THE RISK of metabolic dysfunction-associated steatotic liver disease (MASLD) increases following menopause before the age of 50, a 2026 global cohort study has found.
MASLD and Menopause
MASLD is a growing public health concern and increases the risk of both liver related and cardiovascular complications.
The prevalence of MASLD in women increases sharply at approximately 50-years-old. It is suggested that pre-menopausal oestrogens exert protective effects against MASLD.
Early menopause has also been linked to higher risks of Type 2 diabetes and hypertension. Conditions of abrupt or unusually early loss of endogenous oestrogens are associated with higher rates of steatotic liver disease, steatohepatitis, and hepatic fibrosis.
Post-menopausal women with MASLD are more likely to develop severe fibrosis compared with pre-menopausal women with MASLD.
Current screening guidelines do not consider menopause alone as a sufficient risk factor for MASLD screening.
Impact of Early Menopause
The TriNetX global federated network was used to identify women with earlier menopause, defined as younger than 50. The control cohort consisted of similarly aged pre-menopausal women.
Propensity-score matching adjusted for baseline characteristics and metabolic risk factors. There were two matched cohorts of nearly 30,000 women.
Over a five-year follow-up period, women with menopause before the age of 50 had a significantly higher risk of MASLD (616 new diagnoses) compared with pre-menopausal women (450 new diagnoses).
Earlier menopause was also associated with an increased risk of developing new-onset dyslipidaemia, and pre-diabetes.
Limitations
The use of electronic health records gave rise to limitations surrounding classification of, for example, women in the peri-menopausal transition. Despite robust propensity score matching, granular lifestyle data including calorie intake and specific physical activity levels also proved difficult to capture through electronic health records.
The relatively short follow-up period may have limited the detection of later-onset MASLD and more advanced liver disease.
Clinical Implications
Amid recent developments in pharmacotherapies for MASLD, the early identification of high-risk populations was emphasised.
Researchers encouraged future studies to assess the incorporation of menopause timing into specific cardiometabolic risk assessment for women, particularly given that close to half of all women experience menopause before 50.
Reference
Stokar j, Dresner-Pollak R. Earlier menopause and risk of metabolic dysfunction-associated steatotic liver disease: A global cohort study. Diabetes Metab Res Rev. 2026;DOI:10.1002/dmrr.70121.
