Understanding Liver Disease In Women

While there have been great strides in increasing awareness of many conditions that affect women, there is one that often flies under the radar—liver disease. Many women are surprised to learn that liver disease is among the top 10 causes of death in the United States and that it affects one in six American women.

As the largest internal organ in the body, the liver plays many important functions, including filtering the blood of alcohol, drugs and toxins; manufacturing essential body proteins and regulating the balance of many hormones. The liver is the only organ that can repair itself but various diseases can cause reversible and irreversible damage. Approximately 5.5 million Americans are currently living with chronic liver disease,
and up to 30 percent of adults have excessive fat in their liver which could lead to more serious liver disease.

There are more than 100 different liver diseases, and several are more likely to be diagnosed in women, including:

Alcoholic liver disease

A common cause of cirrhosis, alcoholic liver disease is more common in women because women absorb more alcohol relative to their body size than men. As little as two drinks a day may be enough to cause this condition. Yet, it is highly preventable by avoiding or minimizing consumption of alcohol.

Autoimmune hepatitis

This inflammation of the liver happens when immune cells mistake the liver’s normal cells for harmful invaders and attack them. It can occur along with other autoimmune diseases like Graves disease, inflammatory bowel disease and lupus. Approximately 80 percent of patients diagnosed with autoimmune hepatitis are women.

Viral hepatitis

Hepatitis is inflammation of the liver caused by the hepatitis A, B, C, D or E virus. Each type is spread different ways, including by eating unclean food, having sex or sharing needles. With some types, the virus goes away on its own. In others, it can be a lifelong condition. Hepatitis E is particularly dangerous in pregnant women.

Non-alcoholic fatty liver disease (NAFLD)

As the most common liver disease, non-alcoholic fatty liver disease affects 60 to 80 million Americans. Excessive fat can be toxic to the liver and cause inflammation. It is the leading cause of cirrhosis in the US with risk factors that include diabetes and obesity. NAFLD is the leading indication for liver transplantation in people less than 50 years of age and it is the most common predisposing factor for primary liver cancer in the U.S.. NAFLD can be prevented by eating a healthy diet and maintaining a healthy weight and exercising regularly. In people with NAFLD, diet, exercise and weight loss can reverse the condition. In women, vitamin E can also help reverse this condition.

Primary biliary cholangitis (PBC)

Diagnosed almost exclusively in women, this chronic condition causes bile ducts in the liver to slowly be destroyed. Over time, bile can back up in the liver and lead to irreversible scarring of liver tissue (cirrhosis). PBC is commonly associated with other conditions such as thyroid disease, osteoporosis, dry eyes, dry mouth and breast cancer. When recognized early, this condition can be effectively treated.

Benign liver tumors

Benign liver tumors are relatively common and rarely pose a serious health risk. They are more common in women. Certain types have been linked to oral contraceptive use where higher doses of estrogen were used.


Cirrhosis is an overly scarred liver due to chronic inflammation. It is a consequence of any chronic liver disease and can lead to such complications as hepatic encephalopathy, esophageal varices, abdominal ascites, liver failure and liver cancer. Cirrhosis is potentially reversible if treated appropriately and all people with cirrhosis require close medical follow up.

Although some forms of liver disease have no preventable causes, others can be prevented by maintaining healthy lifestyle habits.

“Liver disease is common in women, and it is widely underdiagnosed,” said Dr. David Bernstein, chief, Division of Hepatology at Northwell Health. “By keeping alcohol intake low, maintaining a healthy diet and exercising regularly, women can significantly reduce their chance of developing some of the most common types of liver disease.”

Because your liver is the largest internal organ in the body and processes what you eat and drink into energy, it’s very important to keep it healthy. This means eating a healthy, well-balanced diet and avoiding excess alcohol use; ensuring a healthy diet and exercise program; being cautious when taking herbs and natural products and following up regularly with your healthcare provider.

Signs and symptoms of liver disease often get overlooked during the onset of the disease. Early symptoms can include fatigue and muscle weakness, nausea, yellowing of the skin, pain on the upper right side of the abdomen, dark colored urine, fever and chills, unexplained weight loss and itching.

If you are experiencing symptoms that may indicate liver disease, talk with your doctor. A blood test can check the levels of enzymes that may signal inflammation or damage to the cells in your liver. If they are elevated, your doctor may request additional tests to determine the cause.

For more information, call the Katz Institute for Women’s Health Resource Center at 855-850-5494.

—The Katz Institute for Women’s Health

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David Bernstein
David Bernstein, MD, is a columnist for Long Island Weekly and chief of gastroenterology, hepatology and nutrition at North Shore University Hospital and Long Island Jewish Medical Center.

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