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Evidence summaries

Hormone Therapy and Risk of Gallbladder Disease

Hormone therapy increases the risk of gallbladder disease requiring surgery compared to placebo. Transdermal oestrogen may be safer with respect to gallbladder disease. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 4 trials comparing hormone therapy (HT) with placebo for three to seven years. Gallbladder disease requiring surgery was increased with HT compared to placebo: oestrogen-only HT (RR 1.72, 95% CI 1.40 to 2.19; 3 trials, n=8930); combined continuous HT (RR 1.64(1.30 to 2.06); 1 trial, n=14 203).

In a prospective cohort study (Million Women Study) 2 in UK 1 001391 postmenopausal women were recruited at NHS breast screening centres and followed for gallbladder disease. Compared with never users of HT, current users were more likely to be admitted for gallbladder disease but risks were substantially lower with transdermal therapy (RR 1.17, 95% CI 1.10 to 1.24) than with oral therapy (RR 1.74, 95% CI 1.68 to 1.80). Among women using oral therapy, equine oestrogens were associated with a slightly greater risk of gallbladder disease than estradiol (RR 1.79, 95% CI 1.72 to 1.87 vs RR 1.62, 95% CI 1.54 to 1.70) and higher doses of oestrogen increased the risk more than lower doses. The risk of gallbladder disease decreased with time since stopping therapy.

The article has been checked but no substantial changes have been made.

References

  • Marjoribanks J, Farquhar C, Roberts H et al. Long-term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database Syst Rev 2017;(1):CD004143. [PubMed]
  • Liu B, Beral V, Balkwill A, Green J, Sweetland S, Reeves G, for the Million Women Study Collaborators. Gallbladder disease and use of transdermal versus oral hormone replacement therapy in postmenopausal women: prospective cohort study. BMJ 2008;337:a386. [PubMed]

Primary/Secondary Keywords