Managing Fatty Liver Disease and Menopause

Fatty liver disease typically presents similarly in both females and males, but the risk increases significantly for women after menopause. Hormonal shifts, including increased testosterone levels, play a role in this heightened risk. Here's what you need to know about fatty liver disease, its symptoms, and how to manage the condition, especially in the context of menopause.

Symptoms of Fatty Liver Disease

Both nonalcoholic fatty liver disease (NAFLD) and alcohol-associated liver disease (ALD) often exhibit few to no symptoms, making it challenging to detect without medical support. Some individuals may experience:

• Fatigue

• Pain in the upper right side of the abdomen

If unmanaged, fatty liver disease can lead to cirrhosis, a serious condition involving liver scarring. Cirrhosis symptoms include:

• Stomach pain

• Unexpected weight loss

• Loss of appetite

• Nausea

• Yellow skin (jaundice)

• Dark-colored urine

• Pale stools

• Visible web-like clusters of blood vessels

• Skin itchiness

• Swelling of the legs (edema)

• Disorientation

Cirrhosis can be life-threatening, so consult a doctor if you experience these symptoms.

Fatty Liver Disease and Menopause

While fatty liver disease is more common in men, postmenopausal women face a significantly higher risk. A 2021 study involving nearly 17,000 people in Japan found that women aged 50-59 are at higher risk compared to other age groups, suggesting that hormonal changes play a role. Increased serum testosterone levels appear to raise the risk of developing liver disease.

Women with polycystic ovary syndrome (PCOS), characterized by low estrogen levels, also face an increased risk of fatty liver disease.

Other Risk Factors for Fatty Liver Disease

Several factors can increase the risk of fatty liver disease in both females and males, including:

• Overweight or obesity

• Type 2 diabetes

• Older age, especially in females

• Family history of the disease

• Long-term use of certain medications (e.g., methotrexate, tamoxifen, amiodarone)

• Pregnancy complications like gestational diabetes

• History of viral hepatitis C infections

• Sleep apnea

• Exposure to toxic substances or chemicals

• Rare genetic disorders like Wilson’s disease

Fatty liver disease is most common among certain racial and ethnic groups, with the highest prevalence in Hispanic people, followed by non-Hispanic white people and Asian Americans.

Treatment for Fatty Liver Disease

The primary treatment for fatty liver disease involves lifestyle changes, such as:

• Regular physical activity (at least 30 minutes a day, most days)

• Eating a nutrient-rich diet low in saturated and trans fats

• Cutting calories to achieve a moderate weight

• Limiting or abstaining from alcohol

• Avoiding medications or supplements that may damage the liver

In March 2024, the FDA approved Rezdiffra (resmetirom), the first treatment for fatty liver disease in people with stage 2 to 3 fibrosis. Additional treatments for advanced disease may include:

• Medication to treat underlying conditions like high cholesterol or diabetes

• Bariatric surgery for weight loss

• Liver transplant as a last resort

Treatment for Menopause

Menopause is a natural process that doesn't necessarily require treatment, but managing its side effects can ease discomfort and reduce the risk of health complications. Tips for managing menopause include:

• Staying well-hydrated

• Dressing in breathable layers to manage hot flashes

• Getting plenty of sleep

• Engaging in regular exercise

• Practicing relaxation techniques like yoga, meditation, or deep breathing

• Quitting smoking

• Using vaginal lubricants for dryness or discomfort during sex

• Doing pelvic floor exercises (Kegels)

• Taking plant-based estrogen (phytoestrogens)

• Considering menopausal hormone therapy (MHT)

Always consult with a doctor before starting new supplements or treatments.

FAQ

What is your life expectancy with fatty liver disease? A 2022 study indicates that people with fatty liver disease have a life expectancy around 2.8 years shorter than average. However, various treatment options are available to manage the condition.

What hurts when you have a fatty liver? Fatty liver disease can cause pain in the upper right side of the abdomen, though this is rare. Most people do not experience noticeable symptoms.

Is fatty liver dangerous? Fatty liver itself is not dangerous but can lead to cirrhosis, a life-threatening condition if left untreated.

Takeaway

Fatty liver disease often presents without visible symptoms in both men and women. However, postmenopausal women face a significantly increased risk. Maintaining a healthy lifestyle, including a balanced diet and regular exercise, is crucial for managing both liver disease and menopausal symptoms.