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Are Early Menopause and Hepatitis C Treatment Response Connected?

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Compared to women in their childbearing years, menopausal women have a disadvantage in the battle against Hepatitis C. However, those who begin menopause prematurely have an even greater hurdle to overcome.

Women who cease menstruating earlier than usual have several more health risks than women who enter menopause in their 50s. Unfortunately for women with chronic Hepatitis C who have undergone early menopause, not being able to achieve a sustained virologic response (SVR) is among those health risks.

Experts consider menopause to be premature when it occurs in women under age 40, with 51 being the average age of natural menopause for American women. While the symptoms of early menopause are essentially the same as those that occur during normal menopause, they may be more severe. These symptoms may include:

  • irregular or missed menstrual periods
  • periods that are heavier or lighter than usual
  • hot flashes
  • irritability/depression
  • mood swings
  • bloating
  • sore breasts
  • decreased sex drive
  • vaginal dryness
  • bladder irritability and incontinence
  • dry skin, eyes or mouth
  • insomnia

Women in menopause – whether they arrive there at the usual age or prematurely, experience lowered estrogen levels as their ovaries stop the majority of this hormone’s production. This decrease in estrogen levels is the cause of an increased risk of various health problems associated with menopause, such as osteoporosis, colon cancer, ovarian cancer, periodontal disease and cataracts.

Recently emerging evidence indicates that an increased risk of liver damage and reduced likelihood of achieving SVR after Hepatitis C treatment are also among the menopause risks. As the premiere indicator that antiviral therapy has eliminated Hepatitis C from a person’s body, SVR is a critical benchmark defining successful treatment of this challenging viral infection of the liver.

Unfortunately, these health risks appear to be greater for women who enter menopause early. Experts surmise that this is because, compared with women who go through natural menopause, women undergoing premature menopause spend a greater portion of their lives without the protective benefits of their own estrogen.

Hepatitis C infection progresses slower and liver damage tends to be less severe in women than in men:

  1. Spontaneous Hep C Clearance – One of the edges women have over men is that they are more likely to completely clear Hepatitis C from their bodies without ever developing chronic liver disease. In general, about 80 percent of people who are infected with Hepatitis C develop a chronic infection – but that rate is lower for women. A German study of 1,018 young women infected with Hepatitis C in 1978-1979 through contaminated immunoglobulin transfusions found that, after 20 years, about 45 percent had cleared the virus on their own. Researchers suspect that estrogen plays a role in this indisputable female advantage.
  2. Liver Disease Progression – As a group, women tend to experience less aggressive liver disease progression than men. Women with chronic Hepatitis C tend not to develop liver cirrhosis, liver cancer or liver failure as rapidly as men. Among those with Hepatitis C who develop serious liver disease, the process usually takes decades. In the German study described above, only four of the 1,018 women had developed cirrhosis after 20 years. Again, this is likely because estrogen seems to protect the liver from damage.

Because chronic Hepatitis C and liver fibrosis progress more rapidly in men and menopausal women than in women of reproductive age, researchers from Italy investigated the associations among menopause, SVR and liver damage in patients with chronic Hepatitis C. As published in the March 2011 edition of Gastroenterology, Erica Villa and colleagues performed a prospective study of 1,000 consecutive, treatment-naïve patients 18 years of age and older with compensated liver disease from chronic Hepatitis C. They found that SVR was achieved by:

  • 67.5 percent of women of reproductive age
  • 51.1 percent by men
  • 46 percent by post-menopausal women

Further analysis demonstrated that early menopause was the only independent factor that predicted lack of an SVR among women with genotype 1 Hepatitis C virus infection – the most common type in the US. As such, the researchers concluded that among women with chronic Hepatitis C, early menopause was associated with a low likelihood of SVR, probably because of inflammatory factors that change at menopause.

This new information provides women who have entered early menopause with yet another health challenge to overcome. However, the connection between estrogen levels, liver disease progression and achieving a successful outcome from antiviral treatment could lead to a greater understanding of the Hepatitis C virus. Eventually, such insight has the potential to produce an improvement in how we defend against Hepatitis C – from estrogen-inspired vaccine development to therapeutic intervention.

References:, The Liver & Early Menopause, Mike Parker, Retrieved April 1, 2011, Demand Media, Inc., 2011., Early Menopause Is Associated With Lack of Response to Antiviral Therapy in Women With Chronic Hepatitis C, Erica Villa, et al, Retrieved March 31, 2011, Gastroenterology, March 2011., Women and HCV, Liz Highleyman, Retrieved April 1, 2011, Hepatitis C Support Project, 2011., Early Menopause Linked to Poor Hepatitis C Treatment Response, Liz Highleyman, Retrieved March 31, 2011,, 2011., Premature Menopause, Retrieved April 1, 2011, WebMD, LLC, 2011.

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