1. What Is Fatty Liver Disease?

Fatty liver disease happens when excess fat builds up in the liver. In its early stage, it’s called NAFLD (Non-Alcoholic Fatty Liver Disease). Left untreated, it can progress to NASH (Non-Alcoholic Steatohepatitis), then to scarring (fibrosis), and eventually to cirrhosis or liver failure.

The biggest concern? Many women with fatty liver feel fine—until it’s advanced. Early detection is key.

2. Unexplained Fatigue and Low Energy

One of the most common and overlooked signs in women is persistent fatigue. If you’re sleeping well but still feel chronically tired, sluggish, or mentally foggy, your liver could be under stress.

When the liver can’t function efficiently, it struggles to detox the blood and support energy metabolism—leaving you drained.

3. Mild Discomfort in the Upper Right Abdomen

The liver sits on the right side of your torso, just beneath the rib cage. Early signs may include:

A dull ache or feeling of fullness in that area

Pressure or bloating that isn’t linked to food

Occasional cramping on the right side

This can feel similar to bloating or menstrual discomfort—making it easy to dismiss.

4. Unexplained Weight Gain (Especially Around the Belly)

Many women with early-stage fatty liver notice increased belly fat, even without major changes in eating or exercise habits. This is due to insulin resistance, which often coexists with fatty liver and leads to stubborn fat storage.

Some also develop visible “liver belly”—a bloated or protruding midsection caused by liver inflammation or fluid retention.

5. Brain Fog and Trouble Concentrating

When the liver is overworked, toxins can remain in the bloodstream longer than they should. This may impact cognitive function and cause:

Memory lapses

Trouble focusing

Feeling mentally "sluggish"

This is especially common in perimenopausal and postmenopausal women, when hormone changes already affect brain clarity.

6. Elevated Liver Enzymes on Bloodwork

Sometimes the only clue is hidden in your lab results. Many women discover they have a fatty liver after routine blood tests show elevated liver enzymes (ALT, AST, or GGT).

If your doctor flags your enzymes—even slightly—ask about an abdominal ultrasound to check for fat deposits.

7. Dark Patches of Skin or Skin Tags

Insulin resistance, often tied to fatty liver, may cause acanthosis nigricans—dark patches of skin (especially on the neck or armpits)—and skin tags. These may appear suddenly in middle age, even in women who are not obese.

While they may seem like cosmetic issues, they can be early red flags for deeper metabolic problems.

8. Menstrual Irregularities or PCOS History

Women with Polycystic Ovary Syndrome (PCOS) are at higher risk for fatty liver due to chronic insulin resistance and hormone imbalances. If you have a history of irregular cycles, elevated testosterone, or facial hair growth, your liver deserves extra attention.

Even postmenopausal women can develop liver fat due to shifts in estrogen levels.

9. What Can You Do If You Suspect It?

The good news? Fatty liver is reversible—especially if caught early. Talk to your doctor about:

Getting a liver function panel and ultrasound

Reducing sugar and refined carbs

Increasing omega-3s and fiber

Losing 5–10% of body weight (this alone can dramatically reduce liver fat)

Exercising regularly, even just walking

There are also new medications in development (like obeticholic acid) and supplements (like milk thistle or berberine) that may offer additional support—but always consult a professional first.