HRT as a Skin Patch Can Lower the Risk of Cholecystitis

A study reported in the British Medical Journal has compared transdermal (skin patch) with oral hormone replacement therapy ( HRT) with regard to the incidence of gallbladder disease. Previous randomized trials have shown a clear increase in the risk of gallbladder disease (cholelithiasis, cholecystitis, or cholecystectomy as outcomes) with the use of hormone replacement therapy by postmenopausal women. The Oxford researchers examined data from women registered with the UK National Health Service.

Over a million postmenopausal women (average age 56) were recruited between 1996 and 2001 from breast screening centers and followed by record linkage to routinely collected National Health Service hospital admission data for gallbladder disease.

During the follow-up period almost 20,000 women were admitted for gallbladder disease; 86% of them had gallbladder removal (cholecystectomy). Current HRT users were 1.64 times more likely to be admitted for gallbladder disease. However, the risk was substantially lower in those using HRT in a patch form than in those taking tablets orally - 1.17 times versus 1.74 times more likely than women not on any HRT. Another way of looking at the effect: hospital admission rates for cholecystectomy per 100 women over five years were 1.1 in never-users, 1.3 with skin-patch therapy, and 2.0 with oral therapy.

It seems clear that, if you are going to use hormone replacement therapy, a transdermal skin patch carries less risk of provoking gallbladder disease than oral forms. As the investigators put it, “Use of transdermal therapy rather than oral therapy over a 5-year period could avoid one cholecystectomy in every 140 users”. And, if you stop HRT , the study reported here shows that the risk of gallbladder disease decreased over time.