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Gastroenterology (Expert Forum)
Gallbladder disease and the contraceptive pill
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Gallbladder disease and the contraceptive pill
by Adele__0, May 08, 1998 12:00AM
I have recently been diagnosed with gallbladder disease and gall stones and am awaiting a gall bladder removal operation. However, by chance I was reading the information sheet inside my packet of Levlen ED (Contraceptive pill) to find that a serious side effect of the pill is gallbladder disease. I have only been taking the pill for about 6 months - I am 44 years of age and a non-smoker. I take the pill to relieve severe period pain and heavy periods, and it is working fabulously. However, I have only been having gallbladder attacks for the last 8 weeks - they are very severe but last approx. 45 mins.
My questions are, did I have gallbladder disease before I took the pill - or has the pill given me gallbladder disease? If I don't have the gallbladder operation and gave up the pill, would my attacks cease? If I have the operation and stay on the pill would it do any more damage?
Two specialists have told me the gallstones will come back, even if I have them lasered, if I don't have the gallbladder removed.
I really don't know what to do - can you please assist?
Dear Adele,
A number of reports have shown that the risk of gallstones is 2.0 to 2.5 times higher in women taking oral contraceptive pills. There are several mechanisms felt to contribute to this increased risk. The use of oral contraceptives increases the concentration and total output of cholesterol in bile. Furthermore, bile acids that make bile more soluble are less available. This is because there is less enterohepatic recycling of bile acids and bile is sequestered in the gallbladder and intestine.. The contractility and rate of emptying of the gallbladder are also markedly reduced. Other studies have shown that pregnant women or women taking oral contraceptive agents often require gallbladder surgery. This suggests that estrogen exposure may accelerate the development of symptoms in patients with pre-existing gallstones. The risk of gallbladder disease may also be related to the duration of oral contraceptive use. The increased incidence of gallstones generally occurs during the first 5 years on oral contraceptive pills and decreases in subsequent years. This supports the theory that women who are predisposed to developing gallstones experience a temporary acceleration of cholesterol gallstone formation with oral contraceptive use. The dose and potency of the oral contraceptive may also increase the risk for gallstone formation as well.
It is difficult to state with absolute certainty whether or not the gallstones were present before you started taking the oral contraceptive pills. The only way to document that would be if you had an ultrasound or CT scan of the abdomen (that was performed before you started treatment) which showed gallstones. It would be unlikely that gallstones would disappear without treatment even if you would discontinue the pills at this time. If one compares your situation to the case of a pregnant woman, the data suggest that only about one third of small stones would disappear post-partum (after delivery or in your case with the discontinuation of oral contraceptive pills).
The current treatment for symptomatic gallstones is to surgically remove the gallbladder. This is accomplished more easily today with laparoscopic cholecystectomy. Your doctor can recommend a surgeon who can explain this technique to you in more detail. Other treatments for gallstone therapy including shock wave lithotripsy (sound waves that break up gallstones) and medications such as ursodeoxycholic acid (Actigall) are usually considered in patients who are not good surgical candidates. Gallstones do recur after lithotripsy or with the discontinuation of medical therapy. It would be impossible for you to develop gallstones after your gallbladder is removed. However, sometimes stones can develop in the bile ducts even after cholecystectomy (surgery to remove the gallbladder).
Good luck to you. I hope you find this information helpful.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
If you would like to be seen at our institution please call 1-800-653-6568, our Referring Physicians’ Office and make an appointment to see Dr. Muszkat, one of our experts in Gastroenterology.
HFHSM.D.-ym
*Keywords: oral contraceptive pills, gallstones, laparoscopic cholecystectomy
My questions are, did I have gallbladder disease before I took the pill - or has the pill given me gallbladder disease? If I don't have the gallbladder operation and gave up the pill, would my attacks cease? If I have the operation and stay on the pill would it do any more damage?
Two specialists have told me the gallstones will come back, even if I have them lasered, if I don't have the gallbladder removed.
I really don't know what to do - can you please assist?
Dear Adele,
A number of reports have shown that the risk of gallstones is 2.0 to 2.5 times higher in women taking oral contraceptive pills. There are several mechanisms felt to contribute to this increased risk. The use of oral contraceptives increases the concentration and total output of cholesterol in bile. Furthermore, bile acids that make bile more soluble are less available. This is because there is less enterohepatic recycling of bile acids and bile is sequestered in the gallbladder and intestine.. The contractility and rate of emptying of the gallbladder are also markedly reduced. Other studies have shown that pregnant women or women taking oral contraceptive agents often require gallbladder surgery. This suggests that estrogen exposure may accelerate the development of symptoms in patients with pre-existing gallstones. The risk of gallbladder disease may also be related to the duration of oral contraceptive use. The increased incidence of gallstones generally occurs during the first 5 years on oral contraceptive pills and decreases in subsequent years. This supports the theory that women who are predisposed to developing gallstones experience a temporary acceleration of cholesterol gallstone formation with oral contraceptive use. The dose and potency of the oral contraceptive may also increase the risk for gallstone formation as well.
It is difficult to state with absolute certainty whether or not the gallstones were present before you started taking the oral contraceptive pills. The only way to document that would be if you had an ultrasound or CT scan of the abdomen (that was performed before you started treatment) which showed gallstones. It would be unlikely that gallstones would disappear without treatment even if you would discontinue the pills at this time. If one compares your situation to the case of a pregnant woman, the data suggest that only about one third of small stones would disappear post-partum (after delivery or in your case with the discontinuation of oral contraceptive pills).
The current treatment for symptomatic gallstones is to surgically remove the gallbladder. This is accomplished more easily today with laparoscopic cholecystectomy. Your doctor can recommend a surgeon who can explain this technique to you in more detail. Other treatments for gallstone therapy including shock wave lithotripsy (sound waves that break up gallstones) and medications such as ursodeoxycholic acid (Actigall) are usually considered in patients who are not good surgical candidates. Gallstones do recur after lithotripsy or with the discontinuation of medical therapy. It would be impossible for you to develop gallstones after your gallbladder is removed. However, sometimes stones can develop in the bile ducts even after cholecystectomy (surgery to remove the gallbladder).
Good luck to you. I hope you find this information helpful.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
If you would like to be seen at our institution please call 1-800-653-6568, our Referring Physicians’ Office and make an appointment to see Dr. Muszkat, one of our experts in Gastroenterology.
HFHSM.D.-ym
*Keywords: oral contraceptive pills, gallstones, laparoscopic cholecystectomy
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