Menopause and Fatty Liver
If you’re in menopause, you may be more likely to get new health problems because of changes that happen when your body stops producing estrogen. One of these health problems can be nonalcoholic fatty liver disease (NAFLD). You may also hear it called metabolic dysfunction-associated steatotic liver disease (MASLD).
As research advances, sometimes the names of some diseases change. Unfortunately, the name “fatty liver disease” caused unintended problems because many people misunderstood the disease. The name caused them to believe that the disease was related to poor diets or obesity. For this reason, the medical community changed the name from fatty liver disease to steatotic liver disease; NAFLD became MASLD; and alcohol-related fatty liver disease became alcohol-related steatohepatitis.
Menopause also affects transgender men, either when they have surgery to remove their reproductive organs or naturally if they choose not to have the surgery.
Does Menopause Cause Fatty Liver?
Menopause doesn’t cause fatty liver, but it can increase your risk of developing MASLD. One study shows that the increased risk can be up to 2.4 times higher. For example, if in general 10 people out of 100 get fatty liver, 24 out of 100 people in menopause will.
MASLD is one of the most common forms of chronic liver disease, and it’s related to how your liver stores fat. The more fat there is in your liver, the more it becomes inflamed. The disease can cause liver scarring or a more serious liver disease, like cirrhosis.
Why Does Menopause Increase the Risk of Fatty Liver Disease?
There are a few reasons why menopause increases the risk of developing fatty liver disease, but most are connected to you having less estrogen in your system than before you were in menopause.
When more estrogen circulates through your body, it affects how your body fat is distributed, how your body uses sugar (diabetes can contribute to fatty liver disease), how fat moves to the liver, and even slows down liver damage. In other words, as your estrogen levels drop, your fat distribution changes, and your body doesn't break down the fat as well. This can lead to worsening liver problems.
What Does Science Say?
The science is pretty clear about a connection between menopause and an increased risk of fatty liver disease.
A recent study reviewed other earlier studies that looked at menopause and fatty liver disease. The researchers found high-quality studies that all concluded there was more than twice the risk of getting the disease if you’re menopausal. Also, lower estrogen causes many women to have more fat in their belly area as the fat is redistributed in their body. This abdominal fat is another risk of getting fatty liver disease, according to a recent study.
How to Prevent Fatty Liver in Menopause
Fatty liver can’t always be prevented, but there are some steps you can take that might reduce your risks of having the disease, and they’re all related to lifestyle.
- Eat a healthy diet. What you eat can put stress on your liver, especially if you already have other chronic illnesses like type 2 diabetes or if you have obesity. Foods that can be harmful include fast food, soft drinks and other drinks with added sugar, and red meat. Instead, focus on whole foods, like vegetables, fruit, nuts, and whole grains. Some doctors and nutritionists advise you follow the Mediterranean diet.
- Avoid drinking alcohol. We know that too much alcohol can cause alcohol-related liver damage, but experts don’t know how damaging it can be for people with nonalcoholic fatty liver disease. To keep your liver from working too hard, they recommend you avoid alcohol altogether.
- Exercise. Regular exercise helps your body overall by helping you lose weight or maintain a healthy weight.
- Lose weight if you’re obese or not at a healthy weight. If diet and exercise aren’t helping you lose weight, speak to your doctor about other options that might work for you.
- Follow your treatment plans. If you have other conditions, like type 2 diabetes or metabolic syndrome, follow your treatment plan and take your medications as prescribed. Go to all your recommended follow-up appointments and checkups to make sure that all is well.
Some health systems have specific fatty liver care programs. If you’ve been diagnosed with fatty liver disease or if you're at higher risk, ask your health care provider if this is an option for you.
Can hormone therapy prevent MASLD?
Since having less estrogen in your body is a risk factor for fatty liver disease, it would make sense to wonder if maybe women should take hormone therapy to lower that risk. The research is still early, but one study found that women who took estrogen either in a pill or through a skin patch did have a small improvement in if the disease began or if it got worse.
It's important to understand that the research is still in the early stages, though, so there are no recommendations yet for doctors to prescribe hormone therapy to prevent or manage fatty liver.
When to Contact Your Doctor
If you’re perimenopausal, it’s important to understand your body’s changes so you can prepare for possible health issues related to those changes. This includes learning about fatty liver.
- Discuss your concerns during your annual physical. Point out if you have any other risk factors, like type 2 diabetes or obesity, and ask for blood tests that check your liver health.
- If you're already menopausal and you have fatty liver, chances are that you don’t have any symptoms and may have only found out about the condition while having a routine blood test or perhaps an abdominal ultrasound to check for something else that was making you sick, like gallstones perhaps.
If you develop any of these symptoms, consult your doctor because they could mean you have fatty liver disease:
- Fatigue
- Generally not feeling well, often called malaise
- Pain or pressure/discomfort in the upper right part of your abdomen
If you have fatty liver that has gotten worse, you could have:
- An enlarged spleen
- Blood vessels appearing just below your skin, looking like spider webs
- Itchy skin
- Jaundice, yellowing of your skin and the whites of your eyes
- Red palms of your hands
- Shortness of breath
- Swelling in the abdomen, called ascites
- Swelling in your legs
Takeaways
Fatty liver disease, now called metabolic dysfunction-associated steatotic liver disease (MASLD) is a common disease. The risk of getting it rises after you enter menopause. This is because of the lower levels of estrogen circulating in your body. Some steps that might reduce your risk of fatty liver include losing weight if you need to, eating a healthy diet, and avoiding alcohol.
FAQs on Menopause and Fatty Liver
Which hormone can cause fatty liver?
No hormone causes fatty liver, but having less estrogen circulating through your body after menopause can put you at higher risk of developing it.
Can menopause affect liver enzymes?
Yes, two liver enzymes, alanine aminotransferase (ALT) and aspartate aminotransferase (AST), change after menopause. They both go up in early menopause, and then ALT starts to go down, but AST remains higher.
Can menopause cause liver pain?
Menopause itself doesn’t cause liver pain.
How is fatty liver in menopause treated?
Treatment for fatty liver in menopause focuses on lifestyle changes, like eating a healthy diet, exercising, losing weight, and avoiding alcohol. Medications to treat other conditions, like type 2 diabetes, must be taken as prescribed as well.
Until recently, there weren’t any medications to prescribe, although if the disease is advanced, vitamin E and pioglitazone help some people. In early 2024, the FDA approved a new drug called Rezdiffra (resmetirom) for NASH, nonalcoholic steatohepatitis.
How can you support your liver in menopause?
You can support your liver in menopause by taking steps to reduce the risk of developing fatty liver. This means eating a healthy diet, avoiding high-sugar or processed foods, exercising, losing weight if you need, and avoiding alcohol.
