Research has indicated that the resumption of menstrual cycles in women after liver transplantation may predict better long-term liver health. Chronic liver disease (CLD) which disrupts hormonal balance, often caused women’s periods to stop, a change sometimes mistaken for menopause. The study found that women whose menses returned within a year of liver transplantation were much less likely to develop graft liver disease (GLD).
Rising Burden of CLD in Young Women
The study background noted that CLD has increased among young women, with a rising incidence of cirrhosis and greater numbers of liver transplants over recent decades. Evidence indicates that hepatic steatosis affects approximately 40-50% of liver transplant recipients within 10 years, largely independent of the underlying disease aetiology. Sex-specific differences in liver disease susceptibility are well established in the general population but remain poorly characterised in transplant recipients, leaving a gap in understanding how reproductive health intersects with graft outcomes.
Understanding Graft Liver Disease
GLD refers to new or recurrent liver injury after transplantation, often detected through imaging or biopsy showing fibrosis or fat accumulation in the absence of alcohol-related damage. While post-menopausal women are known to face a higher risk due to declining oestrogen, the study highlighted that persistent absence of periods in younger women may similarly signal increased vulnerability.
Study Design and Key Findings
Researchers conducted a single-centre retrospective cohort study of 88 women aged 18-55 who received liver transplants between 2014 and 2022.Within one year of transplantation, 43 women (49%) had resumed menstrual cycles. Over a median follow-up of four years, 28% of participants had developed GLD. Women without menses were significantly more likely to experience liver complications that those whose periods returned (36% versus 9%). After adjustment for age, liver disease type, and metabolic conditions, absence of menstrual recovery was associated with an eightfold increase in GLD risk.
Implications for Post-Transplant Liver Care
The study was limited by its single-centre, retrospective design and modest sample size of 88. Furthermore, menstrual status was derived from electronic health records and is not a validated variable, raising the possibility of misclassification. Nonetheless, the association persisted across women aged 45 and under, in whom menstrual return would typically be expected.
Findings suggest that menstrual recovery could serve as a simple, non-invasive marker of graft health. Persistent amenorrhoea may reflect ongoing metabolic disruption or accelerated biological ageing despite successful transplantation. Incorporating reproductive assessments into follow-up care could provide clinicians with an additional tool to identify patients at higher risk of liver complications and to personalise monitoring and intervention strategies.
Reference
Cooper KM, Devuni D. Menstrual status after liver transplantation: An underappreciated predictor of graft liver disease in women transplant recipients. J Liver Transplant. 2026;DOI:10.1016/j.liver.2026.100327
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