Estrogen And Your Gallbladder: Friend or Foe?
I love hormone therapy if you’re a candidate BUT they are not without risks. Gallbladder problems (or disease) is a big one if you’re taking oral estrogen. This includes estradiol or Premarin capsules for menopause or the synthetic estrogen in birth control pills. Your gallbladder is a badass. It helps you break down fats from your diet. It stores bile from your liver and releases it when needed. However, when things go wrong, it puts you at risk for gallbladder pain, inflammation, stones, and possibly even needing surgery!
Knowing this, how do estrogens play a role?
When I was in medical school, I learned the 4-F’s for gallbladder disease.
It’s more common in those who are FEMALE.
It’s more common in those who are overweight, as that visceral FAT around the liver/gallbladder area creates a problem.
It’s more likely to show up in women entering their FORTIES and above. In fact, it’s 10x more likely to show up here.
It’s more common in women who are FERTILE in reference to pregnancy or high estrogen states. However, this could be induced with prescription estrogens.
Sometimes you’ll also hear it’s more common in women who are FAIR complected. Although, this isn’t always the case.
Based on a prospective cohort study in the British Medical Journal, the researchers found the following related to hormone replacement:
Hormone replacement therapy by postmenopausal women increases the risk of gallbladder disease however it depends on the type and dose (oral estrogen pills being the highest risk).
The (and other studies) found substantially lower risk of gallbladder disease with use of transdermal therapy than with oral therapy. This could include estrogen creams, gels, and patches. Yay!
Oral estrogens get swallowed, broken down, and end up in the liver, then bile. This may explain why it cause cause more gallbladder problems. Topical estrogens don’t go this route.
Estradiol pills under 1mg had less risk than estradiol pills over 1mg.
Use of equine estrogen (Premarin, for example) was associated with a slightly higher risk of gallbladder disease than estradiol (bioidentical).
Estradiol implants (like a pellet) increased the relative risk of gallbladder disease to a level somewhere between oral users and transdermal users.
Adding in a progestogen (progesterone or synthetic progestin) did not increase the risk in this review however other studies found synthetic progestins DID increase the risk.
All the studies I read advised you tell your practitioner if you’ve ever been told you have gallstones, gallbladder issues or have a family history of gallbladder stones/issues. It’s also important to note that central abdominal adipose (the visceral fat around your center), also increases your risk for gallstones.
If you’re choosing to go on estrogen replacement, this is one of the reasons transdermal (topical) is likely the suggestion of choice. If you’re on estrogen and feeling pain in the right upper quadrant of your belly that might shoot to your right shoulder blade area, having light color stools, or feeling nausea or bloating after high fat meals, don’t pass go! Tell your practitioner ASAP.