We all have a small amount of fat in our livers. That’s normal. Fatty liver disease happens when too much fat has built up in this essential organ; it’s diagnosed when fat makes up 5% of your liver’s weight.
Fatty liver disease affects women and people assigned female at birth (AFAB) differently than men and people assigned male at birth (AMAB). Women are less likely to have it before turning 50. But once menopause begins, women are about 20% more likely than men to get fatty liver disease and to have it become a more advanced liver disease.
Women who have fatty liver disease also die from heart problems more than men. By age 60, their risk of heart disease is twice as high as that of men at that age.
Common Fatty Liver Symptoms in Women
Often, fatty liver disease doesn’t have any symptoms at all. For that reason, some experts refer to it as a "silent" liver disease.
Early symptoms of fatty liver disease, if they occur, can include:
- Belly (abdominal) pain
- A full feeling in the upper right part of your belly, where your liver is located
- Fatigue
For most people who get fatty liver disease, it won’t progress to serious liver disease. But sometimes it does.
It’s much more likely that symptoms will develop if your fatty liver disease progresses to advanced liver disease. If you have cirrhosis, which is a late stage of liver disease where healthy liver tissue gets replaced by scar tissue, your symptoms may include:
- Nausea
- Jaundice, which is yellowing of the skin and eyes. It happens when your liver can no longer filter out excess amounts of a waste product called bilirubin, which instead builds up in your bloodstream.
- Unplanned weight loss
- Ascites, which is a buildup of fluid between the two layers of your peritoneum, the lining of your abdomen and the organs inside it, like your stomach, liver, spleen, and your large and small intestines
- Swelling, or edema, in your legs, hands, and feet, which happens because of high pressure in your portal vein, which carries blood to your liver. This pressure is called portal hypertension.
- Appetite loss, which may result from inflammation as well as other things like ascites, belly pain and nausea, and imbalances of hunger hormones
- Internal bleeding, which happens when small blood vessels burst due to portal hypertension. It also can happen when portal hypertension causes veins in your esophagus and stomach to enlarge.
- Confusion, which can be caused by hepatic encephalopathy. This happens when your diseased liver can no longer remove toxins from your blood very well. As those toxins build up, they begin to affect your brain.
- Dark urine and light-colored poop
- Visible blood vessels that resemble a spiderweb, called spider angioma, possibly due to a rise in proteins called vascular growth factors
Itchy skin
You may live with advanced liver disease, and especially cirrhosis, for many years before the disease starts to make its presence known.
Fatty liver disease and menstruation symptoms
Women and people AFAB may have abnormal periods due to imbalances in the hormones estrogen and progesterone. Liver disease can trigger such imbalances, leading to very heavy bleeding during menstruation or to missed periods. Liver problems can also make your blood less able to clot. That means that uterine bleeding may not stop even if your menstrual cycle remains normal.
In fact, long or irregular periods may be an early warning sign that you are at risk of fatty liver disease.
Fatty Liver Symptoms in Menopause
Menopause doesn't appear to trigger different symptoms of fatty liver disease, but it does have a serious impact on your risk of the disease.
Before age 50, women are less likely to have fatty liver disease than men. With menopause, women and people AFAB become more likely than men and people AMAB to be diagnosed.
Experts think that hormone changes during menopause help explain it. For example, the female sex hormone estrogen appears to protect against fatty liver disease. It also helps prevent fibrosis, or scarring in the liver. But that protection ends after menopause, when the ovaries produce much less estrogen.
A female reproductive hormone called estradiol also plays a role. During menopause, the level of this hormone begins to drop. As it does, the risk of fatty liver disease starts to rise, along with the risk of type 2 diabetes, high triglycerides, and an increase in belly fat.
According to some research, postmenopausal women and people AFAB have more severe scarring of the liver than those who have yet to begin menopause. But experts still don’t know how much of a role sex differences play in the progression of the disease.
Acute Fatty Liver of Pregnancy (AFLP) Symptoms
This is a rare but dangerous condition in which fat builds up in the liver during pregnancy. This makes your liver less able to break down fat. When that happens, it gets harder for your liver to do its job. AFLP, which usually happens toward the end of the third trimester of pregnancy, can lead to several severe complications, including:
- Liver failure
- Kidney failure
- Lung failure
- Infection
- Hemorrhage, which is bleeding caused by damaged blood vessels
Doctors aren't able to predict who will get AFLP, nor can it be prevented. If it remains untreated, AFLP can be fatal. But keep in mind that this condition happens in only 1 in every 10,000 to 20,000 pregnancies.
Experts don’t know what causes it, though it may be genetic, meaning you may have inherited the risk from your parents. Things that make it more likely to happen include:
- Pregnancy for the first time
- Twin pregnancy
- Pregnancy with a male child
Some health conditions also add to the risk, including:
- Diabetes
- Obesity
- Preeclampsia
- Cholestasis of pregnancy, another liver problem that can happen during pregnancy
The symptoms of AFLP resemble those of advanced liver disease. They include:
- Belly pain (abdominal pain), which you’ll likely feel in the upper right side, where your liver is located
- Nausea
- Vomiting
- Fatigue
- An overall feeling of being unwell
- Reduced appetite
- Feeling very thirsty
- Yellowing of the skin and eyes, called jaundice
- Trouble thinking and staying focused
Risk Factors for Fatty Liver in Women
Women share many risk factors for fatty liver disease with men. Some are:
Being overweight or having obesity. Excess weight is the biggest risk factor. An estimated 3 out of 4 overweight people have fatty liver disease, while about 90% of people with severe obesity have the disease.
Having diabetes. Type 2 diabetes is another important risk factor. As many as two-thirds of people with type 2 diabetes have fatty liver disease.
Race or ethnicity. Being Hispanic raises your risk more than being in any other ethnic group. Non-Hispanic White and Asian American people are next, followed by non-Hispanic Black people. Genetics likely play some role in the different risks among racial and ethnic groups.
Other risk factors include:
- Alcohol use disorder
- Metabolic syndrome, the name for a cluster of conditions that raises your risk of diabetes and heart disease. These conditions are high blood pressure, high cholesterol, high blood sugar, and a large waistline, indicating too much belly fat.
- Obstructive sleep apnea, a condition that disturbs your sleep by repeatedly interrupting your breathing
- Hypothyroidism, in which your level of thyroid hormones is below normal
- Hypopituitarism, in which your level of pituitary gland hormones is below normal
- Hypogonadism, in which you have low levels of sex hormones (estrogen and progesterone in women; testosterone in men)
Other risk factors for fatty liver disease are specific to women. These include:
Age of menarche (first menstruation or period). If you had your first period before age 12, you may have a higher risk of fatty liver disease when you’re an adult.
Menopause. The sex hormone estrogen appears to protect against fatty liver disease. But a significant drop in your body’s production of estrogen comes with menopause and, as a result, a rise in your risk of fatty liver disease.
Use of tamoxifen. This drug, used to prevent and treat breast cancer, raises the risk of fatty liver disease. Some research has shown that about a third of women get fatty liver disease after taking tamoxifen for one to three years. The drug also makes it more likely that your condition will progress to a more serious liver disease.
Turner syndrome. This condition only affects women and people AFAB. Up to 1 in 2,500 are born with it. People with Turner syndrome lack one of their two X chromosomes. The disease greatly increases the risk of cirrhosis, or advanced liver disease, and may make fatty liver disease more likely as well.
Polycystic ovary syndrome (PCOS). This condition causes your ovaries to produce high levels of androgens, male sex hormones that women and people AFAB typically have in only small amounts. PCOS affects your menstrual cycle. It also more than doubles the risk of fatty liver disease, even if you don’t have other significant risk factors like overweight, obesity, or diabetes. Of even greater concern: It’s been linked to metabolic dysfunction-associated steatohepatitis (MASH), a more advanced form of fatty liver disease, in women under 40.
Treatment for Fatty Liver Symptoms in Women
There are many treatment options to help improve the health of your liver and prevent the disease from getting worse. The earlier you catch the disease and start addressing it, the more likely you will be able to reverse it. Here’s what you should do if you have fatty liver disease:
See a specialist. Get a referral to a hepatologist or gastroenterologist. Both have focused expertise in caring for the liver.
Manage other metabolic health problems. It’s important that you follow your treatment plan for conditions like diabetes, high cholesterol, and high triglycerides.
Don’t drink. Even if alcohol did not cause your fatty liver disease, it can make it worse, so it’s best to avoid it altogether.
Lose weight. If you’re not at a healthy weight or have obesity, options to help you achieve a healthier weight can include diet, exercise, weight loss drugs, and weight loss surgery. Keep in mind that even a small amount of weight loss will bring benefits. Here are some general guidelines:
- Dropping 5% of your body weight will bring improvements if you have fatty liver disease. But experts don’t yet know the best weight loss targets for people who have gone through menopause.
- Dropping 7% to 10% of your body weight should help if your disease has progressed to MASH, a more serious form of fatty liver disease. But women may need to lose a greater percentage of weight to see improvements in MASH.
Eat well. A nutritionist can tailor an eating plan that will support the health of your liver and help you lose weight.
Exercise. Regular physical activity can help with weight loss and liver function, and building muscle also may help improve fatty liver disease. Aim for more than 150 minutes of exercise each week. Your doctor can help you come up with a safe and effective program.
Take prescribed medication. So far, only one drug – resmetirom (Rezdiffra) – has been approved by the FDA to treat the type of liver scarring that happens in MASH. It reduces the amount of fat that builds up in the liver. If your doctor prescribes it, you’ll take it while following your diet and exercise plan. Some people with fatty liver disease may benefit from vitamin E supplements and certain diabetes drugs.
Menopause hormone therapy
Hormone replacement therapy (HRT), for menopause symptoms like hot flashes, night sweats, and vaginal dryness, provides estrogen and, sometimes, the hormone progesterone as well. But experts don’t yet know whether HRT protects against fatty liver disease or is a treatment for the condition. So far, studies looking into this have had mixed results.
If you’re interested in trying it for this purpose, talk to your doctor. You may be able to take part in a study that could provide you access to potentially helpful treatment.
Takeaways
Fatty liver disease is a common condition that often has no symptoms in men or women. But there can be symptoms if the disease progresses and damages your liver. The disease becomes more likely after menopause, when your body produces much less of the hormone estrogen. You can reduce your risk of fatty liver disease getting worse by making lifestyle changes, avoiding alcohol, and managing other health problems you may have.
FAQs: Fatty Liver Symptoms in Women
Why would a woman have a fatty liver?
People who are overweight or obese have a higher risk of fatty liver disease, as do those with type 2 diabetes, high cholesterol, and high triglycerides. Alcohol use disorder also can lead to it. Women and people AFAB tend to develop it later than men and people AMAB because the hormone estrogen offers some protection against it. But after menopause, estrogen drops and the risk rises.
Is fatty liver in women reversible?
In its early stages, you may be able to reverse it with exercise and a healthy diet. If it has progressed, diet, exercise, and other interventions can keep it from getting worse.
What are some of the alcoholic fatty liver symptoms in women?
Whether due to alcohol abuse or other causes, the symptoms are the same and may not show up until the disease has become quite advanced. Some of symptoms you may have include:
- Pain in your belly area
- Nausea and vomiting
- Yellowing of the skin and eyes, called jaundice
- Unexplained weight loss
- Swelling, which can happen in your belly, legs, hands, and feet
