The liver doesn’t get enough credit for being the body’s overworked multitasker—it detoxifies, stores energy, and helps with digestion all while staying (mostly) quiet about it. But like any underappreciated team player, it has its limits, and when things go wrong, they can go very wrong.
From substances we willingly ingest to autoimmune curveballs and hormonal rollercoasters, the liver sees it all—especially in women, who often face a unique set of challenges when it comes to liver health. Before we look into the gritty details of specific liver diseases, let’s acknowledge that the liver may not be glamorous, but it sure knows how to stir up problems when it’s unhappy.
Women may experience liver disorders differently than men due to biological factors like hormonal influences, body composition, and metabolism.
Let us have a closer look at differences in a few of the common liver diseases:
- Alcohol and toxic liver injury: Women are more susceptible than men to the toxic effects of alcohol on the liver for any given dose, despite men abusing alcohol more. This may be due to differences in metabolism and lower body water content, resulting in higher blood alcohol levels.
According to Dr. Lovkesh Anand, women with alcoholic liver disease progress more rapidly to fibrosis, even after abstaining. “They are also more likely to present with drug-induced hepatotoxicity and acute liver failure, possibly due to differences in drug metabolism and excretion,” he says.
- Non-Alcoholic Fatty Liver Disease (NAFLD): Women may be less likely to develop NAFLD but more prone to severe outcomes like fibrosis once affected. “Contributing factors include morbid obesity, sedentary lifestyle, and health neglect. Hormonal fluctuations, such as during pregnancy, menopause, and PCOS, increase risk,” Dr. Anand says.
- Autoimmune Liver Diseases: Women are far more likely to have conditions like primary biliary cirrhosis (PBC) and autoimmune hepatitis. These, he explains, can occur younger in women and cause symptoms like fatigue and jaundice. “Sex hormones may influence these diseases, possibly through effects on gene expression and immune response. Environmental risks such as hair dye, UTIs, smoking, and oestrogen deficiency may also contribute,” Dr. Anand adds.
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Viral Hepatitis: Women clear acute HCV infection more effectively than men, and severe progression is less common. “HBV affects both sexes similarly. Oestrogen may protect against fibrosis, which accelerates after menopause,” he says.
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Liver Tumours: According to Dr. Anand, benign tumours like hepatic adenoma and haemangioma are more common in women, while malignant tumours like HCC are more common in men. Female sex hormones are thought to be protective; HCC risk rises after menopause without hormone therapy. OCP use is associated with hepatic adenomas.
- Pregnancy-Related Liver Disorders: Conditions such as Intrahepatic Cholestasis of Pregnancy (ICP) and HELLP syndrome can affect the liver during pregnancy and require prompt medical care.
- Liver Cirrhosis: Women are less likely to develop chronic liver disease, and when they do, he says, it often progresses more slowly—especially premenopausally. However, in advanced disease stages, women face higher waitlist mortality and lower transplant rates.
What Women Should Know:
- Awareness: Know your risks for liver conditions.
- Early Detection: Look for symptoms and get regular checks.
- Lifestyle: Healthy habits matter—diet, exercise, and alcohol limits.
- Hormonal Changes: Monitor liver health during hormonal transitions.
- Consultation: Seek medical advice when concerned.
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