From the Guidelines
Elevated liver function tests (LFTs) in patients with polycystic ovary syndrome (PCOS) should be managed with lifestyle modifications and targeted medications to address underlying insulin resistance and metabolic dysfunction, as recommended by the American Association for the Study of Liver Diseases 1. The primary treatment approach involves:
- Weight loss of 5-10% through a balanced diet low in processed carbohydrates
- Regular exercise (at least 150 minutes of moderate activity weekly)
- Metformin at 500-2000mg daily to improve both PCOS symptoms and liver function by reducing insulin resistance
- Vitamin E (800 IU daily) for patients with confirmed non-alcoholic steatohepatitis Key considerations for PCOS management include:
- Combined hormonal contraceptives to regulate menstrual cycles and reduce androgen levels
- Spironolactone (50-200mg daily) to help with hirsutism Regular monitoring of LFTs every 3-6 months is recommended to track improvement, as outlined in the guidelines for abnormal liver function tests 1. It is essential to address the underlying metabolic dysfunction through lifestyle changes and targeted medications to improve both PCOS and liver function simultaneously, while also avoiding alcohol, limiting acetaminophen use, and discussing all supplements with a healthcare provider to minimize potential liver damage.
From the Research
Elevated Liver Function Tests (LFTs) and Polycystic Ovary Syndrome (PCOS)
- Elevated LFTs are commonly observed in women with PCOS, particularly those with nonalcoholic fatty liver disease (NAFLD) 2, 3, 4, 5, 6
- The prevalence of NAFLD is significantly higher in women with PCOS, and its pathogenesis can be associated with various risk factors such as hyperandrogenemia, insulin resistance, obesity, chronic low-grade inflammation, and genetic factors 4, 5
- Liver biopsy is considered the gold standard for diagnosing liver damage, but its routine use in PCOS can be related to a higher rate of complications, and simple and reliable surrogate markers such as serum aminotransferases levels or surrogate indexes (i.e. fatty liver index and NAFLD-fatty liver score) can be used for the assessment of fatty liver in PCOS women 2, 3
Diagnostic Approaches
- Serum aminotransferases levels and surrogate indexes (i.e. fatty liver index and NAFLD-fatty liver score) can be used as diagnostic markers for NAFLD in PCOS women 2, 3
- Lifestyle changes, including dietary regiment and physical activity, are the mainstay of the management of NAFLD in PCOS, although prospective randomized controlled clinical studies remain a priority in the field 2, 3, 4
Management Options
- Metformin may be the drug of choice for treating PCOS patients with NAFLD when pharmacologic therapy is considered 2, 3
- Liraglutide, a glucagon-like peptide-1 receptor agonist, has shown favorable effects on the reduction of liver fat content and visceral adipose tissue in overweight women with PCOS 2, 3
- Bariatric surgery may also be a treatment option for NAFLD in obese women with PCOS 4