Association of Menopause with Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and Quality of Life in Women

Background: Menopause represents a critical physiological transition associated with hormonal changes that influence both metabolic health and quality of life (QoL). Metabolic dysfunction-associated steatotic liver disease (MASLD), a common metabolic condition, is closely linked to menopause; however, its independent contribution to QoL impairment remains unclear. This study aimed to investigate the interplay between menopausal status, metabolic dysfunction, MASLD, and QoL in midlife women. Methods: A cross-sectional observational study was conducted including 80 women aged 45–55 years, comprising both premenopausal and menopausal participants. Clinical, anthropometric, biochemical, and imaging data were collected. MASLD was diagnosed using magnetic resonance imaging in the presence of metabolic dysfunction. Metabolic assessment included glucose, insulin, liver enzymes, C-reactive protein, and indices of insulin resistance (HOMA-IR) and sensitivity (QUICKI). QoL was evaluated using the Utian Quality of Life (UQOL) scale. Associations were examined using univariate and multivariable linear regression models. Results: MASLD prevalence was significantly higher in menopausal women compared with non-menopausal women (61.9% vs. 15.8%, p < 0.001). Metabolic parameters, particularly insulin resistance and body mass index, were strongly associated with MASLD. The mean total UQOL score indicated moderate QoL. In multivariable analysis, menopausal status was the only independent predictor of reduced total QoL (b = −4.93, p = 0.01) and occupational health domain (b = −4.60, p = 0.001). MASLD and metabolic parameters were not independently associated with overall QoL. Correlation analyses revealed modest associations between metabolic markers and specific QoL domains, particularly occupational and physical health. Conclusions: Menopause is the primary determinant of reduced QoL in midlife women, particularly affecting functional domains, while MASLD does not independently impact QoL despite its strong association with metabolic dysfunction. These findings suggest that menopausal status may play a more prominent role in quality-of-life outcomes than MASLD in women undergoing the menopausal transition. However, the cross-sectional design does not allow conclusions regarding causal or mechanistic relationships.