From the Guidelines
Estrogen and Progesterone Association with Elevated Liver Function Tests (LFTs)
Estrogen and progesterone, commonly used in hormone replacement therapy (HRT), are not typically associated with significantly elevated Liver Function Tests (LFTs) in most women, although monitoring is recommended for those with pre-existing liver conditions.
- The use of combined hormonal contraceptives, which contain estrogen and progestin, does not significantly affect disease progression or severity in women with hepatitis, cirrhosis, or benign focal nodular hyperplasia 1.
- However, women with a history of intrahepatic cholestasis of pregnancy (ICP) are at a higher risk of experiencing cholestatic liver injury when taking combined hormonal contraception, with approximately 10% of women with a history of ICP experiencing this condition 2.
- Regular monitoring of serum liver tests is advisable for women using hormonal contraceptives, especially those with pre-existing liver conditions 3.
- The risk of hepatic impairment is lower in women with pre-existing cholestatic liver disease, but caution is still advised 2.
- Progestin-only methods and intrauterine devices can be safe alternatives for women with severe hepatitis or decompensated cirrhosis, where the risks of combined hormonal contraceptives may outweigh the benefits 2.
From the FDA Drug Label
C Drug–Laboratory Test Interactions The following laboratory results may be altered by the use of estrogen plus progestin therapy: Increased sulfobromophthalein retention and other hepatic function tests.
The use of estrogen and progesterone (hormone replacement therapy) is associated with elevated Liver Function Tests (LFTs), including increased sulfobromophthalein retention and other hepatic function tests 4.
From the Research
Estrogen and Progesterone Prescriptions and Liver Function Tests (LFTs)
- The relationship between estrogen and progesterone prescriptions, such as hormone replacement therapy (HRT), and Liver Function Tests (LFTs) has been studied in various research papers 5, 6, 7, 8, 9.
- A study published in 2008 found that increasing doses of HRT resulted in a significant decrease in certain liver enzymes, suggesting that exogenous estrogen may improve liver function 5.
- Another study published in 2020 discussed the role of estrogen in the progression of chronic liver diseases, highlighting the complex and multifaceted relationship between estrogen and liver health 6.
- Several studies have investigated the effect of HRT on liver function tests, with some finding no evidence of deterioration in liver function 7, 8.
- A meta-analysis of eight clinical trials found that combined estrogen-androgen hormone replacement therapy did not have a significant impact on liver biochemistry parameters compared to estrogen alone 8.
- Research on low-dose estrogen oral contraceptives has also shown minimal effects on liver function tests, with a low incidence of abnormalities in liver function tests during therapy 9.
Key Findings
- Estrogen and progesterone prescriptions may have a complex relationship with LFTs, with some studies suggesting a positive effect on liver function 5, 6.
- The use of HRT has been found to have minimal effects on liver function tests in some studies 7, 8.
- Low-dose estrogen oral contraceptives have been shown to have a low incidence of abnormalities in liver function tests 9.
- Further research is needed to fully understand the relationship between estrogen and progesterone prescriptions and LFTs, particularly in the context of chronic liver diseases 6.