Menopause brings a significant shift in metabolic health, one that increases the risk of fatty liver disease in women. Research suggests that declining oestrogen levels after menopause contribute to fat redistribution, insulin resistance, and liver fat accumulation.
A 2021 study notes that “the prevalence of non-alcoholic fatty liver disease increases significantly in patients experiencing premature ovarian insufficiency, as well as surgical or natural menopause,” highlighting how hormonal changes can directly influence liver health.
More recent evidence also points to the role of early menopause in accelerating this risk. A 2024 longitudinal study that followed nearly 1,900 women for over a decade found that those who experienced menopause earlier had a higher likelihood of developing metabolic dysfunction-associated fatty liver disease (MAFLD). The study reports that “the risk of developing MAFLD was higher in women with premature menopause (<40 years) than in those with menopause aged ≥50 years.”
To understand why this happens and how women can reduce their risk, we spoke to Dr Vivekanandan Shanmugam, Lead Surgeon, HPB and Liver Transplant, SIMS Hospital, Chennai.
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Why menopause increases liver fat risk
Dr Vivekanandan Shanmugam explained that menopause triggers significant hormonal changes, particularly a sharp decline in oestrogen levels, which plays a protective role in metabolic health. This drop, he said, leads to a shift in fat distribution, from the hips and thighs to the abdomen, raising the risk of visceral fat accumulation.
“When the oestrogen drops, what happens is that the fat distribution shifts from the hip and the thighs and goes on to the abdomen,” he said.
He further explained that increased abdominal fat is closely linked to insulin resistance, which raises blood sugar levels and increases the risk of diabetes. Over time, these metabolic changes contribute to fat accumulation in the liver.
From fatty liver to serious complications
Dr Shanmugam said that fatty liver disease often begins silently and is typically detected during routine scans. In its early stages, it may only appear as graded fatty changes on an ultrasound.
“Of course, in the initial stages, you only see this on an ultrasound scan, which says that it's grade 1, 2, or grade 3 fatty liver disease,” he said.
He explained that if left unmanaged, the condition can progress to non-alcoholic steatohepatitis (NASH), where inflammation and liver damage begin. While this stage is still reversible, he warned that further neglect can lead to fibrosis and eventually cirrhosis, a condition marked by permanent liver damage. He also pointed out that there is growing concern about the risk of liver cancer in such patients.
Diet and lifestyle changes can make a difference
Dr Shanmugam emphasised that lifestyle modifications play a key role in preventing and reversing early-stage liver damage. He said that reducing sugar and refined carbohydrates, while increasing protein and fibre intake, can help manage weight and improve metabolic health.
“Once people achieve menopause, they have to alter their food intake by reducing sugar and carbohydrates and increasing protein and fibre,” he said.
He further noted that combining aerobic exercise with strength training is essential to improve overall health and prevent excess weight gain.
Regular screening and medical guidance are key
Dr Shanmugam stressed that regular health check-ups are essential, especially after menopause, to detect early signs of liver disease and associated conditions like diabetes and high cholesterol.
“What is important is that people in menopause should have a regular check once a year with ultrasound scans and blood tests,” he said.
He added that while some women may benefit from hormone replacement therapy (HRT), they should not start it without medical advice. “I suggest that they go to the doctor before they start HRT on their own,” he said.
He concluded that with timely intervention and consistent lifestyle changes, fatty liver disease is largely preventable.
This story is done in collaboration with First Check, which is the health journalism vertical of DataLEADS