Gilbert’s Syndrome, Your Hormones and Women’s Health:
Why understanding the liver may help us better understand hormone balance
By Dr Hazel Batten, Integrative GP at Remede Wellness Medicine
If you have ever been told you have Gilbert’s syndrome, you have probably also been told that it is nothing to worry about.
For most people, that is absolutely true.
Gilbert’s syndrome is a common inherited condition affecting around one in ten people. It simply means the liver processes a substance called bilirubin more slowly than usual. Bilirubin is a natural pigment produced when old red blood cells are broken down.
Because it is cleared a little more slowly, bilirubin can build up slightly in the blood. This is why some people with Gilbert’s syndrome have a mildly elevated bilirubin level on blood tests. Occasionally, the whites of the eyes may look slightly yellow during times of stress, illness, fasting or heavy exercise.
Many people never notice any symptoms at all and only discover it incidentally on routine blood tests.
As a GP, this is exactly how I used to explain it to patients, and in most cases I still do. Gilbert’s syndrome is considered a benign condition and does not require treatment.
That reassurance is important and, for most people, completely appropriate.
But over time, as I have worked more in women’s hormonal health, I have become curious about a slightly different question.
What else does this liver pathway do, and could it matter in other areas of health for some women?
A Small Step Into Liver Physiology
The liver has many jobs. One of them is to help the body process and remove substances it no longer needs, including hormones.
Oestrogen, for example, is not simply “used up” after it has done its job. It is actively broken down and prepared for removal. This is one of the ways the body keeps hormone levels balanced over time.
One of the key steps in this process involves attaching small molecules to hormones so they can be safely carried out of the body. This is known as glucuronidation.
You do not need to remember the term. What matters is the idea.
Think of the liver as a recycling and packaging centre. Before waste products can leave the body, they need to be packaged in a way that makes them water soluble so they can be excreted in bile or urine.
In people with Gilbert’s syndrome, one of the enzymes involved in this process, called UGT1A1, is less active than usual. We know this clearly affects bilirubin handling.
Researchers have also explored whether this pathway may play a role in processing certain oestrogen metabolites as well. This is still an area of ongoing research rather than a settled clinical conclusion.
Why This Might be Relevant for Some Women
Hormone related symptoms are rarely caused by one single factor. They tend to arise from a combination of influences, including genetics, ovarian hormone production, thyroid function, stress physiology, gut health, nutrition and lifestyle factors.
In this broader context, I am interested in whether differences in liver processing of hormones may be one contributing factor for some women.
This does not mean Gilbert’s syndrome causes hormonal symptoms. Most women with Gilbert’s syndrome will never experience any hormone related issues because of it.
However, in clinical practice, I do sometimes see women with patterns such as:
| Symptoms I often see | Possible considerations |
| Heavy or painful periods | Hormonal balance is complex and involves multiple systems |
| Premenstrual mood changes or bloating | Sensitivity to normal hormone fluctuations may be influenced by several factors |
| Difficulty tolerating oral contraceptives or hormonal treatments | Individual variation in hormone metabolism may play a role |
| Breast tenderness or cyclical fluid retention | Oestrogen exposure and clearance vary between individuals |
| Persistent fatigue or brain fog | Often multifactorial, including thyroid, stress and metabolic factors |
These symptoms are common and non specific. They are not diagnostic of any single underlying cause. The table simply reflects patterns that sometimes prompt me to consider hormone metabolism more broadly as part of a full clinical assessment.
The Gut Also Plays a Role
The liver is not working alone.
Once hormones have been processed by the liver, they are excreted into the gut. In most cases, they leave the body in the stool without issue.
However, some gut bacteria produce enzymes that can change this process. These enzymes can essentially reverse some of the liver’s work, allowing certain hormones to be reabsorbed into circulation.
This means that gut health can influence hormone balance in ways that are only beginning to be fully understood.
A diverse, healthy gut microbiome appears to support more efficient hormone elimination. This is one of the reasons gut health is increasingly recognised as an important part of overall hormonal wellbeing.
What About Menopausal Hormone Therapy
It is important to say clearly that Gilbert’s syndrome is not a reason to avoid menopausal hormone therapy, often called MHT.
MHT can be very effective for symptoms of menopause and can have significant benefits for quality of life, bone health and other aspects of wellbeing. I prescribe it regularly in my own practice.
For women with Gilbert’s syndrome or other factors that may influence hormone metabolism, the approach is not to avoid treatment, but to individualise it.
This may include considering the type of hormone used, the dose and the route of administration, as well as supporting overall liver and gut health where appropriate.
How I Think About This in Practice
When I see women with hormonal symptoms, I try to step back and look at the whole picture rather than focusing on a single test result.
This often includes:
- Understanding symptoms in detail over time
- Considering thyroid function and metabolic health
- Looking at nutrition, stress and lifestyle factors
- Thinking about gut health and bowel function
- Reviewing medications and hormonal treatments carefully
- Using pathology when it is helpful, but not relying on it alone
- Choosing the most appropriate form of MHT when it is indicated
Not every woman needs extensive investigation. But some women benefit from a broader conversation about how these systems interact.
A Final Reflection
Gilbert’s syndrome is still considered a benign condition, and that message remains important and reassuring.
Nothing in this article should change that.
What has changed for me over time is not the diagnosis itself, but the way I think about it.
I have become more aware that the body is an interconnected system. The liver, gut, hormones and genetics all influence one another in subtle ways. Sometimes those interactions may help explain why two people with similar blood tests can feel very different.
I do not believe Gilbert’s syndrome explains every hormonal symptom.
But I do think it may be one small piece of a much larger picture for some women.
As doctors, our job is not only to interpret blood tests, but to understand the person in front of us. Sometimes that means staying curious about patterns that do not yet have simple answers.
And for me, that curiosity is one of the most valuable parts of clinical practice.