How Do Hormonal Influences Impact Liver Disease in Women?
Guest blog by the Global Liver Institute
While many are aware that some diseases and patterns of care differ between men and women, it’s less commonly known that hormones can significantly impact liver health in women. Hormones, particularly estrogen, play a pivotal role in liver function and disease progression. Estrogen has protective effects on the liver, such as regulating bile production and reducing inflammation, which can protect against liver diseases. However, fluctuations during menstruation, pregnancy, and menopause can alter these mechanisms, increasing vulnerability to liver diseases. This hormonal influence contributes to the unique challenges women face with liver disease. Moreover, conditions like polycystic ovary syndrome (PCOS) and endometriosis, which involve hormonal imbalances, can also exacerbate liver conditions by promoting insulin resistance and fat accumulation in the liver, further complicating the overall health picture for women. These fluctuations are particularly prominent during certain phases of a woman’s life course:
- Menstruation: During menstruation, hormonal shifts can alter liver enzyme levels, impacting overall liver health. While typically transient, these fluctuations can sometimes exacerbate pre-existing liver conditions or contribute to the development of liver-related symptoms, such as increased fatigue or abdominal discomfort. Understanding the cyclical nature of these changes is essential for tailoring liver disease management to women’s specific needs.
- Pregnancy: Hormonal changes during pregnancy, including a surge in estrogen, initially protect the liver. However, pregnancy also brings risks, such as intrahepatic cholestasis of pregnancy (ICP), a condition where bile flow is impaired, leading to itching and potential complications for both mother and baby. Other serious complications, like preeclampsia and hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome (a severe form of preeclampsia involving liver damage), require immediate medical attention. Rare conditions like acute fatty liver of pregnancy (AFLP) can also lead to liver failure, underscoring the need for close monitoring during pregnancy to ensure both maternal and fetal health.
- Menopause: Hormonal shifts during menopause contribute to an increased risk of fatty liver disease. Postmenopausal women have 2.4 times higher odds of developing fatty liver disease than premenopausal women. The decrease in estrogen levels during menopause can lead to metabolic changes, such as weight gain and insulin resistance, which are significant risk factors for fatty liver disease.
Health care providers should consider the heightened vulnerability for women’s liver health across each of these distinct times during an individual’s life.
Why Does the Lack of Attention to Hormonal Influences Lead to Gender Disparities in Care?
Despite growing recognition of these risks and patterns in liver health, women often face challenges in timely diagnosis and access to appropriate care. Symptoms of liver disease can be subtle and easily overlooked, leading to delays in diagnosis and treatment. Traditional diagnostic criteria and treatment guidelines often do not account for the unique physiological and hormonal factors influencing liver health in women, potentially contributing to misdiagnoses or suboptimal care; thus, gender-specific medicine is essential. Research has shown that these disparities may be partly due to the underrepresentation of women in clinical trials and liver disease studies.
Studies also reveal that among those with end-stage liver disease, women are less likely than men to undergo liver transplantation, despite facing higher risks of disease progression in certain conditions. This, among other gender disparities, underscores the urgent need for improved awareness of hormonal influences on liver health, enhanced diagnostic strategies tailored to women, and equitable access to specialized care and treatments.
Steps to Improve Liver Health Management for Women:
- Discuss Hormonal History: In conversations with your physician, include details about menstrual cycles, pregnancies, and menopause status.
- Regular Monitoring: Schedule regular liver function tests (LFTs), especially during significant hormonal changes like pregnancy or menopause. LFTs are part of the comprehensive metabolic panel ordered as part of many routine checkups.
- Personalized Treatment Plans: Work with your physician to develop treatment plans that consider hormonal fluctuations and are tailored to your needs.
- Seek Specialized Care: If needed, consult a hepatologist or endocrinologist who might better understand the interplay between hormones and liver health to get the most accurate and effective care.
- Stay Informed: Keep up with the latest research and guidelines (such as the American Association for the Study of Liver Disease’s guidelines on reproductive health and liver disease) on liver health in women to help advocate for yourself and ensure you receive the most up-to-date care.
Promising Paths and Advocacy Efforts for the Future
Advancements in liver research are paving the way for a more nuanced understanding of hormonal influences on liver disease and potential avenues for personalized medicine. Initiatives like MELD 3.0, an updated scoring system for liver transplant prioritization, consider sex disparities and use “sex assigned at birth” in their calculations for liver transplants. This innovation represents a significant step towards fairer health care outcomes, increasing transplant opportunities for women. These changes could lead to more equitable health care for women with liver disease, ensuring they receive the attention and treatment they need. As regulatory bodies like the FDA develop guidelines for clinical trial diversity, they should consider not just racial and geographic diversity, but also sex, gender, and age to capture women’s distinct health factors throughout the life course.
Empowering women with knowledge about their unique risks, advocating for gender-inclusive research, promoting early intervention through regular screenings, and encouraging women to share their stories for enhanced awareness are crucial steps toward minimizing the impact of liver disease. By fostering collaboration between health care providers, researchers, policy makers, and advocacy groups, we can strive toward a future where gender disparities in liver health are minimized, ensuring everyone gets the comprehensive care they deserve.
About Global Liver Institute
Global Liver Institute (GLI) is a 501(c)3 nonprofit organization founded in the belief that liver health must take its place on the global public health agenda commensurate with the prevalence and impact of liver illness. GLI promotes innovation, encourages collaboration, and supports the scaling of optimal approaches to help eradicate liver diseases. Operating globally, GLI is committed to solving the problems that matter to liver patients and equipping advocates to improve the lives of individuals and families impacted by liver disease. GLI holds Platinum Transparency with Candid/GuideStar, is a member of the National Health Council, and serves as a Healthy People 2030 Champion. Follow GLI on Facebook, Instagram, LinkedIn, and YouTube or visit www.globalliver.org.