menopause and metabolic dysfunction–associated steatotic liver disease (MASLD)
By Lisa Collins | Fact Checked | Sources
There’s something about menopause that makes women more likely to develop metabolic dysfunction–associated steatotic liver disease (MASLD). 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 metabolic dysfunction–associated steatotic liver disease?
Metabolic dysfunction–associated steatotic liver disease 101
Metabolic dysfunction–associated steatotic liver disease (MASLD) 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 MASLD are nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH). Individuals usually develop one type of MASLD, 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 MASLD?
Risk factors for MASLD 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 MASLD?
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:
Our Top Picks
- 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.
MASLD 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 (now called MASLD) 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 (now called MASLD) to liver fibrosis, which can progress to cirrhosis, liver failure, and the need for a liver transplant.
How to prevent or manage MASLD naturally
Lifestyle changes are key for the prevention and management of MASLD. 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 MASLD, 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.
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 MASLD. Exercise also helps improve factors related to MASLD, 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 MASLD. 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 MASLD. 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 MASLD. 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
MASLD 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.
