Hormone replacement pills in menopause risky to gallbladder

The risks of taking hormone replacement therapy pills for menopausal women include gallbladder surgery, a large French study suggests.

Gallstone disease is common in developed countries and its complications are a major reason for hospital admissions.

Among women, those over the age of 50 are at greatest risk of gallstone disease.

Researchers in France analyzed data on 70,928 menopausal women who were asked about their use of estrogen hormone therapy every two years between 1992 and 2008. They were checking for an increased risk of gallbladder surgery, also called cholecystectomy and for complications of gallstones.

"Over five years, about one cholecystectomy in excess would be expected in every 150 women using oral estrogen therapy without a progestagen, compared with women not exposed to menopausal hormone therapy," Dr. Antoine Racine of South Paris University and his co-authors said in Monday's issue of the Canadian Medical Association Journal.

"Complicated gallstone disease should be added to the list of potential adverse events to be considered when balancing the benefits and risks associated with menopausal hormone therapy."

In France, hormone therapy is usually given in patch or gel form on the skin rather than orally as is common in North America, the United Kingdom and the Netherlands, Dr. Bette Liu of the University of New South Wales in Australia said in a journal commentary published with the study.

In the study, non-oral types of hormone replacement therapy were not associated with an increased risk of gallbladder surgery.

Racine's team speculated that absorbing estrogens through the skin bypasses the liver.

The liver metabolizes the hormone when it's taken orally, leading to higher cholesterol levels that are thought to increase the risk of gallstone complications.

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Hormone replacement pills in menopause risky to gallbladder