Estrogen deficiency promotes hepatic lipid accumulation, insulin resistance, fibrosis, and multisystem metabolic dysfunction including adipose and skeletal muscle metabolism disruption
Target Population
Postmenopausal women experiencing estrogen deficiency
Care Setting
Clinical management of postmenopausal women at risk for or diagnosed with MASLD
Key Highlights
MASLD prevalence and severity increase significantly after menopause, with rates in women becoming comparable or higher than men.
Estrogen deficiency disrupts hepatic estrogen signaling, leading to metabolic dysfunction and progression of MASLD.
Hormone replacement therapy (HRT) use is increasing, but its impact on MASLD development and progression in postmenopausal women remains poorly studied.
Guideline-Based Recommendations
Diagnosis
Recognize MASLD as a sexually dimorphic condition with increased risk post-menopause.
Consider menopausal status and estrogen deficiency in MASLD risk assessment.
Management
Evaluate potential benefits and risks of estrogen-based hormone replacement therapy (HRT) in postmenopausal women with MASLD.
Develop sex-specific treatment strategies tailored to postmenopausal women.
Monitoring & Follow-up
Monitor liver-related morbidity and cardiovascular risk in women with MASLD, especially postmenopausal.
Track metabolic parameters influenced by estrogen deficiency including hepatic lipid accumulation and insulin resistance.
Risks
Uncertainty remains regarding whether HRT mitigates or promotes MASLD progression.
Potential for increased MASLD-related mortality in women if estrogen deficiency is unaddressed.
Patient & Prescribing Data
Postmenopausal women receiving hormone replacement therapy
HRT prescriptions have increased over fourfold in the UK from 2015 to 2024, but clinical evidence on HRT's effect on MASLD is limited and inconclusive.
Clinical Best Practices
Incorporate menopausal status and estrogen levels into MASLD risk stratification.
Consider estrogen signaling pathways and receptor profiles when evaluating metabolic dysfunction in postmenopausal women.
Encourage research and clinical trials focused on estrogen-based therapies for MASLD in women.
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