, however, this age-related change is striking at the menopausal transition stage. With falling estrogen levels, high-density lipoprotein (HDL) cholesterol, also known as the “good cholesterol”, starts to decline. On the other hand, the age-related decline in estrogen levels increases low-density lipoprotein (LDL) cholesterol, also known as the “bad cholesterol”. These changes in cholesterol levels are very detrimental to health because it drastically increases one’s risk of developing fatal medical conditions such as heart disease, stroke, cancer, diabetes, and hypertension. While diet and lifestyle modifications can be beneficial in improving cholesterol profile, there is strong evidence that ERT may also help normalize cholesterol levels:
1. In healthy postmenopausal women, oral estrogen supplementation increases HDL cholesterol levels by 15-18%. 
2. In healthy postmenopausal women who had surgical removal of the uterus, both oral and transdermal estradiol for 4 weeks increase HDL by 7.1%. [405-406]
3. In healthy premenopausal women, ERT increases HDL and decreases LDL levels without any adverse side effects. [407-418]
4. In postmenopausal women with elevated cholesterol levels, ERT produces significant and therapeutic reductions in LDL cholesterol. [419-421]
5. Oral estrogen administration for 6 months significantly increases HDL and decreases LDL in menopausal women, making it the most effective route. [422-423]
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