Systematic Review and Meta-analysis Result in Improvements in Total Cholesterol Levels in Postmenopausal Women after Green Tea Supplementation

One of the main health issues for women, including postmenopausal women is the risk of cardiovascular disease.  After all, cardiovascular disease is the number one cause of mortality in women.

Over 60 million women (44%) in the United States are living with some form of heart disease. [i]Heart disease is the leading cause of death for women in the United States and can affect women at any age.

In 2023, it was responsible for the deaths of 304,970 women—or about 1 in every 5 female deaths. [ii] Only about half (56%) of US women recognize that heart disease is their number 1 killer. [iii]

The normal physiological drop in estrogen in postmenopausal women is associated with metabolic changes that can increase the risk for cardiovascular disease, as well as type 2 diabetes.  Epigallocatechin-3-gallate (EGCG), a polyphenol in green tea  has been shown to affect certain metabolic pathways. This systematic review and meta-analysis evaluated the effects of green tea consumption on the metabolic profile of postmenopausal women.

Several data bases were searched: Medline, Embase, Web of Science, Cochrane Library, and LILACS which ended in November 2025. Randomized controlled trials (RCTs) were eligible if they met the following criteria: population studied was postmenopausal women; intervention of green tea (extract or infusion); and placebo as the comparison. Study outcomes included body weight, body mass index (BMI), body composition, fat mass, waist circumference, total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides, adiponectin, leptin, fasting glucose, serum insulin, and the homeostatic model assessment of insulin resistance (HOMA-IR).

Seven RCTs were selected for the review.  The studies were published between January 2012 and January 2023 and involved 549 postmenopausal women aged 49–67 years. Study durations ranged from one month to 12 months. Green tea interventions included caffeinated green tea extract capsules and tablets, a catechin-rich green tea beverage, and a green tea extract supplement.

Body weight and BMI were assessed in three studies, which included 162 participants across the green tea groups and 163 across the control groups. No significant differences in body weight or BMI were observed between the intervention and control groups. In three studies, no significant differences were observed between the green tea groups in waist circumference.

Four studies (with 550 participants in the green tea groups and 559 in the control groups) evaluated changes in TC (total cholesterol), HDL-C, LDL-C, and TG (triglycerides). The improvement in total cholesterol in the green tea group was significantly greater compared with the control group.

The adipokines, adiponectin, and leptin were evaluated in two studies but no significant differences between groups were observed.  There were also no significant between-group differences for blood glucose levels in four studies; for serum insulin levels in three studies; or for HOMA-IR outcomes in two studies.

For body weight, body mass index (BMI), HDL-C, and triglycerides, the certainty of evidence was very low due to a high risk for bias and imprecision. The evidence supporting a decrease in total cholesterol levels was low, also due to a risk for bias. The evidence lacked certainty for adipokines, glycemic markers, and waist circumference.

A minimum effective dose could not be definitively established but the trials that reported favorable metabolic effects used EGCG doses greater than 400 mg daily.

Commentary: This systematic review provides some evidence that green tea consumption may lead to modest reductions in total cholesterol levels in postmenopausal women, although no significant effects were observed for other metabolic outcomes.

In another systematic review and meta-analysis, published in 2023 [iv] green tea supplementation was associated with small but significant improvements in the lipid profile by decreasing TC and LDL. Green tea supplementation also resulted in increases in HDL. In terms of TG, subgroup analyses showed that green tea supplementation had significantly favorable effects on TG in long-term interventions.  Green tea also showed favorable effects on the glycemic profile by decreasing fasting blood sugar (FBS) and hemoglobin A1c (HbA1c) without any changes in fasting insulin and HOMA-IR.

With these possible benefits of green tea on select cardiovascular risk factors, it is one more reason to recommend green tea, although in the end, the outcomes that need to be assessed is whether or not green tea reduces cardiovascular disease and mortality related to cardiovascular disease in women.

References: Zago IHR, Colonetti L, Balbinot EL, et al. Effects of green tea use on the metabolic profile of postmenopausal women: systematic review and meta-analysis. Eur J Nutr. June 2, 2026;65(4):150.

[i] Tsao CW, Aday AW, Almarzooq ZI, et al. Heart disease and stroke statistics–2023 update: a report from the American Heart Association. Circulation. 2023;147(8):e93–e621.

[ii] National Center for Health Statistics. Multiple Cause of Death 2018–2023 on CDC WONDER Database. Accessed February 1, 2025.

 [iii] Mosca L, Hammond G, Mochari-Greenberger H, Towfighi A, Albert MA, American Heart Association Cardiovascular Disease and Stroke in Women and Special Populations Committee of the Council on Clinical Cardiology, Council on Epidemiology and Prevention, Council on Cardiovascular Nursing, Council on High Blood Pressure Research, and Council on Nutrition, Physical Activity and Metabolism. Fifteen-year trends in awareness of heart disease in women: results of a 2012 American Heart Association national survey. Circulation. 2013;127(11):1254–1263, e1–e29.

[iv] Zamani M, Kelishadi M, Ashtary-Larky D, et al.  The effects of green tea supplementation on cardiovascular risk factors: A systematic review and meta-analysis. Front Nutr.  2023 Jan 10;9:1084455.