Effect of estrogen therapy on gallbladder disease

Area of Science:

• Endocrinology
• Gastroenterology
• Women's Health

Background:

• Estrogen therapy is commonly associated with gallstone formation and cholecystitis.
• Existing data primarily stem from observational studies, lacking the rigor of randomized trials.

Purpose of the Study:

• To investigate the impact of estrogen therapy on gallbladder disease outcomes in healthy postmenopausal women.
• To provide evidence from randomized controlled trials regarding estrogen's effect on biliary tract health.

Main Methods:

• Two large, randomized, double-blind, placebo-controlled trials involving over 22,000 postmenopausal women.
• Participants received either conjugated equine estrogens (CEE) or estrogen plus progestin (E + P), or placebo.
• Gallbladder disease events and procedures were tracked and analyzed using Cox proportional hazards regression.

Main Results:

• Estrogen therapy significantly increased the risk of any gallbladder disease or surgery (HR 1.67 for CEE, 1.59 for E + P).
• Higher risks were observed for cholecystitis (HR 1.80 for CEE, 1.54 for E + P) and cholelithiasis (HR 1.86 for CEE, 1.68 for E + P).
• Estrogen users were more likely to undergo cholecystectomy.

Conclusions:

• Postmenopausal women using estrogen therapy exhibit an elevated risk of biliary tract disease.
• The increased morbidity and associated costs necessitate careful consideration when prescribing estrogen therapy.