Women with irregular menstrual cycles may have a higher risk of developing nonalcoholic fatty liver disease (NAFLD), a disease that causes fat to build up in the liver, according to new research.
The study, which was published in the Endocrine Society’s Journal of Clinical Endocrinology and Metabolism, is the first to discover a link between long or irregular periods in young premenopausal women and an increased risk of NAFLD.
The relationship between irregular periods and NAFLD is unclear, but scientists believe estrogen exposure and hepatic iron accumulation may play a role.
Researchers suggest women with irregular periods should consider making lifestyle changes to reduce their risk of NAFLD.
“Early implementation of diet and lifestyle changes would be paramount for this subset of women as, to my knowledge, no medication exists to treat the resultant liver damage,” Dr. Kecia Gaither, a double board certified OB-GYN and maternal-fetal medicine physician and director of perinatal services at NYC Health + Hospitals/Lincoln in the Bronx, told Healthline.
Not everyone assigned female at birth identifies with the label “woman.” While we aim to create content that includes and reflects the diversity of our readers, specificity is key when reporting on research participants and clinical findings.
It’s important to note the research referenced in this article did not include data on participants who are transgender, nonbinary, gender nonconforming, genderqueer, agender, or genderless.
Researchers evaluated 72,092 women under age 40. Twenty-eight percent had irregular menstrual cycles and 7 percent had previously been diagnosed with NAFLD.
The group with irregular periods was also associated with younger age, high blood pressure, diabetes, obesity, insulin resistance, and high cholesterol and triglycerides.
The research team followed up with the participants after 4 years and identified new cases of NAFLD in 9 percent of them.
Researchers say obesity, insulin, and other confounders — including polycystic ovary syndrome (PCOS) — do not seem to explain the increased risk of NAFLD.
In some cases, menstrual irregularity could be caused by certain health factors, like stress and disordered eating, which could contribute to the risk of NAFLD.
The study states there is currently no evidence that modifying certain factors — like smoking, obesity, and alcohol consumption — may offset the risk, but researchers suspect those with irregular periods may benefit from lifestyle changes.
According to researchers, the findings suggest that diagnosing irregular menstruation may help identify premenopausal women at risk of NAFLD.
The mechanisms behind the associated link between irregular menstruation and NAFLD are currently unknown.
Previous research has identified a link between long or irregular periods and type 2 diabetes and cardiovascular disease.
Long or irregular periods have also been associated with metabolic or endocrine disorders.
Irregular cycles are often, but not always, caused by PCOS, a condition that causes dysfunctional hormonal fluctuations.
“It is known however that PCOS can preclude to liver damage — in part due to the insulin resistance and hyperandrogenism as risk factors for liver damage,” said Gaither.
Typical androgen levels help balance fat and lean mass, and hyperandrogenism may lead to fat accumulation.
According to the study, exposure to estrogen may contribute to the associated risk.
“While the data is still very much in its infancy, studies have shown that estrogen suppresses inflammation and improves a number of metabolic processes shown to be dysregulated in NAFLD, including mitochondrial pathways, oxidative stress, and insulin signaling,” said Dr. Bubu Banini, a Yale Medicine hepatologist.
Estrogen may therefore slow the progression of chronic liver diseases like NAFLD, according to
Low estrogen levels and anti-estrogen medications have been linked to NAFLD, and 2020 research suggests estrogen replacement therapy can decrease the risk of NAFLD.
The report also suggests that hepatic iron accumulation — which can occur from irregular periods — may impact the risk of NAFLD.
The role of lifestyle factors that are characteristic of irregular menstruation — such as disordered eating and stress — should be considered as well, Banini added.
“These potential mechanisms need to be further investigated in pre-clinical and population studies,” Banini said.
An irregular period includes menstrual cycles that are inconsistent. Your period may be late or the window between them may fluctuate.
“I believe a good takeaway from the study should be that women with irregular cycles should have a visit with a reproductive endocrinologist, have their liver functions and hormonal levels assessed,” Gaither said.
Lifestyle changes, like adding physical activity, eating a nutritious diet, and limiting alcohol use, may potentially help some people with irregular periods reduce their risk of NAFLD.
Banini said she would encourage all women to adopt these measures to cut their risk of metabolic disease.
Bess Berger, a registered dietitian who treats PCOS, and owner of Nutrition by Bess, said changing carbohydrate sources can help decrease the risk of NAFLD.
This doesn’t mean people should omit carbs completely. Rather, they can avoid processed carbs that are harder for the body to digest.
“This gives our body a huge break trudging through processed carbs and provides refreshing, nutrient dense, high quality options,” Berger said.
New research suggests irregular menstrual cycles may be linked to a higher risk of developing nonalcoholic fatty liver disease (NAFLD).
Irregular periods have previously been associated with type 2 diabetes and heart disease. The link between irregular menstruation and NAFLD is unclear, but researchers suspect it has to do with estrogen exposure and hepatic iron buildup.
Certain lifestyle changes may help cut the risk of NAFLD and other metabolic diseases.