Relationship between MASLD and women's health: A review

Metabolic dysfunction-associated steatotic liver disease (MASLD; formerly non-alcoholic fatty liver disease, NAFLD) is a common chronic liver disease strongly linked to obesity, metabolic syndrome (MetS), and type 2 diabetes. It starts as benign hepatic steatosis, but may progress to severe fibrosis, cirrhosis, or hepatocellular carcinoma. Today, MASLD represents one of the leading indications for liver transplantation. This review summarizes current knowledge on MASLD, including its pathogenesis, management strategies, regional disparities, and its specific relevance to women's health. The influence of sex hormones on MASLD has been documented. Polycystic ovary syndrome (PCOS) and the menopause increase MASLD prevalence by more than twofold. Moreover, PCOS increases the risk and severity of MASLD, independent of BMI. The role of menopausal hormone replacement therapy in MASLD remains controversial. However, transdermal estrogen and micronized progesterone or dydrogesterone seem to be more appropriate options. In pregnancy, MASLD is associated with >3-fold increased risk of gestational diabetes and preeclampsia. It may also increase the risk of MASLD development in the offspring-an effect that appears to be mitigated by breastfeeding for longer than six months. Given these findings, it is essential that clinicians involved in women's healthcare are aware of MASLD and its implications across the female lifespan.