Why Women Who Don’t Drink Can Still Get Cirrhosis

Women can be more susceptible to cirrhosis than men
Group Of Women Sitting Around Table Eating Dessert

You might think that men are more likely to develop cirrhosis than women because they drink alcoholic beverages much more often than women. But women actually are at higher risk of developing cirrhosis — even when they drink only half the amount of alcohol men drink.

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If you’re a woman, you may be at risk for developing cirrhosis, even if you are young and don’t drink alcohol. That’s because women’s risks for developing cirrhosis change as they age, hepatologist Jamile Wakim-Fleming, MD, says.

“This is a unique feature of women and it should make them more vigilant about their liver health – not only when they are older but throughout their life, and regardless of how old they are,” Dr. Wakim-Fleming says. 

Cirrhosis in young women

Surprisingly, women as young as their late teens and early 20s can develop cirrhosis.

For example, autoimmune hepatitis is more common in women than men and can begin at a very early age. It may cause abdominal pain, jaundice, fatigue, weight loss and disabling joint pain. If left untreated or undiagnosed, autoimmune hepatitis may develop into cirrhosis.

Another liver disease that is more common in women than men is primary biliary cirrhosis. This is a relatively slow-progressing disease that affects women in their late 40s and 50s. It can have debilitating symptoms of itching and fatigue and, like autoimmune hepatitis, can happen at a younger age in women than in men.

These two autoimmune disorders of the liver may coexist or overlap in the same patient. Although they are treatable, they are not curable. Over time patients may end up requiring a liver transplant because of cirrhosis, liver failure or liver cancer.

It is unclear why these autoimmune diseases are more common in young women than men, but sex hormones like estrogen, genetics and environmental factors seem to play a role.

Another liver disorder unique to the young woman, which begins in pregnancy, is intrahepatic cholestasis of pregnancy. This can have consequences on the liver years down the road, including gallstones, complications from gallstones and cirrhosis.

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Liver disease after menopause

The lack of estrogen following menopause can have a negative effect on the liver. For example, fatty liver disease in women can progress into cirrhosis more rapidly after menopause.

Fatty deposits in the liver can be the result of alcohol drinking, but also can result from a condition called non-alcoholic fatty liver disease. Non-alcoholic fatty liver disease is rising in men and women as well as in children. 

If you have gone through menopause, you are more likely to develop a fatty liver, Dr. Wakim-Fleming says.

“After menopause, women in general are at risk of gaining more weight because of hormonal changes and because they may not exercise as much for many social and medical reasons,” Dr. Wakim-Fleming says.

“When women gain weight, fat accumulates in the liver cells. This creates a toxic environment for the liver, which leads to fibrosis, then cirrhosis and eventually cancer. Fatty liver is fast becoming the No. 1 reason for liver transplant,” Dr. Wakim-Fleming says.

Cirrhosis related to drug or alcohol use

Women are more sensitive to drug- or alcohol-related liver disease than men, due in part to their body composition, Dr. Wakim-Fleming says.

“Drugs and alcohol affect women’s livers earlier and more rapidly than men, and at a lower dose,” Dr. Wakim-Fleming says. “Women are smaller and also they have more body fat, both of which cause them to metabolize drugs and alcohol at a slower rate than men.”

This means you can’t drink the same amount of alcohol as your husband or male friends and expect to have a healthy liver.

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You also need to be cautious with certain medications, such as pain medications, antibiotics or medications you buy in health drug stores.  You are much more likely to have toxicity from drugs than men, whether prescribed by a doctor and taken in excessive amounts or bought in a health drug store.

Protecting yourself from cirrhosis

Cirrhosis is a silent killer, Dr. Wakim-Fleming says: “You may not know you have it until it is too late to reverse it.”

Once cirrhosis develops, the only cure is a liver transplant. Women are more likely to die on the waiting list for a liver transplant than men and are more likely to have acute liver failure.

While some risk factors for cirrhosis, such as  genetics, are beyond your control, adopting a healthy lifestyle at any age can help to reduce your risk:

  • Limit the amount of alcohol you drink. Even if you’re young and you feel healthy, alcohol will affect your liver over time. Women should not have more than one drink per day.
  • Eat a healthy diet. Avoid saturated fats, and eat foods that include healthy, unsaturated fats, like fish, nuts and olive oil.
  • Exercise. If you include exercise in your daily routine, it will help you combat the weight gain that’s associated with menopause.
  • Avoid overuse of non-prescription drugs and illegal drugs. The use of illegal drugs can lead to viral hepatitis, and ultimately to cirrhosis. Non prescription drugs may be toxic.

As for supplements, Dr. Wakim-Fleming says women can save their money and skip them.

“The problem with herbal preparations is that they’re not regulated by the FDA, so you don’t really know what’s in them,” she says. “You don’t need herbal supplements to stay healthy. One multivitamin, a calcium supplement and a healthy diet should be all you need.”

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