Surgical menopause may not increase the risk of non‐alcoholic fatty liver disease

Abstract

Background Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide. Oestrogen is theorised to have protective effects in women, preventing disease development and slowing progression. Prior studies rely on self-reporting of menopause onset, therefore are fraught with recall bias. Surgical menopause provides clear dates from which the progression of NAFLD can be studied. Methods This a retrospective study of prospectively collected data. Patients without prior diagnosis of NAFLD were prospectively enrolled in a NAFLD prevalence study from February 2015 to October 2018. They were screened for NAFLD with FibroScan (FS), MR elastography (MRE) and LiverMultiScan (LMS). Subjects exceeding pre-specified cut-off values on any imaging test were offered a liver biopsy. A retrospective chart review was performed on all female enrollees for history of surgical menopause, defined as bilateral salpingo-oophorectomy (BSO). Results Two hundred and sixty-six females met inclusion criteria with a total of 31 patients with a history of BSO. Data analysis demonstrated no statistical difference between BSO and non-BSO groups as measured by FS (4.4 ± 1.0 kPa vs 5.1 ± 2.3 kPa; P = 0.44), MRE (2.1 ± 0.3 kPa vs 2.1 ± 0.4 kPa; P = 0.80) and LMS (5.1 ± 6.5% vs 4.4 ± 5.1%; P = 0.58). Subset analysis of women with BSO before 51 years old was also conducted. Based on liver biopsy and non-invasive assessment, there was no statistical difference in NAFLD diagnosis between the BSO, non-BSO group or subset analysis group. Conclusion In this retrospective study of prospectively collected data, we found that surgical menopause is not associated with a higher prevalence of NAFLD, diagnosed by non-invasive modalities and liver biopsy.