Cirrhosis of the liver in women: what symptoms? Survival?

Cirrhosis is a chronic condition of the liver that causes 15,000 deaths per year to be present the 5th cause of death in France, according to the French Society of Hepatology. According a large Canadian studythe incidence of cirrhosis has increased over the past two decades, especially among women,”who have a higher risk of developing alcohol-related liver disease“, tells us Dr. Lucia Parlati, gastroenterologist and hepatologist, member of the Scientific and Organizational Committee of theFrench Association for the Study of Faithe (AFEF). But also a “fatty liver” (steatotic liver disease or NASH), especially after menopause. Are there any specific symptoms in women? More risk factors than in humans? At what age does it occur? What survival?

What is the incidence of cirrhosis of the liver in women?

The incidence of cirrhosis in women is 74 per 100,000 per year.

In the retrospective cohort study carried out in Canada, cited above, the authors demonstrated that there was an overall increase in the prevalence and incidence of cirrhosisespecially in people born after 1980 And in women. “The standardized annual incidence of cirrhosis in women is 74 per 100,000 per year (Lancet Gastroenterol Hepatol 2019; 4:217–26). These data could be explained by increased prevalence of fatty liver disease in womenAbove all after menopause, and by a greater susceptibility of women to developing alcohol-related liver disease. Indeed, over the past few decades, the epidemiology of alcohol use between the sexes has begun to even out.” (source: Alcohol Clin Exp Res 2011; 35: 2101–12, BMJ Open 2016; 6: e011827).

What are the symptoms of liver cirrhosis in women?

“There are no specific differences between symptoms of cirrhosis in women and men. The common problem for both genders is that the symptoms of cirrhosis appear late in the natural history of the disease. Actually, the liver has enormous functional reserves and patients may have chronic liver disease which is asymptomatic and manifests only when the disease is advanced“, explains our interlocutor. In women as in men, cirrhosis can manifest itself by:

► symptoms related to hepatocellular insufficiency :

• jaundice (yellow skin, yellow color of the white of the eye, dark urine)
• hepatic encephalopathy (drowsiness, trouble concentrating, confusion)

► symptoms related toportal hypertension :

• ascites (swollen belly with fluid inside)
• ankle edema
• digestive bleeding (oesophageal varices)

► general symptoms :

• fatigue,
• anorexia,
• weightloss

At what age does cirrhosis occur in the average woman?

“This same Canadian study showed that the risk of cirrhosis increased with age with incidence peaks around age 75 for men as well as for women. The average age of diagnosis of cirrhosis in France is 55-60 years old“, says Dr. Parlati.

What are the risk factors in women?

“It exists specifics of risk factors hepatopathy (disease affecting the liver) in women”warns Dr. Parlati, such as:

► increase fatty liver disease (fatty liver or NASH), especially after menopause. Steatotic liver disease is the hepatic manifestation of the metabolic syndrome (high blood pressure, overweight and obesity, dyslipidemia and diabetes).

► the susceptibility to develop more severe liver disease even in the presence of less alcohol consumption than in humans

► the dysimmune liver diseases (conditions for which we are sure of the involvement of the immune system, but whose precise mechanism of action or triggering is not known) and cholestatic which are more common in women

► the risks for viral hepatitis: “THE female drug users are more inclined to share their equipment and to passive injection, sex workers (risk factors for precariousness) and those who underwent a transfusion in the 70s to 80s during childbirth are also people at risk“

Are women more likely to survive than men?

Cirrhotic women generally have a better prognosis than men.

Women with cirrhosis usually have a better prognosis compared to men. “In an American longitudinal study of patients with cirrhosis, female gender was associated with a survival advantage probably due to lower rates of non-liver related deaths. Women were not at increased risk of liver-related death despite lower rates of liver transplant and transplant listing. A another monocentric study (carried out by the same research team) on the factors associated with survival after a diagnosis of unresectable liver cancer on cirrhosis demonstrated that female gender was associated with better survival in patients with advanced cancer“, emphasizes our expert. Note that 5-year survival is about 80% with liver transplantation and a lifespan of the graft of 20 years, indicates Inserm.

What are the chances of recovery for cirrhotic women?

“The chances of recovery are not impacted by sex but are mainly dependent on the etiology of the liver disease and its stage at diagnosis“, concludes Dr. Parlati.

Thanks to Dr Lucia Parlati, gastroenterologist and hepatologist, member of the Board of the French Association for the Study of the Liver (AFEF)