Hepatitis C: An In-Depth Guide

What do women need to know about Hep C?

This FAQ offers basic Hep C information specific to women and answers some common questions asked by women living with the virus:

Does Hep C affect women differently than it does men?

For some people who get Hep C, the virus goes away on its own within the first six months after infection. This happens more often for women than for men.

For women who have chronic Hep C, liver damage generally happens more slowly than it does for men (about half as fast). This can change as a woman gets older—liver damage may happen more quickly for women who are going through menopause.

Is Hep C treatment successful for women?

Hep C treatment is successful for many women, especially women who start treatment before menopause. Even so, there are many factors to consider when making the decision to start Hep C treatment. For example, treatment may not be a priority if liver damage is happening very slowly.

Does Hep C affect a woman’s reproductive or sexual health?

It is common for women with advanced liver damage to experience changes in the menstrual cycle, such as missed or shorter periods. This can also happen as a side effect of Hep C treatment. A healthcare provider can help you figure out why changes are happening and what is the best way to address them.

Hep C can also affect a woman’s options for birth control:

  • Most birth control pills contain a hormone called estrogen. If the liver has a lot of scarring, it may not be able to break down estrogen. This can make estrogen-based birth control pills less effective at preventing pregnancy.
  • Simeprevir (Galexos)—new medications to treat Hep C—can decrease the effectiveness of hormone-based birth control in preventing pregnancy.

There are other options for birth control, including intrauterine devices (IUDs) and barrier methods (a condom, for example), that are not affected by Hep C or Hep C treatment.

Pregnancy and breastfeeding: Are they safe?

You can have healthy pregnancies and healthy babies when you have Hep C.

Generally, pregnancy does not affect liver health. Pregnancy does not affect how fast liver damage from Hep C happens.

Women with Hep C have a low risk of passing on the virus to their baby during pregnancy or childbirth. Fewer than 5 out of every 100 women who have Hep C pass it on to the baby. The risk may increase if a woman has a high amount of Hep C virus in the blood (a high viral load). Though the risk also increases if a woman is co-infected with HIV, she can have a healthy pregnancy and a healthy baby. For more information about HIV and pregnancy, check out the booklet You can have a healthy pregnancy if you are HIV positive.

Some women want to try to clear Hep C before becoming pregnant. If this is the case, it is recommended that treatment be finished for at least six months before becoming pregnant. This is because ribavirin, one of the drugs used to treat Hep C, may cause severe birth defects if taken during pregnancy. No one should attempt to conceive a baby while on Hep C treatment. This also means that pregnant women cannot start treatment until after childbirth. You may be asked to take a pregnancy test before starting Hep C treatment, during treatment and every month for six months after treatment is finished.

If you are a woman who wants to get pregnant and take treatment for Hep C, a healthcare provider may be able to help you decide which order is right for you.

Research does not show that Hep C can be passed from a woman to a baby during breastfeeding. Still, it is recommended that if your nipples are cracked or bleeding, you should stop breastfeeding until they are healed. Tips to help prevent cracking nipples include:

  • Change the position of the baby at every feeding.
  • Rub a bit of breast milk on the nipple after every feeding and let it air dry. Breast milk is a natural moisturizer!

If you also have HIV, there is a risk of HIV passing to your child through breastfeeding. Guidelines strongly encourage HIV-positive mothers to bottle-feed with baby formula. If you can’t afford baby formula, some provinces and territories provide it free.

How does menopause affect women with Hep C?

Menopause and liver damage

Liver damage can happen more quickly for women who have gone through menopause. Research has not yet been able to show whether or not hormone replacement therapy (HRT) can prevent liver damage for women with Hep C. 

Menopause and Hep C treatment response

There is not a lot of information about how menopause affects Hep C treatment response. Some research suggests that women who have gone through menopause clear Hep C less often than women who are pre-menopausal.