Fatty Liver Symptoms in Women

Fatty liver disease happens when too much fat builds up in your liver. People who are overweight or have obesity have a higher risk of fatty liver disease, as do those with type 2 diabetes, high cholesterol, and high triglycerides. Alcohol use disorder also can lead to it. Women are less likely to have it before turning 50. After menopause, however, women are about 20% more likely than men to get fatty liver disease and have it become a more advanced liver disease.

After menopause, your risk increases as estrogen levels drop. Estrogen helps manage body fat and protect your liver. Women with polycystic ovary syndrome (PCOS) also face higher risks due to insulin resistance and hormonal imbalances that can lead to fat buildup in the liver. Women who have fatty liver disease also die from heart problems more than men. By age 60, their risk of heart disease is twice as high as that of men at that age.

Early fatty liver disease often has no symptoms, making it a ”silent” condition. When symptoms do appear, you might feel tired all the time, have belly pain, or have a full feeling in the upper right part of your belly, where your liver is located. If you have fatty liver that has gotten worse, you could have jaundice (yellowing of your skin and the whites of your eyes), shortness of breath, swelling in your legs, or other symptoms.

Pay attention to your midsection. Women with fatty liver disease often develop more belly fat, even if they haven't gained weight elsewhere. This isn't just regular weight gain — it's specifically around your middle. You might notice your pants fitting differently or abdominal swelling that seems out of proportion to the rest of your body.

Feeling exhausted even after a full night's sleep? Persistent fatigue is one of the most common fatty liver symptoms in women. Your liver works harder when it's filled with fat, which can drain your energy. This isn't the normal tiredness from a busy day — it's a deep exhaustion that rest doesn't seem to fix.

During menopause, declining estrogen leads to changes in fat distribution and metabolism that can trigger fatty liver development. Some women notice symptoms like weight gain, particularly around the abdomen, and increased fatigue during this transition. Hormone replacement therapy (HRT) may help some women manage these changes. However, experts don't yet know whether HRT protects against fatty liver disease.

Check your skin for clues. Some women with advanced fatty liver disease develop yellowing of the skin or eyes (jaundice), itchy skin, or reddened palms. Spider-like blood vessels might appear on your skin. These changes happen when your liver isn't filtering toxins properly.

Women with polycystic ovary syndrome (PCOS) have a higher risk of developing fatty liver disease due to insulin resistance and hormonal imbalances. If you have PCOS and experience unexplained fatigue, abdominal discomfort, or weight changes, talk to your doctor about checking your liver health.

Fatty liver may be diagnosed accidentally during routine blood tests, or perhaps an abdominal ultrasound to check for something else that was making you sick, such as gallstones. Aside from blood tests, doctors use imaging tests and sometimes a liver biopsy to diagnose fatty liver. Be open with your doctor about all symptoms, even ones that seem unrelated.

The good news is that fatty liver disease can often be improved or reversed with lifestyle changes. Lose weight if you're not at a healthy weight. Avoid alcohol, which can make fatty liver worse. Get at least 150 minutes of exercise a week. Only one drug, resmetirom (Rezdiffra), has been approved by the FDA to treat the type of liver scarring that happens with metabolic dysfunction-associated steatohepatitis (MASH), an advanced form of fatty liver disease.