Steatotic liver disease (SLD) affects both men and women. However, research indicates that the percentage of people who have it, risk factors and health outcomes for SLD differ between genders. 

More men under the age of 50 years develop SLD compared with women.xlix However, after menopause, it becomes more common in women after the age of 50 and peaks at 60-69 years.^l

Reproductive hormones 

Female reproductive hormones seem to play a role in the development of steatotic liver disease in women. For example, female-specific conditions such as polycystic ovary syndrome (PCOS) and Turner syndrome influence the development and progression of SLD. ^li

Starting periods early (under the age of 12 years) is also linked to risk factors for SLD such as weight issues, insulin resistance, and PCOS. 

The decline of oestradiol (the most plentiful female reproductive hormone) during menopause is associated with an increased risk for type 2 diabetes, accumulation of fat in the belly and SLD. Women who go through premature or early menopause are at increased risk.^lii

Distribution of body fat 

Too much fat on the belly is a risk factor for SLD. Reduced levels of oestrogen around menopause cause fat to be stored on the waist, increasing their belly fat, rather than thighs and hips.liii This in turn increases the risk of SLD in post-menopausal women compared with men of the same age. 

Muscle mass 

As women age, they generally lose more muscle mass than men do. Progressive loss of muscle mass, function and strength has been linked to SLD. People who continually lose muscle increase their risk of liver steatosis by 1.5 – 2.5 times.^liv

Alcohol 

Alcohol is a significant risk factor for steatotic liver disease. Research shows that women are more sensitive to alcohol-related liver damage than men.^lv

Women with fatty liver symptoms and SLD have a higher risk for cardiovascular disease compared with men of the same age. This risk increases with age and becomes greater after menopause.^lvi

Women over the age of 50 who have steatotic liver disease are 1.2 times more likely to develop MASH (Metabolic dysfunction-Associated Steatohepatitis) than men of the same age. Their condition is also more likely to progress to advanced fibrosis.^lvii

Read more about MASH. 

Research has also shown once women get MASLD (Metabolic dysfunction-Associated Steatotic Liver Disease), they show a faster progression of liver fibrosis, more damage to the cells in their liver and inflammation of their liver. Treatments for liver steatosis are also more limited than those for men.^lviii

Fatty liver is also common during pregnancy. There are two different types. 

• MASLD is common in pregnancy. It’s thought that mothers being overweight and being of older age in many Western countries, increases the risk. This type of fatty liver is managed by careful attention to diet. If it occurs with gestational diabetes, medication for the diabetes may be needed.lix 
• Acute fatty liver of pregnancy is a very rare complication of pregnancy where fat develops in the liver. It’s a serious condition that may threaten the life of mother and baby. Fortunately, the condition usually disappears within seven to 10 days after delivery.^lx

Research into how steatotic liver disease affects men and women is ongoing. 

However, the good news is there’s a lot you can do to look after your liver. 

The Melbourne Health Writer, 2024. Last reviewed June 2024.