How Hepatitis C Symptoms Differ in Females

Early and Late Stage Symptoms

Hepatitis C (HCV)—commonly referred to as hep C—is a potentially fatal viral infection that can cause long-term damage to the liver. Although similar, hepatitis C symptoms in females can progress differently than in males. Women also face specific issues when it comes to health problems; with hepatitis C these include transmission of the disease during pregnancy, breastfeeding concerns, and more.  

Hepatitis C Symptoms in Females

When a woman initially gets hep C, there is an acute (severe, short-term) infection. This acute stage of the infection can occur during a time span of weeks, months, and can cause symptoms that range from mild to severe.

Early Stages

Symptoms of hepatitis C rarely appear in the early stages of the disease; when symptoms do appear early-on, they are minor, and many times go undetected. In fact, the infection is commonly discovered when blood tests (usually liver enzymes are found to be higher than normal) are taken for other conditions.

Minor symptoms in the earlier stages of hepatitis C may include:

  • Nausea 
  • Fatigue
  • Muscle weakness
  • Joint and muscle pain
  • Poor appetite

These symptoms are very non-specific and could be easily misconstrued as a variety of other maladies.

Progressive Symptoms

As the disease progresses, hepatitis C symptoms during the chronic (long-term) stage may include:

  • Itching of skin
  • Severe fatigue
  • Bruising or bleeding
  • Retention of fluid (in the abdomen)
  • Swelling in the lower extremities
  • Weight loss
  • Confusion
  • Jaundice (yellowing of the skin or eyes)

Note, both women and men can develop chronic hepatitis C, (when the infection does not clear on its own) but the disease usually progresses much slower in women. Of course, there are always exceptions—some women do develop very fast progression of the infection and develop liver damage. But, for women, progression of hep C usually occurs after menopause. 

Clearance of Hepatitis C

Clearance is a situation where a person’s immune system can clear an infection (such as hepatitis C) without medical treatment in the first six months of contracting the infection. One older study discovered that as many as 20% to 50% of study subjects with hepatitis C showed spontaneous clearance (called spontaneous viral clearance) without any treatment at all. In women, clearance of acute infections (including hep C) is said to occur more commonly than in men.

Experts believe this is because estrogen (a primary sex hormone in women) plays a role in fighting infection in the body. In fact, in a 2017 study, published by World Journal of Gastroenterology, the study authors explained, "These findings suggest a protective role of estrogen affecting not only viral replication [the formation of viruses during the infection process] in the body, but also HCV pathogenesis [the stages involved in how a germ or pathogen causes an infection] in the host." 

Other studies have shown that females with hepatitis C are more likely to clear the virus during the early stages, in fact, an older study published by the journal Gut discovered that 44.6% of the female study subjects cleared the infection, compared to just 33.7% of male study subjects. “This study provides strong evidence in favor of a higher HCV clearance rate in females compared with males,” explained the study authors.

Women's Issues in Hepatitis C Infection

Pregnancy

As with other infectious diseases, there is a risk of transmission of the hepatitis C virus to a pregnant woman’s unborn child. Although it’s not common that transmission occurs in unborn babies (approximately 6 babies out of every 100 born to mothers infected with hepatitis C contract the disease it is possible. If a woman is infected with both the hepatitis C virus and the human immunodeficiency virus (HIV), the risk of transmitting hepatitis C to her unborn child goes up. The only time that an unborn child can contract hepatitis C is at the time of birth. Hepatitis C in females has not been found to cause any birth defects or complications during pregnancy. 

Any child born to a mother with hepatitis C should be tested. The standard testing time period is usually before the baby reaches 18 months, because it takes time for the mother’s antibodies to be cleared in her newborn’s body.

Any woman who is pregnant, who has tested positive for Hep C should discuss the potential treatment plan with the obstetrician or another provider. Some physicians recommend hepatitis C treatment for pregnant women to undergo before giving birth. 

Breastfeeding 

Hep C is not considered a risk for infants who are breastfeeding unless a nursing mother develops bleeding nipples; in this instance, breastfeeding should be postponed until the nipples heal, bleeding subsides, and there are no open areas.  

Note that some medications for HCV are contraindicated (have a potential to cause harm) during breastfeeding because safety has not been established for infants. If you are taking medications for HCV, be sure to discuss this with your pediatrician or another provider. 

Sexual Transmission of Hepatitis C for Women

It is possible to transmit or contract hepatitis C through sexual contact, but the American College of Obstetricians and Gynecologists notes that this is an inefficient means of transmission. The virus may be present in menstrual blood.

A study of sexual transmission in monogamous heterosexual couples found the rate of transmission to be less than 1 in 250,000 sexual contacts. The study also found no association with any one type of sexual practice in heterosexual couples.

Female Hormones and Hepatitis C

When it comes to female hormones, there is a big difference between symptoms of hep C in men versus women. For example, the female hormone estrogen (a primary sex hormone in women that is present between puberty and menopause) has been shown in studies to have anti-viral properties.  

Estrogen is also known to have an impact on the hepatitis C disease process, impacting symptoms of long term hepatitis C, namely cirrhosis (scarring of the liver). Estrogen is thought to impact the symptoms of hepatitis C in females in many ways, these may include:

  • Promoting a higher rate of spontaneous clearance of the virus (compared to men) is thought to be due to estrogen levels.  
  • Changing a woman’s menstrual cycle, during advanced liver damage (caused by hepatitis C). This can result in missed or shorter periods.  
  • Protecting the liver (slowing down long-term liver damage) during the chronic phase of hepatitis C.

Note: after menopause, when estrogen levels begin to drop, the protective effects of estrogen in women with hep C begin to diminish. Post-menopausal women are at higher risk of rapidly advancing cirrhosis than men.

Birth Control

Studies have shown the scarring of the liver caused by hepatitis C can potentially cause birth control to fail, making an accidental pregnancy more likely. This failure is due to the liver’s difficulty in breaking down the hormones (such as estrogen) in contraceptives (including birth control pills, some IUD’s, long acting hormone injections and vaginal rings).

Note that some new medications used to treat hep C can decrease the effectiveness of hormone-based birth control methods (such as oral contraceptives). Be sure to tell your healthcare provider if you are on birth control pills (or other hormone-based birth control methods) before taking HCV medications. 

Two methods of birth control are not impacted by the symptoms of hepatitis C include:

  • The barrier methods (such as condoms)
  • IUD’s (those that don’t have hormones, such as the Paragard IUD)

Progression

As stated, many factors can impact the progression of hepatitis C (to the more severe stages, including cirrhosis of the liver) in women. These include:

  • Age
  • Other infections (also called co-infections) such as HIV
  • Genetic factors

There are many gender-specific effects of hepatitis C progression in women infected with chronic HCV, these may include:

  • Slower fibrosis progression (abnormally large amount of scar tissue in the liver from attempts to repair itself and replace damaged liver cells)
  • Lower rates of cirrhosis (late stage fibrosis or scarring of the liver caused by disease) than men

A Word From Verywell

The progression of symptoms in women with hepatitis C can be very different from that of men. In addition, women have several special concerns (such as the impact of hepatitis C on birth control methods, and on pregnancy and breastfeeding), that don’t directly affect men. Therefore, if you are a woman who has been diagnosed with hepatitis C, it’s important to become educated on how symptoms, treatment and other aspects of the disease can specifically impact females. Although the research shows that hepatitis C often progresses slower in men, it’s important to note that everyone’s body responds differently. There are many factors that can influence the progression and outcome of any disease, therefore, not all women will have the same exact experience once they test positive to hep C.

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Article Sources

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