Women experience various symptoms in their lives due to menopause, some of these symptoms can be very noticeable like hot flashes, mood swings, and weight gain. However, one common symptom, which is usually not noticeable still affects millions of women, is that they are experiencing an internal body transition with huge amounts of liver fat accumulation. Non-Alcoholic Fatty Liver Disease (NAFLD) has become more common among women aged 45 or older than in any previous time, even in those individuals who are not considered to be overweight and who do not consume alcohol.
Recent studies have shown how menopause may be, to some extent, a metabolic shift. A decrease in estrogen will change how your body stores fat, regulates insulin, and causes inflammation. The redistribution of fat from the hips and thighs to the abdomen will happen as your estrogen level decreases, which is a major factor in accumulating visceral fat — that has a very strong correlation to fat in the liver.
In India, fatty liver disease is a pressing health issue. One out of three Indians are estimated to have fatty liver disease, even if you are a non-drinker. Today’s women in menopause are also subjected to sedentary lifestyles, high refined carbohydrate diets, chronic stress, and poor sleep. Studies show that over 50 per cent of postmenopausal women who have type 2 diabetes also have fatty liver disease thus, making this an enormous yet unrecognised healthcare burden.
Fatty liver disease can be a threat because it can be asymptomatic early on in the disease state, but can present with mild fatigue, mild abdominal pain, large waist circumference, unexplained weight gain, or anything that can cause functional impairment, as some may show other mild physical signs as well, such as poor appetite or difficulty in losing weight. Untreated, this disease may progress to liverinflammation, fibrosis, and ultimately, cirrhosis of liver.
One common misconception about fatty liver is that it is only associated with obesity; however, this is not the case. Many Indian women fall into the category of, “actually obese from a metabolic standpoint, yet have normal weight on the scale”. In this instance, although their appearance is normal, they have many hormonal and metabolic factors working against them and have high levels of internal fat.
The importance of early prevention cannot be overstated. The main emphasis is on quality of food consumed rather than solely the number of calories consumed, as well as increasing the amount of protein taken, decreasing the number of refined carbohydrates and sugars eaten, and continuing regular exercise throughout one’s lifetime. Additionally, after 40 to 45 years of age it becomes increasingly pertinent for anyone, especially a woman who has pre-diabetes, PCOS, or central obesity to undergo routine screening.
Blood tests or ultrasound scans should be performed regularly to detect possible early disease. Hormone Replacement Therapy (HRT) is also coming under scrutiny to see if it can help reduce metabolic risk. However, it must be evaluated on an individual basis.
Menopause isn’t only a time of hormonal change, it’s also a metabolic event that can change how health risks are defined for women on a long-term. The increase in liver fat among women aged 45 and older indicates a need to look at more than just visible signs but also internally at their health. The bottom line is by the time symptoms begin to occur, the damage may already have begun occurring. Awareness, early screening, and lifestyle modifications can mean the difference between silently progressing and preventing early intervention.
(The writer, Dr Pravindhira SN, is a consultant - Surgical Gastroenterology & Hepato-Pancreato-Biliary Surgery, SRM Global Hospitals, Chennai)