Objective This study examines the effects of hepatitis B virus on sex hormone levels, menopause, sleep, depression, anxiety, and quality of life in female hepatitis B patients under different alanine aminotransferase (ALT) conditions.

Methods A total of 306 female patients with chronic hepatitis B, exhibiting different viral loads and varying ALT statuses, were randomly selected for stratified sampling. The effects of hepatitis B virus on sex hormone levels, menopause, sleep, depression, anxiety, and quality of life were compared and analyzed across different ALT statuses. Among these, 110 female patients with chronic hepatitis B and ALT levels ≥ 2 times the upper limit of normal received antiviral treatment and were followed for 24 weeks. Changes in the above indicators before and after antiviral treatment were compared and analyzed.

Results In the ALT-normal group and the group with ALT levels ≤ 2 times the upper limit of normal, there was no significant difference in the effects of different hepatitis B virus viral loads on sex hormone levels, menopause, sleep, depression, anxiety, or quality of life in female patients with chronic hepatitis B. However, in the group with ALT ≥ 2 times the upper limit of normal, as the viral load increased (from the low replication group to the high replication group), the estradiol concentration decreased from (84.20 ± 7.78) pg/mL to (64.60 ± 9.18) pg/mL, testosterone increased from (0.33 ± 0.02) ng/mL to (0.45 ± 0.04) ng/mL, follicle-stimulating hormone increased from (47.82 ± 7.62) mIU/mL to (59.68 ± 7.19) mIU/mL, the menopause rate increased from 55.56% to 86.11%, the Pittsburgh Sleep Quality Index increased from 11.02 ± 0.52 to 15.93 ± 0.71, the Self-Rating Anxiety Scale score increased from 46.06 ± 4.92 to 64.66 ± 6.18, the Self-Rating Depression Scale score increased from 44.14 ± 5.47 to 67.08 ± 4.57, and all dimensions of quality of life significantly decreased, with all differences being statistically significant (P < 0.05). After antiviral treatment in 110 female patients with ALT ≥ 2 times the upper limit of normal, estradiol significantly increased, testosterone and follicle-stimulating hormone significantly decreased, sleep indicators and depression and anxiety scores significantly decreased, and all quality of life indicators significantly increased (all P < 0.05).

Conclusion The impact of hepatitis B virus on female patients varies under different ALT conditions. For patients with ALT levels at or above twice the upper limit of normal, actively initiating antiviral treatment can significantly improve sex hormone levels and various physiological and psychological indicators in female patients, thereby enhancing their quality of life.