Skip to main content
British Medical Journal (Clinical Research Ed.) logoLink to British Medical Journal (Clinical Research Ed.)
. 1984 Jun 16;288(6433):1795–1799. doi: 10.1136/bmj.288.6433.1795

Oral contraceptives, pregnancy, and endogenous oestrogen in gall stone disease--a case-control study.

R K Scragg, A J McMichael, R F Seamark
PMCID: PMC1441869  PMID: 6428548

Abstract

A case-control study of gall stone disease in women in relation to use of contraceptives, reproductive history, and concentrations of endogenous hormones was undertaken. The study population comprised 200 hospital patients with newly diagnosed gall stone disease, 182 individually matched controls selected from the community, and 234 controls who were patients in hospital. Use of oral contraceptives was associated with an increased risk of developing gall stones among young subjects but a decreased risk among older subjects. The risk of developing gall stone disease increased in association with increasing parity, particularly among younger women. The risk fell with increasing age at first pregnancy, independent of parity. Mean urinary excretion over 24 hours of oestrone, but not of pregnanediol, was significantly (p less than 0.05) greater for postmenopausal patients than controls. The age dependence of the relative risk associated with exposure to oral contraceptives and pregnancy suggests that there are subpopulations of women susceptible to early formation of gall stones after exposure to either oral contraceptives or pregnancy.

Full text

PDF
1795

Selected References

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

  1. Ahlberg J. Serum lipid levels and hyperlipoproteinaemia in gallstone patients. Acta Chir Scand. 1979;145(6):373–377. [PubMed] [Google Scholar]
  2. Arcomano J. P., Schwinger H. N., DeAngelis J. The spontaneous disappearance of gall stones. Am J Roentgenol Radium Ther Nucl Med. 1967 Mar;99(3):637–641. doi: 10.2214/ajr.99.3.637. [DOI] [PubMed] [Google Scholar]
  3. Bennion L. J., Ginsberg R. L., Gernick M. B., Bennett P. H. Effects of oral contraceptives on the gallbladder bile of normal women. N Engl J Med. 1976 Jan 22;294(4):189–192. doi: 10.1056/NEJM197601222940403. [DOI] [PubMed] [Google Scholar]
  4. Bennion L. J., Knowler W. C., Mott D. M., Spagnola A. M., Bennett P. H. Development of lithogenic bile during puberty in Pima indians. N Engl J Med. 1979 Apr 19;300(16):873–876. doi: 10.1056/NEJM197904193001601. [DOI] [PubMed] [Google Scholar]
  5. Bennion L. J., Mott D. M., Howard B. V. Oral contraceptives raise the cholesterol saturation of bile by increasing biliary cholesterol secretion. Metabolism. 1980 Jan;29(1):18–22. doi: 10.1016/0026-0495(80)90092-x. [DOI] [PubMed] [Google Scholar]
  6. Bernstein R. A., Werner L. H., Rimm A. A. Relationship of gallbladder disease to parity, obesity, and age. Health Serv Rep. 1973 Dec;88(10):925–936. [PMC free article] [PubMed] [Google Scholar]
  7. Brett M., Barker D. J. The world distribution of gallstones. Int J Epidemiol. 1976 Dec;5(4):335–341. doi: 10.1093/ije/5.4.335. [DOI] [PubMed] [Google Scholar]
  8. Cole P., MacMahon B., Brown J. B. Oestrogen profiles of parous and nulliparous women. Lancet. 1976 Sep 18;2(7986):596–599. doi: 10.1016/s0140-6736(76)90666-8. [DOI] [PubMed] [Google Scholar]
  9. Comess L. J., Bennett P. H., Burch T. A. Clinical gallbladder disease in Pima Indians. Its high prevalence in contrast to Framingham, Massachusetts. N Engl J Med. 1967 Oct 26;277(17):894–898. doi: 10.1056/NEJM196710262771702. [DOI] [PubMed] [Google Scholar]
  10. Diehl A. K., Stern M. P., Ostrower V. S., Friedman P. C. Prevalence of clinical gallbladder disease in Mexican-American, Anglo, and black women. South Med J. 1980 Apr;73(4):438-41, 443. doi: 10.1097/00007611-198004000-00012. [DOI] [PubMed] [Google Scholar]
  11. Dökert B., Jaross W., Schentke K. U., Trübsbach A., Sarembe B. Schwangerschaft, orale hormonale Kontrazeption und Gallenlipidzusammensetzung. Dtsch Gesundheitsw. 1978;33(25):1153–1155. [PubMed] [Google Scholar]
  12. Everson G. T., McKinley C., Lawson M., Johnson M., Kern F., Jr Gallbladder function in the human female: effect of the ovulatory cycle, pregnancy, and contraceptive steroids. Gastroenterology. 1982 Apr;82(4):711–719. [PubMed] [Google Scholar]
  13. 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]
  14. Feinstein A. R. Methodologic problems and standards in case-control research. J Chronic Dis. 1979;32(1-2):35–41. doi: 10.1016/0021-9681(79)90009-2. [DOI] [PubMed] [Google Scholar]
  15. Friedman G. D., Kannel W. B., Dawber T. R. The epidemiology of gallbladder disease: observations in the Framingham Study. J Chronic Dis. 1966 Mar;19(3):273–292. doi: 10.1016/0021-9681(66)90132-9. [DOI] [PubMed] [Google Scholar]
  16. Goldberg B. B., Harris K., Broocker W. Ultrasonic and radiographic cholecystography. A comparison. Radiology. 1974 May;111(2):405–409. doi: 10.1148/111.2.405. [DOI] [PubMed] [Google Scholar]
  17. Gough M. H. "The cholecystogram is normal" ... but ... Br Med J. 1977 Apr 9;1(6066):960–962. doi: 10.1136/bmj.1.6066.960. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Gray R. Disappearing gallstones: report of 2 cases. Br J Surg. 1974 Feb;61(2):101–103. doi: 10.1002/bjs.1800610206. [DOI] [PubMed] [Google Scholar]
  19. Greenland S., Neutra R. An analysis of detection bias and proposed corrections in the study of estrogens and endometrial cancer. J Chronic Dis. 1981;34(9-10):433–438. doi: 10.1016/0021-9681(81)90002-3. [DOI] [PubMed] [Google Scholar]
  20. Honoré L. H. Cholesterol cholelithiasis in adolescent females: its connection with obestiy, parity, and oral contraceptive use--a retrospective study of 31 cases. Arch Surg. 1980 Jan;115(1):62–64. doi: 10.1001/archsurg.1980.01380010054010. [DOI] [PubMed] [Google Scholar]
  21. Kirschner M. A., Ertel N., Schneider G. Obesity, hormones, and cancer. Cancer Res. 1981 Sep;41(9 Pt 2):3711–3717. [PubMed] [Google Scholar]
  22. Layde P. M., Vessey M. P., Yeates D. Risk factors for gall-bladder disease: a cohort study of young women attending family planning clinics. J Epidemiol Community Health. 1982 Dec;36(4):274–278. doi: 10.1136/jech.36.4.274. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Lynn J., Williams L., O'Brien J., Wittenberg J., Egdahl R. H. Effects of estrogen upon bile: implications with respect to gallstone formation. Ann Surg. 1973 Oct;178(4):514–524. doi: 10.1097/00000658-197310000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Margulies S. I., Brogdon B. G., Sindler R. A., Perilla F. R. Disappearing gall-stones. Br J Radiol. 1967 Jul;40(475):546–548. doi: 10.1259/0007-1285-40-475-546. [DOI] [PubMed] [Google Scholar]
  25. Metcalf M. G. Are 24-hour urine collections necessary for the measurement of steroid excretion rates? N Z Med J. 1976 Aug 25;84(570):150–153. [PubMed] [Google Scholar]
  26. Nordin B. E., Crilly R. G., Marshall D. H., Barkworth S. A. Oestrogens, the menopause and the adrenopause. J Endocrinol. 1981;89 (Suppl):131P–143P. [PubMed] [Google Scholar]
  27. Richardson J. D., Scutchfield F. D., Proudfoot W. H., Benenson A. S. Epidemiology of gallbladder disease in an Appalachian community. Health Serv Rep. 1973 Mar;88(3):241–246. [PMC free article] [PubMed] [Google Scholar]
  28. Sampliner R. E., Bennett P. H., Comess L. J., Rose F. A., Burch T. A. Gallbladder disease in pima indians. Demonstration of high prevalence and early onset by cholecystography. N Engl J Med. 1970 Dec 17;283(25):1358–1364. doi: 10.1056/NEJM197012172832502. [DOI] [PubMed] [Google Scholar]
  29. Scragg R. K., McMichael A. J., Baghurst P. A. Diet, alcohol, and relative weight in gall stone disease: a case-control study. Br Med J (Clin Res Ed) 1984 Apr 14;288(6424):1113–1119. doi: 10.1136/bmj.288.6424.1113. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Smith D. A., Gee M. I. A dietary survey to determine the relationship between diet and cholelithiasis. Am J Clin Nutr. 1979 Jul;32(7):1519–1526. doi: 10.1093/ajcn/32.7.1519. [DOI] [PubMed] [Google Scholar]
  31. Stolley P. D., Tonascia J. A., Tockman M. S., Sartwell P. E., Rutledge A. H., Jacobs M. P. Thrombosis with low-estrogen oral contraceptives. Am J Epidemiol. 1975 Sep;102(3):197–208. doi: 10.1093/oxfordjournals.aje.a112148. [DOI] [PubMed] [Google Scholar]
  32. Thistle J. L., Eckhart K. L., Jr, Nensel R. E., Nobrega F. T., Poehling G. G., Reimer M., Schoenfield L. J. Prevalence of gallbladder disease among Chippewa Indians. Mayo Clin Proc. 1971 Sep;46(9):603–608. [PubMed] [Google Scholar]
  33. Trichopoulos D., Cole P., Brown J. B., Goldman M. B., MacMahon B. Estrogen profiles of primiparous and nulliparous women in Athens, Greece. J Natl Cancer Inst. 1980 Jul;65(1):43–46. [PubMed] [Google Scholar]
  34. Vermeulen A., Verdonck L. Sex hormone concentrations in post-menopausal women. Clin Endocrinol (Oxf) 1978 Jul;9(1):59–66. doi: 10.1111/j.1365-2265.1978.tb03572.x. [DOI] [PubMed] [Google Scholar]
  35. Vessey M., Doll R., Peto R., Johnson B., Wiggins P. A long-term follow-up study of women using different methods of contraception--an interim report. J Biosoc Sci. 1976 Oct;8(4):373–427. doi: 10.1017/s0021932000010890. [DOI] [PubMed] [Google Scholar]
  36. Wheeler M., Hills L. L., Laby B. Cholelithiasis: a clinical and dietary survey. Gut. 1970 May;11(5):430–437. doi: 10.1136/gut.11.5.430. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Williams C. N., Johnston J. L., Weldon K. L. Prevalence of gallstones and gallbladder disease in Canadian Micmac Indian women. Can Med Assoc J. 1977 Oct 8;117(7):758–760. [PMC free article] [PubMed] [Google Scholar]
  38. Yen S. S., Martin P. L., Burnier A. M., Czekala N. M., Greaney M. O., Jr, Callantine M. R. Circulating estradiol, estrone and gonadotropin levels following the administration of orally active 17beta-estradiol in postmenopausal women. J Clin Endocrinol Metab. 1975 Mar;40(3):518–521. doi: 10.1210/jcem-40-3-518. [DOI] [PubMed] [Google Scholar]
  39. deGraaft C. S., Dembner A. G., Taylor K. J. Ultrasound and false normal oral cholecystogram. Arch Surg. 1978 Jul;113(7):877–879. doi: 10.1001/archsurg.1978.01370190099019. [DOI] [PubMed] [Google Scholar]

Articles from British Medical Journal (Clinical research ed.) are provided here courtesy of BMJ Publishing Group

RESOURCES