The effect of hormone replacement therapy on liver functions and non-alcoholic fatty liver disease in postmenopausal patients

Aim: In this study, we aimed to evaluate the effect of menopausal hormone therapy (MHT) on the liver, using biochemical parameters and ultrasonographic techniques and to determine whether MHT is protective against hepatic steatosis. Materials and Methods: Forty four postmenopausal women were included in this prospective cohort study. Participants were evaluated for menopausal symptoms and divided into two groups: the MHT group (n=22) which would receive MHT and the control group (n=22) which would not receive MHT. Demographic data, biochemical blood results and radiological imaging findings were collected and evaluated at baseline and at six-month follow up. A new radiological imaging technique, tissue attenuation imaging 'Attenuation Imaging' (ATI) was used to evaluate fatty liver. ATI measurements were expressed in decibels/centimeter/megahertz (dB/cm/MHz). Results: In our study, the average age of the MHT group was 48,68 and the average age of the control group was 51,09. No significant difference was detected in the comparison of sociodemographic characteristics between two groups. No significant difference was detected between two groups in terms of biochemistry parameters in the initial evaluations of the participants. When the biochemistry parameters in the sixth month were compared, AST, GGT and LDH values of women not taking MHT were found to be statistically significantly higher that AST, GGT and LDH values of women taking MHT (p<0.05). When the lipid parameters of the participants were compared at the beginning and at the sixth month, LDL and total cholesterol values of women taking MHT were found to be statistically significantly lower than LDL and total cholesterol values of women in the control group (p<0.05). While there was no difference between the groups in the initial FIB-4 scores of the participants, a statistically significant difference was observed between the MHT and control groups at the sixth month. The average FIB-4 score at the sixth month after treatment in the MHT group was 0,73 ± 0,19 and in the control group it was 0,93 ± 0,26 (p = 0,017). While there was no difference between the groups in the initial ATI measument values, a statistically significant difference was observed between the MHT and control groups at the sixth month. The average ATI measurement in the sixth month after treatment in the MHT group was 0,57 ± 0,08 and in the control group it was 0,64 ± 0,09 (p = 0.019). When we determined a regression analysis model that allowed us to evaluate the effect of MHT on all these parameters, it was determined that GGT, LDH, total cholesterol, LDL, FIB-4 and ATI measument exhibited a significant relationship (R=0,572; R2=0,327) with the groups using and not using MHT (χ2 = 29,008; p<0,001). These variables explain %64,4 of the difference between the groups. Conclusion: Quantitative ultrasonographic measurements by ATI is a reliable method in detecting the liver steatotis in women using MHT. It is known that the risk of hepatosteatosis increases due to the increase in lipogenesis during menopause and it is thought that MHT can protect liver againts the risk of hepatosteatosis. Key Words: Menopause, Hepatic Steatosis, Hormone Therapy