Early menopause before age 50 significantly increases the risk of fatty liver disease and metabolic disorders, according to the largest study of its kind presented at the 2025 ESPE-ESE Joint Congress.
Menopause, while a natural part of aging, carries certain health risks that continue to be the subject of ongoing research. A recent study has revealed that women who experience menopause before the age of 50—particularly those under 45—are at a notably higher risk of developing fatty liver disease and related metabolic issues within just one year of menopause.
Considered to be largest and most comprehensive study to date exploring this association over a five-year period, the study was presented at the first Joint Congress between the European Society of Pediatric Endocrinology (ESPE) and the European Society of Endocrinology (ESE) being held in Copenhagen, Denmark, from May 10-13, 2025.
Given that menopause is a natural biological transition, typically occurring between the ages of 45 and 55, these results highlight the need to re-evaluate how menopause timing is factored into women's long-term health assessments.
Menopause signifies the end of a woman's reproductive years, as her ovaries stop releasing eggs. This process is marked by a decrease in estrogen and progesterone production, leading to various symptoms and changes in the body.
Most women experience menopause between the ages of 45 and 55 as a natural part of biological ageing. After menopause, women are at a higher risk of long-term health problems such as fatty liver disease and its related metabolic risk factors — also known as metabolic dysfunction-associated steatotic liver disease (MASLD), a condition caused by a build-up of fat in the liver.
MASLD risk sharply increases around the average age of menopause, but the exact association between the age at menopause and MASLD was unclear.
In this study, researchers from the Hadassah Medical Center and The Hebrew University of Jerusalem in Israel examined 89,474 women and grouped them according to their age at menopause: 40–44 years, 45–49 years and those who had not yet gone through menopause by age 50.
The researchers found that women who experienced menopause aged 40–44, which is classed as early, had a 46% higher risk of fatty liver disease within one year after menopause.
In addition, early menopause was associated with an 11% increased likelihood of pre-diabetes and obesity, a 14% increased risk of hypertension, and a 13% increased risk of dyslipidemia (unhealthy levels of lipids in the bloodstream).
Similarly, women aged 45–49 who entered menopause (classed as early-normal) had a 30% higher risk of fatty liver disease and 16% higher risk of pre-diabetes than those women who had not entered menopause.
Previous studies have not shown the same association between menopause timing and MASLD. That is to say, women who experience menopause before the age of 45 have a higher risk of developing fatty liver disease and its metabolic risk factors, including high blood pressure and obesity.
“Previous research on this association has reached conflicting results but was limited by small numbers of participants and short follow-up. Our study is the largest of its kind with a five-year follow-up period and provides support for the hypothesis that women are relatively protected from cardio-metabolic disease during the perimenopausal state,” said Dr Stokar.