The effect of the pharmacological cessation of menstruation with a GnRH analog on non-invasive hepatic steatosis indexes in women with endometriosis

Purpose: Menopause is associated with metabolic dysfunction-associated steatotic liver disease (MASLD). This study primarily aimed to evaluate changes in non-invasive indices of hepatic steatosis and fibrosis in premenopausal women with endometriosis after treatment with goserelin acetate, resulting in a reversible pharmacologic menopause. Methods: This was a post-hoc analysis of an interventional study. Non-invasive indices of hepatic steatosis and, secondarily, fibrosis were calculated in premenopausal women with endometriosis (intervention group, n=21) before (baseline), 6 months after goserelin treatment (estrogen-deficient period), and 6 months after goserelin discontinuation (estrogen replenishment period). Age- and body mass index (BMI)-matched premenopausal women were recruited for baseline comparisons (control group, n=27). Hepatic steatosis was evaluated using the Hepatic Steatosis Index (HSI), Triglyceride/Glucose Index (TyG), TyG-BMI, Triglyceride/High Density Lipoprotein (TG/HDL), Metabolic Score for Insulin Resistance (MetS-IR), Dallas Steatosis Index (DSI) and Framingham Steatosis Index (FSI). Hepatic fibrosis was evaluated with BMI – Aspartate Aminotransferase (AST)/Alanine Aminotransferase (ALT) Ratio Diabetes Mellitus (BARD). Results: The non-invasive indices of hepatic steatosis and BARD were similar between patients and controls at baseline and did not significantly change after goserelin treatment, except for MetS-IR, which showed an overall significant change (p=0.04); however, in pairwise comparisons after Bonferroni correction, no significant difference in MetS-IR was observed between baseline (34.8 ± 7.7), month 6 (33.3 ± 9.0), and endpoint (35.0 ± 8.1) values. As expected, lipid profiles and insulin resistance worsened during the study. Conclusion: Non-invasive hepatic steatosis and BARD indices were not significantly affected by estrogen deficiency caused by 6-month goserelin treatment in premenopausal women with endometriosis.