At this stage in your life, you may have noticed the ‘change in life’ happening. You may have talked about it with others and even accepted it. But what’s really going on? Why are health issues such as fatty liver disease popping up now?
Perimenopause, the transition period before menopause, is when your ovaries slow estrogen production until menopause begins. Then they stop producing the hormone altogether. After menopause, small amounts of estrogen are still produced in other parts of your body, such as your adrenal glands. Having far less estrogen during menopause raises your risk of developing some health issues or having others get worse. You were protected when your ovaries were pumping out estrogen.
One of these conditions is metabolic dysfunction-associated steatotic liver disease (MASLD), the new name for fatty liver disease. Menopausal women have more than twice the risk of developing MASLD than the general population. A recent study found that over nine years, almost 57 out of every 100 women who had gone through menopause and 49 out of every 100 women in perimenopause developed the condition.
Let’s take a look at how your hormonal changes are connected to your fatty liver disease.
How Are Your Hormones Changing During Perimenopause and Menopause?
Some of your body’s changes — such as thinning bones — can have a significant impact on your overall health, and you might not even know that change is happening. Other changes are more obvious, such as weight gain.
On average, a menopausal woman gains about five pounds. For many, it can be a lot more. “It’s a common refrain among women I see in my practice: ‘I’ve not changed my eating habits. I’m not doing a single thing differently than I was doing five years ago, but I’m still gaining weight,’” said Anurag Maheshwari, MD, a hepatologist at Mercy Hospital’s Institute for Digestive Health and Liver Disease, in Maryland.
What happens during perimenopause?
Aside from irregular periods, you might experience these changes:
Body changes
- Hot flashes
- Sore breasts
- Trouble sleeping
- Dry vaginal tissue
- Peeing more often
- Leaking urine
- Frequent vaginal infections or urinary tract infections (UTIs)
- Loss of sexual desire
- Thinning bones, which could lead to osteoporosis
- Thinning hair
- Dry eyes, skin, and/or mouth
- Headaches
- Increase in low-density lipoprotein (LDL) cholesterol levels, the “bad” cholesterol that can cause clogging in your arteries, raising the risk of stroke or heart attack
- Slower metabolism, leading to slower digestion, constipation, and weight gain
You might also go through things that aren’t on this list. If you’re worried about any changes in your body, speak with your doctor about your concerns.
Brain changes
Brain changes during perimenopause and menopause are not “all in your head!” Research shows there are actual changes going on in the brain. Some women don’t go through any problems; some are bothered, but they manage. But others are affected to the point that they’re worried they might be developing dementia or some other brain disease. The changes in your brain during perimenopause could cause:
- Forgetfulness
- Being much more easily distracted
- Trouble learning new things
Emotional changes
Mood swings can range from switching between emotions very suddenly without reason to more serious issues such as anxiety, depression, or bipolar disorder. If you had a mood disorder before you got into perimenopause, it’s possible that it can worsen now. And if you’ve never been diagnosed with a mood or anxiety disorder, perimenopause or menopause could bring it on.
What happens after menopause?
Do these symptoms go away once you’re in menopause? Some do. If you have breast tenderness, it typically stops once you enter menopause. And if your hot flashes don’t go away, they usually ease up. That said, there are a few issues that may worsen now, such as thinning of the bones, weight gain, and your risk for fatty liver disease.
How Is Your Liver Affected By Your Hormonal Changes?
The hormonal changes you have after menopause raise your fatty liver risks. For people who don’t drink alcohol or drink very little, excess weight is the primary cause of MASLD. The more extra weight someone has, the higher their risk for the condition. If you were diagnosed with MASLD earlier in life, the extra weight that can come after menopause can raise the risk of MASLD getting worse. The fat deposits in your liver causing inflammation can progress to scarring your liver (fibrosis). And that makes it difficult for your liver to filter toxins as it should.
“The loss of a large amount of estrogen in the body is responsible for the reduced basal metabolic rate (BMR). That leads to weight gain in a large number of women,” Maheshwari said. “They burn calories at a lower rate than when they were younger adults. They’re gaining weight because the metabolic rate is lower.”
It’s not just weight gain that increases the fatty liver risk, though. It’s the fact that without estrogen, some other processes in your body change:
Sugar metabolism. Losing estrogen at menopause makes it hard for the body to use sugar properly, leading to insulin resistance. If you have prediabetes or diabetes during perimenopause or after menopause, your risk for MASLD goes up. Diabetes is a risk factor for fatty liver.
Fat metabolism. Your estrogen also plays a role in how much fat goes to your liver. So, when estrogen levels drop, your body can’t break down fat as well as it did before. The fat also gets deposited differently. You’ll notice it mostly around your belly.
Overcoming the Combined Effects of Fatty Liver and Menopause
If you feel frustrated trying to easily go ahead with your health after menopause, it’s likely because much is out of your hands. You have no control over how fat is redistributed or how your body breaks down sugar. But there are some things you can do that can help. According to Maheshwari, making lifestyle modifications is the best way to protect liver health after menopause.
Exercise. “Experts strongly recommend achieving and maintaining a healthy weight with regular aerobic exercise, aiming for at least 150 minutes per week,” he said. “Eating a balanced diet that is high in vegetables, whole grains, and lean proteins and low in added sugars and saturated fats can help control cholesterol and blood sugar.”
Try eating differently. The Mediterranean diet is often recommended by doctors and dietitians. It’s not a strict eating plan but an eating style. It’s heavy on olive oil, fish, and fresh fruits and veggies that are the basics of meals in countries along the Mediterranean Sea, such as Italy and Greece. The Mediterranean diet includes those whole grains and lean proteins that Maheshwari mentioned. If you follow a vegetarian or vegan diet, you can replace the meat-based proteins with plant proteins such as chickpeas, soy beans, and lentils, to name a few.
Cut out alcohol. Another change that helps is avoiding alcohol. “Avoiding alcohol is especially important, since even small amounts can hurt liver health,” Maheshwari explained. “A lot of people still believe that a glass or two of wine per day is beneficial or good for you. That is not true. Clear data show that any amount of alcohol is [bad] for your health. So, abstinence from alcohol as much as possible is the best strategy in terms of long-term management of fatty liver.”
Relax and destress. Having to manage all these changes with your body can be exhausting and overwhelming. If you’re discouraged, it’s hard to make any kind of change, even if you know it’s good for you. Managing your stress levels may be easier said than done, but there are steps you can take that can get you started. Meditation and relaxation are a good start. There are apps you can download to encourage you to stop and take time for yourself. Or, simply sit in a chair with your eyes closed for 15 minutes. Listen to soft music or sit in silence, whichever calms your mind.
Prioritize sleep. Disrupted sleep is something you’re probably familiar with during perimenopause or menopause. But disrupted sleep can also make fatty liver worse. Improving sleep hygiene means doing the things that could help you get a better night’s sleep, such as:
- Keeping no electronics in your bedroom at night
- Trying to go to bed at the same time every night
- Setting up your bedroom to be comfortable and inviting
- Having a regular routine
What Can I Do Right Now?
Lifestyle changes take time. It takes time to create new habits or change old ones. And it takes time for the effects of healthy changes to kick in. So, what can you do right now as you’re dealing with hormonal changes and fatty liver disease? Plenty!
Take stock. Note what’s feeling different about your body, what bothers you the most, and what might be the easiest issue to tackle first. Speak with your family and friends about what’s going on and how you feel. If they’ve been through this, they might have suggestions for you. If they don’t, their support is still important.
Talk to your doctor.Communicate with your family doctor, gynecologist, or hepatologist about what you’re feeling. And talk about the solutions that might be available to you, either with medications or other types of treatments, such as:
Hormone replacement therapy (HRT). Since the lack of estrogen is associated with many health issues after menopause, HRT is worth discussing. Maheshwari said that current guidelines don’t recommend HRT solely for fatty liver disease, even if it’s only short-term. But if there are other issues that are having an impact on your quality of life, it might be an option to consider.
Weight-loss medication. GLP1 agonists such as semaglutide (Ozempic, Wegovy) or tirzepatide (Mounjaro, Zepbound) have been shown to cause significant weight loss, which helps with fatty liver disease. And they’ve also shown benefit in improving fatty liver disease directly. In fact, semaglutide (Wegovy) is now approved for treating metabolic dysfunction-associated steatohepatitis (MASH).
Try another “weigh.” Maybe you’ve gained weight and you’re worried it’s making your liver disease worse. And maybe you feel stuck because trying to lose weight on your own hasn’t worked. Try working with a dietitian, Maheshwari says. Check to see if your insurance covers a consultation. If you don’t have insurance, there might be community resources available, which may give you access to a dietitian, even if it’s in a group setting.
