If you’re a woman, you’re half as likely as a man to get the hepatitis C virus (HCV). But your sex poses special issues about hep C treatments and how to manage your disease. Those concerns may shape your choices and experience with menopause, birth control, pregnancy and breastfeeding.
The female sex hormone estrogen works with cells in your liver to protect against the hepatitis C virus. But that defense goes down as you hit menopause, when your estrogen levels fall and you no longer have your monthly periods. That means HCV can cause more liver damage as you get older.
If you’re nearing menopause, HCV treatment can affect your perimenopause symptoms. You might have more hot flashes than before, or you might have fewer. Your menstrual bleeding might get heavier or might get lighter. You also might notice more vaginal dryness.
Younger women may notice similar changes with their monthly periods.
HCV can raise the chances that your birth control may fail. That’s because the scarring in your liver makes it harder for your body to break down the estrogen in most contraceptives, including birth control pills, some intrauterine devices (IUDs), long-acting hormone injections, and vaginal rings.
Some hepatitis C treatments also can stop hormonal birth control from working well. This includes the drug simeprevir (Galexos). Always use two forms of birth control. A condom or a diaphragm with sperm-killing jelly, for example, can back up your hormone contraceptives.
It’s possible to have a healthy pregnancy if you have HCV. About 1 in 20 infants born to mothers with the virus get it. That can happen in the womb, during delivery, and after birth. The chances go up if you also have hepatitis B or a high level of HCV in your blood.
If you’re pregnant or thinking about having a baby, keep these in mind:
Some hep C treatments can cause birth defects or miscarriage. Wait until you’re clear of the virus for at least 6 months before you try to conceive. Your doctor likely won’t treat your hep C during your pregnancy.
You don’t need to deliver by cesarean section just because you have hepatitis C.
Doctors don’t usually test for HCV during pregnancy. If you have any reason to think you might have it -- because you’ve injected drugs with needles or had sex with someone who has the disease, for example -- get tested. Do it even if you feel fine, because more than 4 out of 5 people with HCV don’t know it.
There is no way to prevent the virus from spreading to your infant. Most doctors recommend testing your baby for hepatitis C when they’re at least 18 months old.
Your newborn isn’t likely to catch the virus from your breast milk. But if your nipples are cracked or bleeding, stop breastfeeding until you heal.
If your treatment includes ribavirin, don’t breastfeed while you’re on it, since we don’t know for sure if the drug passes through breast milk to the baby. It also may be safer not to breastfeed if you’re on the newer direct-acting antivirals. Studies on animals suggest that some antivirals may harm the fetus or lead to birth defects. We don't have enough safety data to know how the drugs may affect humans.