One of the major roles of the liver is to process hormones. It is therefore not irrational to suppose that the menopause may have some effect on a woman’s experience of Gilbert’s Syndrome (and vice versa) due to the enormous hormonal changes and fluctuations that cause it.
During the menopause the ovaries are less able than before to respond to the pituitary hormones follicle stimulating hormone (FSH) and luteinising hormone (LH), and so less oestrogen is produced. Due to the reduction of oestrogen production some androgens that are still produced by the adrenal glands, such as testosterone, are not overridden as they were before the onset of the menopause.
This means there is a major shift in the balance of hormones in the body, with an increase of FSH, LH and androgens for the liver to process.
Scouring the recently published scientific research I could not find any article that had investigated the effects of these changes on people with liver conditions. Common sense suggests that these changes would be an immense shock to the liver (we only have to look at all the other effects on the body to understand that this is a huge physical change). As the liver metabolises hormones and deactivates them when they are no longer useful, it has an increased workload with the excess FSH, LH and androgens. It seems highly possible that this extra strain on the liver of a GS sufferer would bring to the fore GS symptoms that had not previously been recognised when the liver was used to the hormonal balance of the body.
Many symptoms of the menopause and of GS are very similar and thus these symptoms may be enhanced in the GS sufferer. For example, the insomnia or disrupted sleep caused by other menopause symptoms, such as hot flushes, can lead to fatigue and generalised aches and pains, common symptoms of GS. Other symptoms common to both include dizziness and difficulty with cognitive tasks, such as concentration and memory.
Finally, a word about medication. The most commonly used treatment to ease the effects of the menopause is HRT. As yet, we are not fully aware of the exact effects many medications have in relation to GS. We know some medications are processed differently by GS sufferers and so anyone taking any medication who has GS should be aware of this. There is evidence that HRT can affect bile composition (http://hcd2.bupa.co.uk), which may have implications for GS sufferers. It may, therefore, be worth being aware of these scant facts when consulting the GP, in order for them to give the best possible advice for the individual.
Unfortunately, as yet, there are no answers to the dual problem of the menopause with GS, apart from the advice AGS passes on to all GS sufferers: to do everything in our power to reduce the workload of our liver
(originally written by contributor Nicola Southworth)