Effect of Estrogen plus Progestin on Risk for Biliary Tract Surgery in Postmenopausal Women with Coronary Artery Disease: The Heart and Estrogen/progestin Replacement Study

  title={Effect of Estrogen plus Progestin on Risk for Biliary Tract Surgery in Postmenopausal Women with Coronary Artery Disease: The Heart and Estrogen/progestin Replacement Study},
  author={Joel A. Simon and Donald B. Hunninghake and Sanjay Agarwal and Feng Lin and Jane A. Cauley and Christine C. Ireland and James H. Pickar},
  journal={Annals of Internal Medicine},
Data from the Third National Health and Nutrition Examination Survey (1) indicate that 11% of U.S. women have a history of clinical gallbladder diseasethat is, either previous cholecystectomy or self-reported history of gallstones. Factors associated with gallbladder disease, at least in some studies, include older age, female sex, white ethnicity/race, obesity, rapid weight loss, and, among women, greater parity, use of oral estrogencontaining contraceptives, and postmenopausal estrogen… 

Effect of Estrogen Therapy on Gallbladder Disease

An increase in risk of biliary tract disease among postmenopausal women using estrogen therapy is suggested, and the morbidity and cost associated with these outcomes may need to be considered in decisions regarding the use of estrogen therapy.

Cholecystectomy and endometrial cancer: a marker of long‐term elevated estrogen exposure?

A population-based study of endometrial cancer cases and community controls in women aged 40–79 years suggests that this association is attributable, at least in part, to the sharing of hormonal risk factors.

Hormone Replacement Therapy and Gallstone Disease: A Real Association

This first European study shows that the risk of gallstones appeared greater with an increasing duration of use of HRT, and is unable to provide an answer on the effect of dose of estrogen on occurrence of symptomatic gallstones.

The hormone replacement therapy and incidence of gall stones in some selected post menopausal women using HRT

Analysis was done to observe the incidence of Gall Stones in HRT users, their biochemical profile related to serum levels of hormones, effect on hepatic efficiency was studied and a positive relation was found between the use of oral route of HRT and incidence of development of cholesterol containing gall stones.

Is there a link between oestrogen therapy and gallbladder disease?

It is unequivocally confirmed that oral oestrogen use in postmenopausal women is causally associated with gallbladder disease, and the magnitude of the effect is not influenced greatly by the presence or absence of progestins.

Postmenopausal Estrogen Therapy and Risk of Gallstone Disease: A Population-Based Case–Control Study

Postmenopausal estrogen therapy was associated with increased risk of gallstone disease in current and former estrogen users and the results suggested a duration response for current users.

Use of hormone replacement therapy and the risk of colorectal cancer.

The use of oral HRT was associated with a 63% relative reduction in the risk of colorectal cancer in postmenopausal women after adjustment for other known risk factors, which was not found in aspirin users and women with intensive sports participation.

Oral contraceptives and the risk of gallbladder disease: a comparative safety study

In a large cohort of women using oral contraceptives, a small, statistically significant increase in the risk of gallbladder disease associated with desogestrel, drospirenone and norethindrone compared with levonorgestrel is found.

Quality-of-life and depressive symptoms in postmenopausal women after receiving hormone therapy: results from the Heart and Estrogen/Progestin Replacement Study (HERS) trial.

Hormone therapy has mixed effects on quality of life among older women; women without flushing had greater declines in physical measures and energy/fatigue, while women with flushes had improvements in emotional measures ofquality of life.



Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen/progestin Replacement Study (HERS) Research Group.

Treatment with oral conjugated equine estrogen plus medroxyprogesterone acetate did not reduce the overall rate of CHD events in postmenopausal women with established coronary disease and the treatment did increase the rate of thromboembolic events and gallbladder disease.

Non-contraceptive estrogen use and the risk of gallstone disease in women.

If non-contraceptive estrogen use is a risk factor for gallstone disease in women, its effect is very small, and the duration of use was similar in cases and controls.

Effects of Estrogen or Estrogen/ Progestin Regimens on Heart Disease Risk Factors in Postmenopausal Women: The Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial

Estrogen alone or in combination with a progestin improves lipoproteins and lowers fibrinogen levels without detectable effects on postchallenge insulin or blood pressure and in women with a uterus, CEE with cyclic MP has the most favorable effect on HDL-C and no excess risk of endometrial hyperplasia.

Estrogen-induced gallstone formation in males. Relation to changes in serum and biliary lipids during hormonal treatment of prostatic carcinoma.

An increased hepatic secretion of cholesterol results in increased cholesterol saturation of bile and an enhanced rate of gallstone formation during estrogen treatment, which seems to be related to the induced changes in serum lipoprotein metabolism.

Estrogen replacement therapy II: a prospective study in the relationship to carcinoma and cardiovascular and metabolic problems.

Results revealed no statistically significant difference in that incidence of thrombophlebitis, myocardial infarction (MI), or uterine cancer, and patients in the treated group who began the study with elevated beta/alpha lipoprotein ratios showed a reduction in that ratio over the course of the study.

Mechanisms of gallstone formation in women. Effects of exogenous estrogen (Premarin) and dietary cholesterol on hepatic lipid metabolism.

Premarin increases biliary cholesterol by enhancing hepatic lipoprotein uptake and inhibiting bile acid synthesis and these actions of Premarin divert dietary cholesterol into bile.

A Prospective Study of Symptomatic Gallstones in Women: Relation With Oral Contraceptives and Other Risk Factors

There was no substantial increase in the risk of symptomatic gallstones among ever-OC users, although current and long-term users had somewhat elevated risks.

Postmenopausal Hormone Use and Cholecystectomy in a Large Prospective Study

Women using postmenopausal hormones are at an increased risk of cholecystectomy, and women and their physicians should consider the spectrum of risk and benefits when deciding whether to take hormones.