Liver disease in menopause

There are numerous physiologic and biochemicalchanges in menopause that can affect the functionof the liver and mediate the development of liverdisease. Menopause represents a state of growingestrogen deficiency, and this loss of estrogen in thesetting of physiologic aging increases the likelihoodof mitochondrial dysfunction, cellular senescence,declining immune responses to injury, and disarrayin the balance between antioxidant formation and oxidative stress. The sum effect of these changes cancontribute to increased susceptibility to developmentof significant liver pathology, particularly nonalcoholicfatty liver disease and hepatocellular carcinoma, as wellas accelerated progression of fibrosis in liver diseases,as has been particularly demonstrated in hepatitis Cvirus liver disease. Recognition of the unique nature ofthese mediating factors should raise suspicion for liverdisease in perimenopausal and menopausal women andoffer an opportunity for implementation of aggressivetreatment measures so as to avoid progression of liverdisease to cirrhosis, liver cancer and liver failure.