As metabolic dysfunction-associated steatotic liver disease (MASLD) continues to rise, clinicians are increasingly questioning whether current screening approaches fully capture risk in women. While existing guidelines identify key metabolic risk factors, concerns exist regarding their ability to adequately account for the physiologic changes women experience across the lifespan, particularly during transitions like menopause and pregnancy that significantly influence disease progression.
In a segment from a recent episode of Liver Lineup: Updates and Unfiltered Insights, Meena Bansal, MD, joins Nancy Reau, MD, and Kimberly Brown, MD, to examine a critical but often overlooked question in hepatology: should screening strategies for MASLD differ for women?
Watch the full episode here.
The discussion begins with Brown raising the possibility that while current guidelines effectively identify at-risk populations like individuals with diabetes, insulin resistance, or metabolic syndrome, they may not fully account for key transitions in a woman’s life. Bansal agrees that existing frameworks are generally sound but emphasizes that timing and frequency of screening are where clinicians may need to adapt their approach.
Rather than redefining who should be screened, Bansal highlights the importance of adjusting monitoring intervals during periods of increased risk, particularly around menopause. As hormonal changes accelerate metabolic dysfunction and fibrosis progression, she suggests that women in this transition, especially those with additional risk factors like diabetes or early fibrosis, may benefit from more frequent noninvasive assessments. Tools such as vibration-controlled transient elastography or serum-based biomarkers can help identify disease progression earlier, creating an opportunity for timely intervention.
Reau reinforces this point with clinical experience, noting that some patients previously considered low risk can return years later with advanced disease, often after significant metabolic changes and menopause, underscoring the need for greater vigilance during these inflection points.
Beyond hepatology, the conversation further expands to the role of multidisciplinary care. Bansal stresses the importance of engaging obstetricians and gynecologists, who often serve as primary care providers for many women. While awareness is growing, she notes that more education is needed to ensure these clinicians incorporate liver disease screening into routine care for at-risk patients. This includes using simple tools like the FIB-4 index as an initial step, followed by additional testing when indicated.
The group also highlights the importance of patient empowerment. Women are frequently told that “fatty liver” is benign, which may delay further evaluation. Encouraging patients to understand their risk factors, calculate their own FIB-4 scores, and advocate for follow-up care can play a meaningful role in earlier detection.
Editors’ note: Relevant disclosures for Reau include AbbVie, Gilead, Salix, Arbutus, and VIR. Relevant disclosures for Brown include Mallinckrodt Pharmaceuticals, Gilead, Salix, Intercept, Ipsen, and Madrigal. Relevant disclosures for Bansal include Boeheringer-Ingelheim, Boston Pharma, Fibronostics, GSK, Madrigal, Merck, NOVO Nordisk, and The Kinetix Group.
References
DiStefano JK. NAFLD and NASH in Postmenopausal Women: Implications for Diagnosis and Treatment. Endocrinology. 2020;161(10):bqaa134. doi:10.1210/endocr/bqaa134
Sarkar M, Kushner T. Metabolic dysfunction-associated steatotic liver disease and pregnancy. J Clin Invest. 2025;135(10):e186426. Published 2025 May 15. doi:10.1172/JCI186426
