Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 7, 2015; 21(25): 7613-7620
Published online Jul 7, 2015. doi: 10.3748/wjg.v21.i25.7613
Liver disease in menopause
Carla W Brady
Carla W Brady, Division of Gastroenterology, Duke University Medical Center, Durham, NC 27710, United States
Author contributions: Brady CW solely contributed to this paper.
Conflict-of-interest statement: Brady CW has no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Carla W Brady, MD, MHS, Assistant Professor, Division of Gastroenterology, Duke University Medical Center, Box 3913, Durham, NC 27710, United States. carla.brady@dm.duke.edu
Telephone: +1-919-6814044 Fax: +1-919-6681613
Received: March 8, 2015
Peer-review started: March 11, 2015
First decision: April 13, 2015
Revised: May 6, 2015
Accepted: May 27, 2015
Article in press: May 27, 2015
Published online: July 7, 2015

There are numerous physiologic and biochemical changes in menopause that can affect the function of the liver and mediate the development of liver disease. Menopause represents a state of growing estrogen deficiency, and this loss of estrogen in the setting of physiologic aging increases the likelihood of mitochondrial dysfunction, cellular senescence, declining immune responses to injury, and disarray in the balance between antioxidant formation and oxidative stress. The sum effect of these changes can contribute to increased susceptibility to development of significant liver pathology, particularly nonalcoholic fatty liver disease and hepatocellular carcinoma, as well as accelerated progression of fibrosis in liver diseases, as has been particularly demonstrated in hepatitis C virus liver disease. Recognition of the unique nature of these mediating factors should raise suspicion for liver disease in perimenopausal and menopausal women and offer an opportunity for implementation of aggressive treatment measures so as to avoid progression of liver disease to cirrhosis, liver cancer and liver failure.

Keywords: Liver disease, Menopause, Aging

Core tip: There is an interplay of hormonal issues and aging that create a unique path for development of liver disease in menopausal women. Reviewed in this article are the expected liver-related physiologic and biochemical features of menopause and the impact of menopause on the natural history of liver disease. The impact of an understanding of how menopause mediates liver disease is important as there are growing numbers of menopausal women worldwide.