The Hidden Relationship Between Women's Hormones and Liver Function
- Aug 5
- 7 min read
Discover how liver function influences hormone balance during perimenopause and menopause. Learn about oestrogen metabolism, hormone regulation and women's long-term health.
When discussing women's hormones, most conversations focus on the ovaries, thyroid or adrenal glands. Yet one of the most important organs involved in hormone balance often receives far less attention: the liver.
The liver performs hundreds of essential functions throughout the body, from processing nutrients and supporting metabolism to producing proteins and regulating energy use. It also plays a critical role in hormone metabolism, helping to break down, process and eliminate hormones once they have completed their biological tasks.
As women move through perimenopause and menopause, hormonal fluctuations become increasingly significant. During this transition, understanding the relationship between hormones and liver function may provide valuable insight into overall wellbeing, particularly for women considering or using hormone replacement therapy (HRT).
While the liver is not typically thought of as a hormone-producing organ, its role in hormone regulation in women is both substantial and often overlooked.
WHAT IS HEPATIC FUNCTION?
The term 'hepatic function' refers to the liver's ability to carry out its many physiological responsibilities. These include:
Metabolising nutrients from food
Supporting blood sugar regulation
Producing proteins and enzymes
Processing medications
Supporting immune function
Producing bile for digestion
Metabolising hormones
The liver is sometimes described as the body's central processing hub because so many biological pathways pass through it. Among its most important tasks is helping regulate hormone levels by breaking down and preparing hormones for elimination after they have been used by the body. Without efficient hepatic function, normal hormone metabolism may become less efficient.
THE LIVER'S ROLE IN OESTROGEN METABOLISM
One of the liver's most important responsibilities in women's health is oestrogen metabolism.
Oestrogen influences numerous physiological processes, including reproductive health, bone density, cardiovascular function, cognition and vaginal tissue health. After oestrogen has carried out its biological role, the body must process and eliminate it appropriately. This occurs primarily through the liver.
The process is often described in two stages. First, enzymes within the liver transform oestrogen into various metabolites. These metabolites are then prepared for excretion through a process known as conjugation, allowing them to be eliminated via the digestive system and urine. This is a normal and essential aspect of hormone regulation.
Rather than simply focusing on how much oestrogen the body produces, modern hormone medicine increasingly recognises the importance of how effectively hormones are processed and cleared.
THE GUT-LIVER CONNECTION: AN OVERLOOKED PART OF HORMONE HEALTH
When discussing hormones and liver function, it is important to recognise that the liver does not work alone. After hormones such as oestrogen are processed by the liver, they are excreted into the digestive tract where they can be eliminated from the body. The gut microbiome, which consists of trillions of microorganisms living within the digestive system, may influence this process.
Researchers have increasingly explored what is known as the "estrobolome" – a collection of gut bacteria involved in the metabolism of oestrogen. These bacteria may affect how oestrogen is processed and recycled within the body, highlighting the close relationship between digestive health, hormone regulation and metabolism.
This does not mean that gut health is solely responsible for hormonal symptoms. However, it reinforces the idea that hormone balance is influenced by multiple interconnected systems rather than a single organ or gland. For women navigating perimenopause and menopause, this emerging area of research offers another example of how the body's systems work together.
WHY LIVER FUNCTION MATTERS DURING PERIMENOPAUSE AND MENOPAUSE
Perimenopause is characterised by fluctuating hormone levels rather than a simple decline in oestrogen. These fluctuations can contribute to a wide range of symptoms, including:
Irregular menstrual cycles
Mood changes
Sleep disruption
Hot flushes
Cognitive changes
Vaginal dryness
Changes in libido
At the same time, age-related changes in body composition, metabolism and overall health may also influence liver function.
This does not mean menopause causes liver disease, nor does it mean liver function is responsible for all hormonal symptoms. However, it highlights the close relationship between hormonal health and wider metabolic processes.
HORMONE REPLACEMENT THERAPY AND THE LIVER
The relationship between hormone replacement therapy (HRT) and the liver is often misunderstood. Many are surprised to learn that different forms of HRT interact with the body in different ways. For example, oral oestrogen passes through the digestive system before reaching the bloodstream, meaning it undergoes what is known as first-pass metabolism within the liver. By contrast, transdermal preparations such as patches and gels are absorbed through the skin and largely bypass this first-pass hepatic processing.
These differences may be relevant when clinicians are considering treatment options for individual patients. The most appropriate approach depends on a person's symptoms, medical history, risk factors and treatment goals. This is one reason menopause care increasingly emphasises individualised assessment rather than a one-size-fits-all approach.
BEYOND OESTROGEN: THE LIVER AND OTHER HORMONES
Although oestrogen receives much of the attention, the liver also plays an important role in the metabolism of other hormones. These include:
Progesterone
Testosterone
Cortisol
Thyroid hormones
Because these hormones influence energy, mood, metabolism, cognition and sexual wellbeing, liver function may indirectly affect multiple aspects of health. This broader perspective helps explain why hormone regulation in women involves far more than reproductive organs alone. Hormonal health is best understood as a network of interconnected systems working together to maintain balance.
COULD LIVER HEALTH AFFECT SYMPTOMS OF MENOPAUSE?
It is important to avoid oversimplifying the relationship between liver function and menopause symptoms. A healthy liver is not a guarantee of symptom-free menopause, nor are symptoms such as fatigue, low libido or brain fog necessarily signs of impaired hepatic function. However, research increasingly supports the idea that hormonal health, metabolic health and liver function are closely interconnected.
This is particularly relevant when considering long-term health rather than focusing solely on individual symptoms. Supporting overall health through balanced nutrition, regular physical activity, sufficient sleep and appropriate medical care may benefit both metabolic and hormonal wellbeing.
LOW LIBIDO, HORMONES AND THE BIGGER PICTURE
Questions such as "why is my sex drive low as a female" and "how to increase libido for women" are among the most commonly searched topics in women's health and the answer is rarely straightforward. Changes in sexual desire can be influenced by numerous factors, including:
Oestrogen changes
Testosterone levels
Stress
Sleep quality
Relationship factors
Mental wellbeing
Physical comfort
Overall health
For women experiencing vaginal dryness or Genitourinary Syndrome of Menopause (GSM), physical discomfort may also contribute to changes in sexual desire.
This is why a comprehensive assessment is often more valuable than focusing on a single hormone or symptom; understanding the broader biological picture frequently provides greater insight into sexual health than isolated laboratory values alone.
LIVER HEALTH AND FEMALE LONGEVITY
The concept of female longevity extends beyond lifespan alone. Increasingly, longevity medicine focuses on maintaining function, vitality and quality of life throughout the ageing process.
The liver sits at the centre of many systems that influence healthy ageing, including:
Metabolic health
Cardiovascular health
Inflammation regulation
Hormone metabolism
Nutrient processing
While the liver is remarkably resilient, maintaining overall metabolic health may help support the biological processes that contribute to long-term wellbeing. This is a contributing factor as to why liver function is receiving growing attention within the field of longevity medicine.
UNDERSTANDING HORMONAL HEALTH THROUGH A PERSONALISED ASSESSMENT
Hormonal health is about more than individual blood test results. The way hormones are produced, utilised and metabolised throughout the body can be just as important as the levels themselves.
At Reborne Longevity, our Women's Hormone Consultations take a whole-system approach to understanding hormonal health. Led by Dr Hind Abdulkader, assessments may include Hormonal Testing alongside a detailed review of symptoms, medical history, lifestyle factors and wider health markers. This allows us to explore how hormonal changes may interact with areas such as metabolic health, sleep, energy, body composition and overall wellbeing.
For women navigating perimenopause and menopause, understanding these interconnected systems can provide valuable context for symptoms that often seem unrelated on the surface. By examining the bigger picture, we aim to help women make informed decisions about their health while gaining a clearer understanding of the biological changes occurring during this stage of life.
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FREQUENTLY ASKED QUESTIONS
What is hepatic function?
Hepatic function refers to the liver's ability to perform its many essential roles, including processing nutrients, metabolising hormones, producing proteins, supporting digestion and helping regulate metabolic health.
Does menopause affect liver function?
Menopause does not directly cause liver disease. However, hormonal changes that occur during midlife can interact with broader metabolic processes, which may influence overall health and wellbeing. Researchers continue to explore the relationship between liver and menopause health.
What is oestrogen metabolism?
Oestrogen metabolism refers to the process by which the body breaks down and eliminates oestrogen after it has been used. The liver plays a central role in this process by converting oestrogen into metabolites that can be safely excreted.
Does hormone replacement therapy (HRT) affect the liver?
Different forms of hormone replacement therapy interact with the body differently. Oral oestrogen undergoes first-pass metabolism through the liver, whereas transdermal preparations such as patches and gels largely bypass this process.
Can liver health influence hormone balance?
The liver is involved in the metabolism and clearance of multiple hormones, including oestrogen, progesterone and testosterone. For this reason, liver health forms part of the broader picture of hormone regulation in women.
REFERENCES
National Institute for Health and Care Excellence (NICE). Menopause: Diagnosis and Management (NG23). London: NICE, updated 2024.
The British Menopause Society. Tools for Clinicians: HRT Preparations and Equivalent Alternatives. British Menopause Society.https://thebms.org.uk/publications/tools-for-clinicians/
Kuhl, H. "Pharmacology of Estrogens and Progestogens: Influence of Different Routes of Administration." Climacteric 8 Suppl 1 (2005): 3–63.https://doi.org/10.1080/13697130500148875
Miller, Virginia M., and JoAnn E. Manson. "The Timing Hypothesis of Menopausal Hormone Therapy: Lessons Learned from the Women's Health Initiative." Nature Reviews Endocrinology 13, no. 7 (2017): 447–456.https://doi.org/10.1038/nrendo.2017.54
Mauvais-Jarvis, Franck, et al. "Sex and Gender: Modifiers of Health, Disease, and Medicine." The Lancet 396, no. 10250 (2020): 565–582.https://doi.org/10.1016/S0140-6736(20)31561-0
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Your Liver and How It Works.https://www.niddk.nih.gov/health-information/liver-disease/liver-test
StatPearls Publishing. Physiology, Liver. Updated 2024.
Baker, J. M., Al-Nakkash, L., and Herbst-Kralovetz, M. M. "Estrogen-Gut Microbiome Axis: Physiological and Clinical Implications." Maturitas 103 (2017): 45–53.
