Skip to main content
NCBI home page
CMAJ : Canadian Medical Association Journal logoLink to CMAJ : Canadian Medical Association Journal
. 2000 May 16;162(10):1421–1424.

Postmenopausal estrogen replacement therapy and increased rates of cholecystectomy and appendectomy

M M Mamdani 1, K Tu 1, C van Walraven 1, P C Austin 1, C D Naylor 1
PMCID: PMC1232454  PMID: 10834045

Abstract

BACKGROUND: Several studies have indicated that estrogen may prime inflammatory and nociceptive pathways, leading to symptoms that mimic cholecystitis. We set out to confirm the relation between recent estrogen use and cholecystectomy in postmenopausal women and to test the novel hypothesis that a similar relation exists for appendectomy. METHODS: We developed a retrospective cohort using prescribing and surgical procedure information from health administrative databases for approximately 800,000 female residents of Ontario who were over 65 years of age between July 1, 1993, and Mar. 31, 1998. We compared the incidence of cholecystectomy and appendectomy among women recently prescribed estrogen replacement therapy, levothyroxine and dihydropyridine calcium-channel antagonists (DCCA) using age-adjusted Cox proportional hazards models. Patients were followed for a mean of 540 (standard deviation [SD] 449) days. RESULTS: Compared with women taking DCCA, those who had recently begun taking estrogen were significantly more likely to undergo cholecystectomy (age-adjusted risk ratio [aRR] 1.9, 95% confidence interval [CI] 1.6-2.2) and appendectomy (aRR 1.8, 95% CI 1.1-3.0). No significant difference in either outcome measure was found between the levothyroxine users and the DCCA users. INTERPRETATION: This study identifies an increased risk of cholecystectomy and appendectomy among postmenopausal women who have recently begun estrogen replacement therapy.

Full Text

The Full Text of this article is available as a PDF (199.7 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ansbacher R. Oral estrogen replacement and abdominal pain. A report of two cases. J Reprod Med. 1984 Dec;29(12):881–882. [PubMed] [Google Scholar]
  2. Cushman M., Legault C., Barrett-Connor E., Stefanick M. L., Kessler C., Judd H. L., Sakkinen P. A., Tracy R. P. Effect of postmenopausal hormones on inflammation-sensitive proteins: the Postmenopausal Estrogen/Progestin Interventions (PEPI) Study. Circulation. 1999 Aug 17;100(7):717–722. doi: 10.1161/01.cir.100.7.717. [DOI] [PubMed] [Google Scholar]
  3. Cushman M., Meilahn E. N., Psaty B. M., Kuller L. H., Dobs A. S., Tracy R. P. Hormone replacement therapy, inflammation, and hemostasis in elderly women. Arterioscler Thromb Vasc Biol. 1999 Apr;19(4):893–899. doi: 10.1161/01.atv.19.4.893. [DOI] [PubMed] [Google Scholar]
  4. Dennison E. M., Arden N. K., Kellingray S., Croft P., Coggon D., Cooper C. Hormone replacement therapy, other reproductive variables and symptomatic hip osteoarthritis in elderly white women: a case-control study. Br J Rheumatol. 1998 Nov;37(11):1198–1202. doi: 10.1093/rheumatology/37.11.1198. [DOI] [PubMed] [Google Scholar]
  5. Everson R. B., Byar D. P., Bischoff A. J. Estrogen predisposes to cholecystectomy but not to stones. Gastroenterology. 1982 Jan;82(1):4–8. [PubMed] [Google Scholar]
  6. Grodstein F., Colditz G. A., Stampfer M. J. Postmenopausal hormone use and cholecystectomy in a large prospective study. Obstet Gynecol. 1994 Jan;83(1):5–11. [PubMed] [Google Scholar]
  7. Hulley S., Grady D., Bush T., Furberg C., Herrington D., Riggs B., Vittinghoff E. 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. JAMA. 1998 Aug 19;280(7):605–613. doi: 10.1001/jama.280.7.605. [DOI] [PubMed] [Google Scholar]
  8. Lankisch P. G., Dröge M., Gottesleben F. Drug induced acute pancreatitis: incidence and severity. Gut. 1995 Oct;37(4):565–567. doi: 10.1136/gut.37.4.565. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. LeResche L., Saunders K., Von Korff M. R., Barlow W., Dworkin S. F. Use of exogenous hormones and risk of temporomandibular disorder pain. Pain. 1997 Jan;69(1-2):153–160. doi: 10.1016/s0304-3959(96)03230-7. [DOI] [PubMed] [Google Scholar]
  10. Leitzmann M. F., Willett W. C., Rimm E. B., Stampfer M. J., Spiegelman D., Colditz G. A., Giovannucci E. A prospective study of coffee consumption and the risk of symptomatic gallstone disease in men. JAMA. 1999 Jun 9;281(22):2106–2112. doi: 10.1001/jama.281.22.2106. [DOI] [PubMed] [Google Scholar]
  11. Martínez de Pancorbo C., Carballo F., Horcajo P., Aldeguer M., de la Villa I., Nieto E., Gaspar M. J., de la Morena J. Prevalence and associated factors for gallstone disease: results of a population survey in Spain. J Clin Epidemiol. 1997 Dec;50(12):1347–1355. doi: 10.1016/s0895-4356(97)00198-4. [DOI] [PubMed] [Google Scholar]
  12. Matthews K. A., Kuller L. H., Wing R. R., Meilahn E. N., Plantinga P. Prior to use of estrogen replacement therapy, are users healthier than nonusers? Am J Epidemiol. 1996 May 15;143(10):971–978. doi: 10.1093/oxfordjournals.aje.a008678. [DOI] [PubMed] [Google Scholar]
  13. Meier C. R., Sturkenboom M. C., Cohen A. S., Jick H. Postmenopausal estrogen replacement therapy and the risk of developing systemic lupus erythematosus or discoid lupus. J Rheumatol. 1998 Aug;25(8):1515–1519. [PubMed] [Google Scholar]
  14. Mogil J. S., Sternberg W. F., Kest B., Marek P., Liebeskind J. C. Sex differences in the antagonism of swim stress-induced analgesia: effects of gonadectomy and estrogen replacement. Pain. 1993 Apr;53(1):17–25. doi: 10.1016/0304-3959(93)90050-Y. [DOI] [PubMed] [Google Scholar]
  15. Negus S. S., Mello N. K. Opioid antinociception in ovariectomized monkeys: comparison with antinociception in males and effects of estradiol replacement. J Pharmacol Exp Ther. 1999 Sep;290(3):1132–1140. [PubMed] [Google Scholar]
  16. Ridker P. M., Hennekens C. H., Rifai N., Buring J. E., Manson J. E. Hormone replacement therapy and increased plasma concentration of C-reactive protein. Circulation. 1999 Aug 17;100(7):713–716. doi: 10.1161/01.cir.100.7.713. [DOI] [PubMed] [Google Scholar]
  17. Rödström K., Bengtsson C., Lissner L., Björkelund C. Pre-existing risk factor profiles in users and non-users of hormone replacement therapy: prospective cohort study in Gothenburg, Sweden. BMJ. 1999 Oct 2;319(7214):890–893. doi: 10.1136/bmj.319.7214.890. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Troisi R. J., Speizer F. E., Willett W. C., Trichopoulos D., Rosner B. Menopause, postmenopausal estrogen preparations, and the risk of adult-onset asthma. A prospective cohort study. Am J Respir Crit Care Med. 1995 Oct;152(4 Pt 1):1183–1188. doi: 10.1164/ajrccm.152.4.7551368. [DOI] [PubMed] [Google Scholar]
  19. Villablanca A. C., Hanley M. R. 17beta-estradiol stimulates substance P receptor gene expression. Mol Cell Endocrinol. 1997 Dec 12;135(2):109–117. doi: 10.1016/s0303-7207(97)00193-7. [DOI] [PubMed] [Google Scholar]

Articles from CMAJ: Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association

RESOURCES