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menopause and non-alcoholic fatty liver disease

By | Fact Checked |

There’s something about menopause that makes women more likely to develop non-alcoholic fatty liver disease. In fact, postmenopausal women have more than twice the odds to develop the disease than do their premenopausal peers. It’s a phenomenon that researchers have been investigating. But first, what is non-alcoholic fatty liver disease?

Non-alcoholic fatty liver disease 101

Non-alcoholic fatty liver disease is characterized by an accumulation of fat in your liver. This can eventually result in cirrhosis, or scarring of liver tissue. Liver function declines as the amount of accumulated fat increase. When 5 to 10 percent of the liver’s weight is fat, the condition is called hepatic (liver) steatosis. 

The two types of NAFLD are nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH). Individuals usually develop one type of NAFLD, but in some cases people have one type and are diagnosed later with the other type.

  • NAFL involves fat in the liver but little or no inflammation or damage to the organ. If the liver becomes enlarged, it can cause pain, but NAFL usually does not progress to complications or liver damage.
  • NASH has all three characteristics: fat in the liver, inflammation of the liver, and liver damage. The liver damage and inflammation can cause scarring of the liver (fibrosis) and result in cirrhosis with permanent liver damage, and the possibility of liver cancer.

What causes NAFLD?

Risk factors for NAFLD include:

  • sedentary lifestyle
  • type 2 diabetes
  • high cholesterol
  • overweight/obesity
  • use of corticosteroids
  • sudden weight loss
  • poor diet
  • and high triglycerides.

Experts also point to insulin resistance, which is when your cells don’t take in the sugar they should. This results in too much fat deposited in the liver, followed by inflammation and scarring of the organ.

Read about menopause and high cholesterol

What are the symptoms of NAFLD?

Many people don’t even know they have non-alcoholic fatty liver disease because symptoms may not be noticeable. However, if they do develop, they can include:

  • Swelling in the abdomen
  • Jaundice (yellowing of the eyes and skin)
  • Pain in the upper right side of the abdomen
  • Fatigue
  • Enlarged liver or spleen
  • Internal bleeding
  • Fluid retention
  • Mental confusion
  • and loss of healthy liver function can occur if the diseases progresses to cirrhosis.

NAFLD and menopause

A recent meta-analysis involving 12 studies and more than 20,000 participants evaluated both premenopausal and postmenopausal women and the presence of non-alcoholic fatty liver disease. The authors discovered that postmenopausal women had more than double the odds (2.4 times) of having NAFLD than the premenopausal participants. When the investigators adjusted for age and confounding factors such as body mass index, waist circumference, and levels of glucose and lipids, there was still a 2.2 times increased likelihood of developing the disease.  

According to Dr. Jaroen lapnopparat and his colleagues, the significant decline in estrogen levels may explain the elevated odds of women developing non-alcoholic fatty liver disease in menopause. That’s because estrogen is involved in several key processes that can result in NAFLD, including how fatty tissue is distributed in the body, the uptake of free fatty acid from fat tissue to the liver, glucose metabolism, and the gradual progression of NAFLD to liver fibrosis, which can progress to cirrhosis, liver failure, and the need for a liver transplant. 

How to prevent or manage NAFLD naturally

Lifestyle changes are key for the prevention and management of non-alcoholic fatty liver disease. All of these suggestions are also important for supporting and promoting health in the perimenopause and menopause years.

Maintain a healthy weight. According to the American Association for the Study of Liver Diseases, losing excess pounds is essential for improving symptoms and progression of the disease. If you already have NAFLD, losing 3 to 5 percent of body weight can reduce the accumulation of fat in the liver, while dropping 7 to 10 percent of body weight can improve fibrosis, liver scarring, and inflammation.

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Read about perimenopause, menopause and weight loss: the fiber connection

Eat Mediterranean. According to research in the Journal of Hepatology, the Mediterranean diet “is the most recommended dietary pattern for NAFLD.” One reason is that this dietary approach helps reduce three conditions associated with NAFLD, including type 2 diabetes, high blood pressure, and high cholesterol. 

Enjoy physical activity. Both everyday activities such as cleaning the house, shopping, and gardening, as well as structured activities (exercise), including aerobic activities, strength training, and high intensity intermittent training (HIIT), along with diet, are effective ways to manage NAFLD. Exercise also helps improve factors related to NAFLD, such as weight loss, improved insulin sensitivity, and cardiac function. A minimum of 150 minutes of moderate exercise per week is recommended.

Take omega-3 fatty acids. These essential fatty acids have been shown to reduce fat in the liver and lower cholesterol. The authors of a 2016 study reported that individuals with NAFLD who took omega-3s supplements showed improvement in liver fat, total cholesterol, and high-density lipoproteins (HDLs). 

Avoid added sugars. Research has shown that added sugars can contribute to the development of NAFLD. Processed foods that contain sucrose and fructose should be replaced by whole, natural foods. 

Manage high cholesterol. If you have high cholesterol, adopt lifestyle changes that can help manage it, including staying physically active, eat a diet high in fiber (e.g., Mediterranean diet), and lose excess weight. 

Consider herbal remedies. A number of herbal remedies have been studied for their ability to help in the management of NAFLD. In a 2018 article in Diseases, the authors talked about the potential benefits of milk thistle, green tea, resveratrol, turmeric, rosemary, basil, sage, and more on liver health. 

Take vitamin E. Not just any vitamin E, but the tocotrienol form, which has been shown in more than 100 studies to provide significant benefits for issues important to women in menopause, including inflammation, liver health, bone health, brain health, insulin function, high cholesterol, weight loss, blood sugar, and insulin sensitivity. 

Try black seed oil. Also known as cumin seed oil (Nigella sativa), this oil has been used for millennia for its health benefits. In particular, black seed oil has been shown to reduce biomarkers for inflammation in individuals with NAFLD. Experts have also found that black seed oil “may decrease the liver enzymes and lipid profiles” in individuals with NAFLD while also reducing inflammation in the liver. A quality black seed oil supplement like our Morphus ThymoQuin® may also help with insulin resistance, bone health, brain health, immune function, heart health, and overall healthy liver function. 

Bottom line

Non-alcoholic fatty liver disease is more common among postmenopausal women than those in premenopause, and estrogen levels appear to have a significant role. Women can adopt various lifestyle habits to help manage and prevent NAFLD.



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  • Darand M et al. Nigella sativa and inflammatory biomarkers in patients with non-alcoholic fatty liver disease: Results from a randomized, double-blind, placebo-controlled, clinical trial. Complementary Therapies in Medicine 2019 Jun; 44:204-9.

  • Lu W et al. Effects of omage-3 fatty acid in nonalcoholic fatty liver disease: a meta-analysis. Gastroenterology Research & Practice 2016; article 1459790

  • Maldonado IA et al. Dietary sucrose and CD36 receptor in non-alcoholic fatty liver disease (NAFLD). Journal of Liver Research, Disorders & Therapy 2017 Oct; 3(5)

  • Meganathan P, Fu JY. Biological properties of tocotrienols: evidence in human studies. International Journal of Molecular Science 2016 Oct 26; 17(11):1682

  • Perumpail BJ et al. Potential therapeutic benefits of herbs and supplements in patients with NAFLD. Diseases 2018 Sep 10; 6(3):80.

  • Rashidmayvan M et al. The effect of Nigella sativa oil on serum levels of inflammatory markers, liver enzymes, lipid profile, insulin and fasting blood sugar in patients with non-alcoholic fatty liver. Journal of Diabetes and Metabolic Disorders 2019 Sep 11;18(2):453-59.

  • Romero-Gomez M et al. Treatment of NAFLD with diet, physical activity and exercise. Journal of Hepatology 2017 May 22; 67(4):P829-46

  • Vandergriendt C. 10 home remedies for fatty liver disease. Healthline 2023 Feb 1

Lisa is a Registered Holistic Nutritionist (RHN) who focuses on helping women find relief in perimenopause and menopause. Lisa has more than eight years of experience in the health and wellness space. She is also in perimenopause and experiences the occasional hot flashes, some anxiety, and irregular cycles. She is passionate about listening to her body, eating as much of a whole-food diet as possible, and exercising for strength and longevity.