Plethora of evidence demonstrates increased risk of hepatic fibrosis in postmenopausal women with nonalcoholic steatohepatitis in contrast to premenopausal women. However, assessment whether the duration of estrogen deficiency in postmenopausal state can determine an individuals fibrosis risk remains unexplored. 

The authors of the study analyzed the correlation of age at menopause and time from menopause with fibrosis severity in postmenopausal women with nonalcoholic fatty liver disease. The study included data from 488 postmenopausal women with histologic diagnosis of nonalcoholic fatty liver disease and self-reported information on age at menopause were assessed. Multiple ordinal logistic regression models with and without adjusting for clinical confounders were used to analyse the associations of premature menopause (age at menopause of <40 years) and time from menopause (age at study enrollment-age at menopause, years) with fibrosis severity (stage 0-4).

The results showed that among the enrolled population with age at menopause 43.7 ± 8.6 years, 29.3% of women with premature menopause were younger at inclusion of study and used hormone replacement therapy more frequently. Moreover, premature menopause was correlated with an augmented likelihood of having more severe fibrosis, whereas time from menopause was directly related to an increased likelihood of having more severe fibrosis, after adjustingage at enrollment, race, waist circumference standardized by body mass index, current smoking, current alcohol use, hypertension, diabetes/impaired fasting glucose, homeostatic model assessment of insulin resistance, and hormone replacement therapy.

Therefore, extent of estrogen deficiency in postmenopausal state is a remarkable predictor of the risk of fibrosis among postmenopausal women with nonalcoholic fatty liver disease. 

Source: Klair JS, Yang JD, Abdelmalek MF, Guy CD, Gill RM, Yates K, Unalp-Arida A, Lavine JE, Clark JM, Diehl AM, Suzuki A; Nonalcoholic Steatohepatitis Clinical Research Network. A longer duration of estrogen deficiency increases fibrosis risk among postmenopausal women with nonalcoholic fatty liver disease. Hepatology. 2016 Jul;64(1):85-91.