Fatty liver

Fatty liver means fat has built up inside the liver. The NHS website calls the common kind non-alcoholic fatty liver disease. Its newer name is MASLD, metabolic dysfunction-associated steatotic liver disease, and NICE renamed its guideline to match in July 2026. All three names describe the same condition.

The NHS website describes four stages: fat in the liver with no damage, then inflammation (MASH, once called NASH), then scarring, then cirrhosis. It says most people only have the first.

Usually nothing. The NHS website says it does not usually cause symptoms, and that many people have it without realising until tests for something else show it.

Some people feel very tired or generally unwell, or have discomfort under the right side of the ribs, where the liver sits.

The NHS website links it to being overweight, especially with fat around the stomach and waist, to type 2 diabetes, polycystic ovary syndrome, high blood pressure and high cholesterol, and to being over 50.

Menopause may add to that. Liver UK says menopause can increase the risk in women, and the European Menopause and Andropause Society (EMAS), in its 2024 statement on thyroid disease and the menopause, says fatty liver is more common in women at the menopause. A 2023 review in the journal Menopause pooled 12 studies and found postmenopausal women had about 2.4 times the odds of fatty liver compared with women before menopause. The studies were snapshots, so they show a link, not a cause.

The link to visceral fat, the fat packed around the organs, matters here. Liver UK says people of Asian descent may be at higher risk, and that someone can have a healthy BMI and still carry extra fat around the waist and internal organs, which it says is more common in people with a South Asian background. Slim does not mean safe.

• The NHS website says a GP will ask about symptoms, check height, weight and waist, and ask about alcohol to rule out alcohol-related liver disease. They may arrange blood tests and sometimes an ultrasound scan.
• NICE NG49 tells doctors not to use routine liver blood tests to rule fatty liver out (1.1.3). A normal result does not settle it.
• NICE also asks doctors to offer a test for advanced scarring (1.3.1), and notes that MASLD raises the risk of type 2 diabetes, high blood pressure and kidney disease (1.5.1).

The NHS website says healthy lifestyle changes can reduce the fat in your liver and help repair damage or stop it getting worse: a balanced diet, regular exercise, losing weight if you are overweight, and not smoking. NICE says there is some evidence that exercise reduces liver fat (1.6.2).

If there is liver damage, the NHS website says a liver specialist takes over.

If you are thinking about HRT, tell your doctor about your liver. The NHS website says HRT may not suit women with liver disease. Women's Health Concern says estrogen tablets are not generally recommended with severe liver disease, and that patches, sprays or gel may be possible instead (estrogen patches). Neither says where a fatty liver fits, so that is a question for your doctor.

The NHS website says to see a GP if you think you could have fatty liver, or think you are at higher risk. Diabetes, a growing waist, high blood pressure or high cholesterol are all reasons to ask.

If you already know you have it, the NHS website says to expect check-ups at least once a year and tests every two to three years.

Many women hear "fatty liver" and feel judged, as if it says something about their character. It does not. In most Pakistani homes alcohol is not the question, and this kind is not caused by drinking.

Food is part of the picture, and food is family business: the rice, the parathas, the sweet chai, the fizzy drinks at every dawat. Changing one woman's food alone is hard when everyone eats from the same pot. The Pakistan Menopause Society counts shared healthy habits among the ways family can support a woman through menopause (4.2.6).