HRT Patches, Tablets and Gallbladder Surgery: The Five-Year Figures

What happened over five years

The 2008 Million Women Study analysis included 1,001,391 postmenopausal women. Researchers linked reported HRT use to NHS hospital admissions.¹

Their standardized five-year rates of gallbladder removal, called cholecystectomy, were:

• 11 per 1,000 among women who had never used HRT.
• 13 per 1,000 with transdermal HRT, meaning estrogen patches or gel.
• 20 per 1,000 with oral HRT.¹

The oral-versus-transdermal difference was about seven operations per 1,000 women over five years. These were surgery rates, not counts of every gallstone or episode of indigestion.¹

Why the figures cannot choose your prescription

Women were not randomly assigned to a route. Adjustments could not eliminate every difference between groups. These figures cannot predict your outcome. The transdermal rate also remained above the never-user rate.¹

Current Leeds Teaching Hospitals patient guidance still identifies a small increase in gallbladder-disease risk with HRT tablets. Its treatment discussion also considers blood-clot risk, medical history and the hormones needed. A gallbladder comparison is one part of that assessment.²

Check both hormones before changing anything

An estrogen patch does not automatically replace every tablet in a combined regimen. If you have a uterus and use systemic estrogen, you generally also need a progestogen to protect its lining. Leeds describes estrogen-only patches and patches containing both hormones, as well as separate progestogen options.²

Bring the names and doses of every HRT product to the review. Ask the prescriber to write down which product supplies estrogen, which supplies progestogen, and exactly what would change. Keep that list with the prescription instructions.

My Body Changed. Now What? uses a Visit Brief to organize hormone-treatment questions around age, stage, medical history and whether a progestogen is needed. Add any previous gallstones, abdominal investigations or gallbladder surgery, with approximate dates. Ask: “Does my gallbladder history affect the route you would recommend?”

Pain needs its own assessment

Gallbladder attacks can cause upper-right abdominal pain lasting hours, often after a heavy meal. Other conditions can cause similar symptoms. A new pain episode cannot establish that HRT caused a gallstone.³

NIDDK³ advises seeking care right away for abdominal pain lasting several hours, nausea and vomiting, fever or chills, yellowing skin or eyes, or tea-colored urine and pale stools during or after a suspected attack. Do not wait for a routine HRT review when these symptoms occur.³