Polycystic ovary syndrome (PCOS) is a condition that affects how the ovaries work. Normally, your ovaries make hormones that play an important role in menstruation and pregnancy. If you have PCOS, they make too much of certain hormones, causing an imbalance that affects your ovulation cycle. Anyone with ovaries can develop PCOS.
Does PCOS Affect Liver?
PCOS doesn’t just affect fertility — it can also have an impact on other parts of the body, like the liver. The hormone imbalance caused by PCOS often increases insulin levels, a hormone that helps control blood sugar. Too much insulin can make the body store fat in places it doesn’t belong, including the liver. This can lead to a condition called steatotic liver disease (SLD), previously known as non-alcoholic fatty liver disease (NAFLD). Researchers are still studying the link between the two diseases, but they suspect that the hormonal changes in PCOS contribute to liver inflammation and other problems related to SLD.
PCOS and Fatty Liver
A healthy liver has only a small amount of fat. Research suggests that PCOS may contribute to fatty liver, a condition when more than 5% of the organ’s weight is made up of fat.
Doctors now use the umbrella term steatotic liver disease (SLD) to describe the range of conditions caused by extra fat in the liver. These include alcohol-related liver disease (ALD), caused by heavy drinking, and metabolic dysfunction-associated steatotic liver disease (MASLD), which is linked to health problems like obesity and diabetes.
When fat deposits damage the liver, it can develop into a more serious condition called metabolic-associated steatohepatitis (MASH) (formerly nonalcoholic steatohepatitis, or NASH).
One study found that people with PCOS are four times more likely to have SLD, and another estimated that as many as 39% of people with PCOS also have fatty liver.
There are a few reasons for this link:
Insulin resistance. The biggest reason for the connection has to do with insulin, the hormone that helps your cells turn sugar into energy. Many people with PCOS are resistant to insulin, which means their body struggles to use it correctly. This makes it harder to process and break down sugar, and can lead to fat being stored in the liver. Between 50% and 70% of women who have PCOS also have insulin resistance.
High androgen levels. If you have PCOS, increased luteinizing hormones can also be connected to higher levels of male hormones, called androgens. While all females produce small amounts of androgens, like testosterone, too much can disrupt how the body processes cholesterol. Normally, the reproductive hormone estrogen helps manage this process, but high androgen levels can interfere, leading to a buildup of fat in the liver.
Growth of fat cells. In PCOS, fat cells can also grow larger than normal. If those cells press on the blood vessels in fat tissue, they lower blood flow and oxygen. The resulting stress causes inflammation that can affect the liver.
Risk Factors for PCOS and Fatty Liver
PCOS and fatty liver disease have many shared risks that can make their effects on the body worse. These include:
- Insulin resistance. It’s estimated that between 50% and 80% of people with both PCOS and fatty liver disease also have insulin resistance, which means their body has a hard time breaking down sugar.
- Obesity. Between 40% and 80% of people with PCOS also have obesity, which makes them more likely to develop SLD.
- Hyperandrogenemia. High levels of male hormones (androgens) in a female body can lead to insulin resistance, a key trait in both PCOS and fatty liver disease.
- Type 2 diabetes. The insulin resistance often seen in people with PCOS and fatty liver disease can progress to diabetes.
- Sleep apnea. Sleep apnea lowers the amount of oxygen a person gets during sleep, which causes inflammation and lowers the amount of proteins that help control blood sugar and fat metabolism. These changes can lead to insulin resistance and fat buildup in the liver. A recent study found that people with sleep apnea are 2.6 times more likely to have fatty liver disease, while those with PCOS and sleep apnea are 7.6 times more likely to develop it.
How to Manage PCOS and Fatty Liver?
Managing PCOS and fatty liver disease usually involves addressing their shared underlying issues, such as insulin resistance, obesity, and inflammation. With healthy lifestyle changes, you can improve symptoms and lower your chances of having long-term complications.
PCOS and fatty liver diet
Eating healthy is a key part of managing both PCOS and fatty liver disease. The right food choices can help control weight, lower inflammation, and support overall health.
Here are some tips for a PCOS and liver-friendly diet:
- Stay away from fried foods and processed snacks. Fried and processed foods are high in unhealthy fats and calories, which can make inflammation worse and lead to weight gain.
- Limit red meats, cold cuts, and other processed meats. These foods are high in saturated fats and salt, which can also cause inflammation.
- Avoid foods and drinks that are high in sugar. When you eat too much sugar, your body converts the excess into fat. Over time, this can build up in the liver.
- Drink less alcohol. Alcohol is processed in the liver and is another cause of inflammation.
- Eat more omega-3s. Foods like oily fish, walnuts, and flaxseeds are rich in omega-3 fatty acids, which can help lower inflammation and improve liver health. Studies have shown that those who eat more omega-3s have a lower chance of getting liver disease.
- Use olive oil instead of butter or margarine. Olive oil contains healthy fats that support heart and liver health, while butter and margarine are high in saturated and trans fats that can increase fat storage in the liver.
- Choose whole grains instead of white bread. Whole grains like quinoa, brown rice, and barley have more fiber and nutrients, which help regulate blood sugar.
- Eat more non-starchy vegetables. Vegetables like spinach, broccoli, and zucchini are low in calories and high in fiber, so they fill you up faster and can help you maintain a healthy weight. Aim to fill half of your plate with veggies at mealtime.
- Choose whole fruits for dessert. Whole fruits like berries, oranges, and peaches are naturally sweet and have fiber and vitamins without the added sugar found in desserts.
- Stay hydrated. Drinking plenty of water supports overall health by helping the body flush out toxins.
Talk to your doctor or a dietitian about creating a food plan that fits your health needs.
Stay active
Many people with PCOS also struggle with depression, anxiety, and eating disorders. Staying active can be a good way to improve both mental and physical health. Experts recommend exercising a few times each week. This could include 75 to 150 minutes of high-intensity exercise, like running or dancing, or 150 to 300 minutes of moderate intensity exercise, like walking, biking, or swimming.
Try to lose weight
Weight loss can help reverse fatty liver and lower the inflammation that it causes. Losing 5% to 7% of your body weight can help with fatty liver, while 7% to 10% weight loss can reverse the effects of MASH. Once your liver has scarring, the damage can’t be undone.
The best way to lose weight is through a combination of healthy eating and regular exercise. Try to eat at least five servings of fruits and vegetables every day and choose whole grains and lean meats, like chicken and fish. Aim for at least 250 minutes of moderate-intensity exercise or 150 minutes of high-intensity exercise each week in addition to strength exercises like weight training.
Handle stress
Some research suggests that stress may play a role in both PCOS and fatty liver disease. One study found that women with PCOS had higher levels of the stress hormone cortisol, with levels being even higher in those who had obesity. Another study linked stress to a higher chance of developing fatty liver disease.
This connection may be because of the unhealthy habits often associated with stress, including smoking, drinking alcohol, poor eating, and a lack of exercise. But stress hormones like cortisol and adrenaline can also raise inflammation and blood sugar — both of which are linked to PCOS and fatty liver.
Here are some tips for managing stress:
- Eat healthy.
- Exercise regularly.
- Get enough sleep.
- Practice relaxation techniques like yoga or meditation.
- Journal.
- Make time for friends, family, and activities that you enjoy.
- Speak to a therapist or mental health counselor.
Regulate sleep
Sleep is connected to overall health. Not getting enough of it disrupts important hormones in our bodies, including the ones responsible for stress, hunger, and weight. Over time, a lack of sleep can contribute to conditions linked to PCOS and fatty liver, including obesity, hormonal imbalances and prediabetes. Aim for between seven and nine hours of sleep each night.
Medications for PCOS and Fatty Liver
While lifestyle changes are the foundation of managing PCOS and fatty liver disease, your doctor may recommend medication to help treat specific symptoms and underlying issues. These might include:
- Metformin. Metformin is a common medication used to treat and prevent type 2 diabetes. It helps the body process insulin, which lowers blood sugar levels. It is more commonly prescribed for PCOS, as it can also improve ovulation in addition to lowering blood sugar.
- GLP-1 receptor agonists. These newer medications, known as DDLP-1RAs, help manage metabolic issues related to PCOS. They work by helping the body release insulin only when blood sugar levels are high. They also reduce appetite, control hunger, and make you feel fuller for longer, which can help with weight management. Early research suggests DDLP-1RAs could also help treat the causes of fatty liver.
- Pioglitazone. While there aren’t any FDA-approved medications specifically for fatty liver, pioglitazone, a drug used to treat diabetes, can be prescribed. It brings down your blood sugar by making your body more sensitive to insulin and can help manage fatty liver when combined with healthy eating and exercise.
PCOS and Fatty Liver Supplements
There’s some research to suggest that certain supplements may help manage symptoms of PCOS and fatty liver by improving insulin sensitivity, lowering inflammation, and supporting weight loss. These include:
Supplements for fatty liver:
- Vitamin E
- Vitamin D
- Polyphenols
- Omega-3 fatty acids
Supplements for PCOS:
- Vitamin D
- Inositol (vitamin B8)
- Folate (vitamin B9)
- Calcium
- Selenium
- Cinnamon
It’s important to talk to your doctor before taking supplements for PCOS and fatty liver. Supplements shouldn’t be used as a replacement for medications you’re already taking.
When to Contact Your Doctor
You should contact your doctor if you experience any of the following symptoms of PCOS and fatty liver:
- Unexplained weight gain
- Irregular periods, including missed periods or very heavy bleeding
- Excess hair growth on your face, arms, chest, or belly
- Acne
- Frequent abdominal pain
- Feeling exhausted or tired all the time
- Nausea
- Loss of appetite
- Yellow skin or eyes (jaundice)
- Swelling in your abdomen, legs, feet, or hands
- Dark patches of skin, especially around your neck, armpits, groin, or under your breasts
- Problems getting pregnant
Takeaways
While more research is needed to fully understand the connection between PCOS and fatty liver disease, there’s a growing amount of evidence that suggests people with PCOS are more likely to develop fatty liver, which can cause further health problems if it’s not treated. The good news is that lifestyle changes like healthy eating, regular exercise, and stress management can help improve symptoms and prevent long-term damage. If you think you might have PCOS or fatty liver, talk to your doctor about an evaluation and treatment plan.
FAQs
How can I lose weight with fatty liver and PCOS?
The best way to lose weight with fatty liver and PCOS is through a combination of healthy eating and regular exercise. Talk to your doctor or a nutritionist to create a personalized plan that fits your needs and goals.
