Liver Disease In Women: A Hidden Epidemic?

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For ages, diseases like cirrhosis of the liver have been associated with older men—but that’s changing quickly. We’ve recently reported on the rise in cirrhosis among young people. And there’s another demographic that’s been seeing a massive spike in liver disease, especially during the pandemic: Women.

It turns out that women are actually more vulnerable to liver damage from alcohol than men are. And as rates of alcohol use and abuse continue to even out among the genders, the issue of liver disease in women is becoming more and more visible. In fact, there’s reason to believe that liver damage may become more common among female versus male millennials.

So, what’s driving this trend? What makes the female liver more susceptible to damage from alcohol? And what can you do to protect your health?

Women Are Drinking More

younger women drinking wine in the woods
Photo by Kelsey Chance on Unsplash

A study of over 70,000 Americans between 2001 and 2013 showed an overall increase in drinking, but the biggest increases were among women. AUD rose a staggering 84 percent in female study respondents, compared with 35 percent among males. High-risk drinking also increased 58 percent among women, versus only 16 percent among men. More recent data from 2019 suggests that younger women may even be starting to outdrink their male peers.

This increase in alcohol use has come with a parallel increase in liver disease. From 2009 to 2015, alcohol-related liver injury jumped 50 percent in women, compared with 30 percent in men. During a similar time period, more women aged 35 or younger were admitted to the hospital for alcohol-related liver failure than men the same age

But it’s not just an increase in alcohol use at play in this jump in liver disease—it turns out that women also sustain worse damage than men from similar levels of drinking.

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A Higher Risk of Liver Damage

So, why are females more susceptible to liver damage from alcohol?

Less body water: Women have a lower ratio of water to body mass than men, which means the alcohol they consume gets diluted less. This is one of the main reasons women usually have a higher blood alcohol content than men who drink the same amount, which can put greater stress on their livers.

Differences in enzymes: Women have less of certain stomach and liver enzymes that process alcohol, resulting in less efficient alcohol metabolism. This can also contribute to higher levels of alcohol in their systems, and liver stress.

Estrogen and the liver: Estrogen may cause the liver’s Kupffer cells to activate more easily, making women more likely to experience liver inflammation in response to toxins (such as alcohol). Frequent inflammation increases the risk of fibrosis or cirrhosis. While more research is needed, studies on mice show that estrogen blockers can actually slow or limit damage to the liver from drinking.

Liver Cirrhosis in Women

Among the most severe consequences of this increased alcohol sensitivity is cirrhosis of the liver. Although men still have higher rates of cirrhosis overall, women who drink are actually more vulnerable to this disease. In one Australian study, it took female drinkers an average of only 13.5 years to develop cirrhosis, compared with 20 years for men.

Cirrhosis is especially serious in that, unlike some other forms of liver damage, it is very difficult to reverse. To make matters worse, women appear less likely than men to recover from this illness. Women have lower 5-year survival rates from cirrhosis than men, even among people who quit drinking. In fact, in another study comparing men and women with liver damage, only the women progressed to liver cirrhosis after giving up alcohol.

Cirrhosis hospitalizations increased at more than double the rate for women vs men between 2007 and 2014. The majority of cases may still be male. But it’s becoming more and more crucial for women who drink to keep an eye on their liver health.

Signs of Liver Disease in Women

two well-dressed women sitting together and laughing
Photo by alex starnes on Unsplash

Many people, including women, experience few signs and symptoms in the early stages of liver disease. The liver is a remarkably resilient organ, and can continue to function even when up to 80 percent of it is damaged. But as liver disease progresses, women may experience a range of signs and symptoms, including:

  • Fatigue and trouble sleeping
  • Weight loss
  • Missed periods
  • Difficulty getting pregnant
  • Pain in the upper right abdomen
  • Jaundice
  • Edema and abdominal swelling
  • Internal bleeding
  • Confusion and memory loss

Since liver disease can be invisible until it becomes severe, it’s a good idea to get a liver function test if you are at all concerned about your drinking, and are experiencing any of these symptoms.

Steps Women Can Take to Reduce Their Risk of Liver Disease

Ultimately, the most effective way to halt or prevent alcohol-related liver damage is to quit drinking. This is especially important for women. Studies have found that, unlike men, women who consume just one or two drinks per day have a higher risk of liver cirrhosis than women who do not drink at all.

Besides abstinence, there are several steps that women can take to reduce their risk of liver disease:

  • Drink less frequently. In a study on the effects of alcohol on women, participants who drank daily were more vulnerable to liver disease than those who didn’t.
  • Drink with meals. The same study found that women who drank with meals were less likely to experience liver damage than women who drank on an empty stomach.
  • Eat a healthy diet. Certain foods can help prevent or even heal liver damage, while a diet high in fat, salt, and sugar can increase your risk of fatty liver disease—often the first step in the progression of damage to your liver.
  • Schedule a check-up. Since the symptoms of liver disease can be confused with other conditions, it’s important to see a doctor if you suspect you have liver damage. As mentioned above, a liver function test can help you catch the damage before it becomes too severe.

If you’d like to reduce your alcohol consumption, but are having trouble cutting back, there are new, more convenient solutions for getting help. Ria Health offers comprehensive support to reduce or quit drinking, all from an app on your smartphone. Choose moderation or abstinence. Set your own goals, and get a plan customized to your unique needs. We can even prescribe anti-craving medications that are safe for your liver.

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Written By:
Ria Health Team
Ria Health’s editorial team is a group of experienced copywriters, researchers, and healthcare professionals dedicated to removing stigma and improving public knowledge around alcohol use disorder. Articles written by the “Ria Team” are collaborative works completed by several members of our writing team, fact-checked and edited to a high standard of empathy and accuracy.
Reviewed By:
Evan O'Donnell
Evan O’Donnell is an NYC-based content strategist with four years’ experience writing and editing in the recovery space. He has conducted research in sound, cognition, and community building, has a background in independent music marketing, and continues to work as a composer. Evan is a deep believer in fact-based, empathic communication—within business, arts, academia, or any space where words drive action or change lives.
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