Sex-Specific Risks Highlight MASLD Burden Across Women’s Lifespan
A recent comprehensive review outlines how metabolic dysfunction–associated steatotic liver disease (MASLD) uniquely affects women across reproductive stages. The authors synthesize current evidence on pathogenesis, hormonal influences, and clinical considerations.
Study Findings
MASLD is associated with obesity, metabolic syndrome, and type 2 diabetes. Although it begins as simple steatosis, MASLD can progress to advanced fibrosis, cirrhosis, and hepatocellular carcinoma—now representing a leading indication for liver transplantation.
A key focus of the review is the interplay between sex hormones and liver disease. Estrogen appears to confer protective metabolic and hepatic effects, while its decline during menopause increases MASLD prevalence more than twofold. Similarly, women with polycystic ovary syndrome (PCOS) face a significantly elevated MASLD risk and severity, independent of body mass index—a finding that positions PCOS as a critical early-life risk marker.
Hormone replacement therapy (HRT) remains an area of uncertainty. Transdermal estrogen combined with micronized progesterone or dydrogesterone may represent safer options for women at risk of metabolic deterioration, though high-quality evidence is still needed, the authors stated.
Pregnancy-related implications are also substantial. MASLD is linked to more than a threefold increase in gestational diabetes and preeclampsia, adding urgency to early risk stratification. Emerging data further suggest intergenerational effects: in-utero exposure to MASLD may predispose offspring to the disease, though breastfeeding beyond six months appears protective.
Clinical Implications
For health care professionals, the review emphasizes the importance of proactive metabolic screening in women across their lifespan. Clinicians managing PCOS, menopausal transitions, and high-risk pregnancies should consider MASLD as part of a comprehensive assessment, particularly given its silent progression and rising global prevalence.
Understanding hormonal influences may help guide individualized care, from counseling on HRT options to optimizing metabolic control during pregnancy. Integrating MASLD risk assessment into routine women’s health visits may improve early detection and reduce long-term hepatic and cardiometabolic complications.
Reference
Jancova P, Ismail K, Vistejnova L. Relationship between MASLD and women's health: A review. Womens Health (Lond). 2025;21:17455057251376883. doi:10.1177/17455057251376883
