Liver Disease in Women

The cyclical hormonal changes that occur in women are often a reason to exclude females from clinical and basic research studies. However, these very hormones may play a role in the pathogenesis of diseases in women. For this reason, it is important to consider gender when evaluating a patient. In hepatology, gender and sex hormones play a role in the epidemiology of autoimmune diseases (autoimmune hepatitis and primary biliary cirrhosis), the effect of alcohol on the liver, the development of benign and malignant liver tumors, and of course on pregnancy-related liver diseases. This chapter discusses the impact of female gender on the development and/or progression of specific liver diseases. Liver diseases that may coincide with, but are unrelated to, pregnancy usually do not result in significant maternal or fetal mortality. However, in the case of pregnancy-specific liver disease, it is essential to accurately determine the gestational age, and the timing of the disease onset. Liver diseases unique to pregnancy include ovarian hyperstimulation syndrome (OHSS), hyperemesis gravidarum (HG), intrahepatic cholestasis of pregnancy (ICP), acute fatty liver of pregnancy (AFLP), hemolysis-elevated liver enzymes-low platelets (HELLP) syndrome, and hepatic hemorrhage or rupture. OHSS is a potentially fatal iatrogenic complication associated with ovulation-induction therapy. The basic pathophysiologic hallmark of OHSS is an increase in capillary permeability that results in the leakage or exudation of protein-rich fluid from the ovaries or peritoneal surface to the third space compartments.