A Women's Health Issue that Might Surprise You
by Diana Price, Medially Reviewed by C.H. Weaver M.D. 10/2021
For most of us, a quick mental review of common women’s health issues would likely not include gallbladder disease. And yet, according to the American College of Gastroenterology, up to 20 percent of American women will be diagnosed with gallstones by the age of 60, and women between the ages of 20 and 60 are three times more likely to develop gallstones than men.1
“Gallstones are the most common clinical problem related to the gallbladder,” says Konstantinos Spaniolas, MD, Professor of Surgery and Associate Director of the Stony Brook Medicine Bariatric and Metabolic Weight Loss Center. The formation of gallstones, or cholelithiasis, he notes, is “one of several disorders of the gallbladder, which fall under the category of gallbladder disease.”
Also included in this category are inflammation, or cholecystitis, which occurs when bile is blocked and accumulates in the gallbladder, biliary dyskinesia, a functional condition that leads to poor emptying of the gallbladder, as well as gallbladder cancer, which is very rare.
Given the increased risk among women for gallbladder disease, and gallstones specifically, here’s what you should understand about additional risk factors, prevention, symptoms, and treatment options related to this common health issue.
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Gallstones 101: What, Where, and Why
The gallbladder is a small, pear-shaped organ situated behind the liver on the right-hand side of the abdomen. The organ functions to store and release bile, a digestive fluid produced in the liver. When you eat foods that contain fat, a hormone is released that causes the gallbladder to contract and release bile into the small intestine, aiding in digestion.
Gallstones, which are hard, pebble-like formations, ranging in size from a speck to golf ball, form when bile in the gallbladder crystalizes due to high concentrations of cholesterol (cholesterol stones) or bilirubin (pigment stones).2 The crystals group together to form the stones. Gallstones can also form in the bile ducts, a series of small tubes that connect the liver to the small intestine, a condition referred to as choledocholithiasis.3
When gallstones form, they can prevent the gallbladder from draining, leading it to become irritated or infected with bacteria, which causes inflammation, known as acute cholecystitis. In some cases, if gallstones are located in the bile ducts, they can prevent the liver or pancreas from draining, resulting in pancreatitis (inflammation of the pancreas) or impacting liver function.4
Risk Factors: Why Are Women at Higher Risk?
The female sex hormones contribute to the increased incidence of gallstones among women. “Women are more likely to develop gallstones because higher circulating estrogen levels lead to higher secretion of cholesterol in the bile, and progesterone slows the emptying of the gallbladder, which, over time, can lead to gallstone formation,” Dr. Spaniolas says.
In addition to female gender, risk factors for gallstones include multiple pregnancies, family history of gallstones, Hispanic or American Indian heritage, obesity, and rapid loss of weight.5
According to the National Institute of Diabetes and Digestive and Kidney Diseases, certain health conditions can also raise risk for gallstones. These include cirrhosis; infections in the bile ducts; sickle cell anemia; some intestinal diseases that affect normal absorption of nutrients, such as Crohn’s disease; high triglyceride levels; low HDL cholesterol; metabolic syndrome; and diabetes and insulin resistance.6
Could I Have Gallstones? Be Aware of Common Symptoms.
Eighty percent of people who develop gallstones do not experience symptoms.7 Those with “silent stones” generally only learn they have gallstones through diagnostic testing for a different issue.
Dr. Spaniolas says that among those who do experience symptoms from gallstones, “pain in the upper right abdomen is most common, sometimes associated with some nausea and vomiting, though pain may also be present in the middle of the abdomen or in the right shoulder or chest area.” These typical symptoms, often occurring within 15 to 20 minutes of a meal or intake of fatty or fried foods, are referred to as a gallbladder attack or a gallstone attack, also known as biliary colic. In some cases, gallstones may cause infection of the gallbladder (acute cholecystitis) or severe, ongoing attacks, referred to as chronic cholecystitis.
While these are typical symptoms, Dr. Spaniolas says that “it’s very common for patients to initially present with only nausea or only pain.” As gallbladder disease becomes more severe, he says, a person might develop further symptoms, including fever and chills, ongoing pain that could last several hours and not ease up, and, in some cases, jaundice, all of which would require immediate medical attention.
Answers and Solutions: Diagnosis and Treatment of Gallstones
When symptoms of gallstones are present, a doctor will generally recommend testing to confirm the diagnosis. “Abdominal ultrasound is a low-risk, low-cost test that can readily show gallstones,” Dr. Spaniolas says, “so that’s usually the first step.”
The test is non-invasive and uses high-frequency sound waves—delivered through a transceiver passed over the outside of the abdomen—to create an image of the inside of your abdomen. If an ultrasound is negative, meaning the image does not reveal gallstones, additional testing may be ordered.
Dr. Spaniolas says, “It’s important for patients to understand that not all gallbladder disease will be revealed through an ultrasound. An individual may still have functional disease that requires treatment.” He encourages patients to share any information they can with their physician about triggers for the symptoms they experience, which can help lead toward a conclusive diagnosis.
If further diagnostic testing is required, one or more of the following may be ordered: a CT Scan (computerized tomography), an x-ray test (not safe during pregnancy); a hepatobiliary iminodiacetic acid (HIDA) scan, which “involves injection of a tiny amount of radioactive tracer into the blood, which quickly accumulates in the liver and gallbladder and can be seen with a special camera;” or, very rarely, an ERCP (Endoscopic Retrograde Cholangiopancreatogram), used to diagnose gallstones in the bile duct.8
If gallstones are diagnosed, the most common treatment is to remove the gallbladder. “Once you form gallstones, there really is no other effective way to treat the condition,” Dr. Spaniolas says, “and once a person is experiencing symptoms, the disease could progress to become more severe—and potentially life threatening.”
According to the American College of Gastroenterology, surgical options include open cholecystectomy, which requires an abdominal incision and a five-to-seven-day recovery in the hospital, and laparoscopic cholecystectomy, during which the gallbladder is removed with a lighted tube (called a laparoscope) through a small incision in the abdomen, while the surgeon views the procedure on a monitor.9
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“Minimally invasive surgery, laparoscopic or robotic, which is an outpatient procedure, is the more common surgery today,” Dr. Spaniolas says, “and patients are able go home within a few hours.”
While we can live without a gallbladder, there can be some digestive side effects after the gallbladder is removed. Most often, side effects are limited to changes in bowel habits, gas, or bloating, and they improve over time.
In some cases, an oral medication, ursodeoxycholic acid (Actigal®), can be prescribed to dissolve gallstones and has been shown to be effective in 40 to 80 percent of cases when taken over six to 12 months.10
Prevention Tip: Steady Weight Maintenance
Unfortunately, there’s no one definitive step to take to prevent gallstones. However, it’s clear that maintaining a consistent, healthy weight can go a long way toward avoiding this health issue.
Research has shown that people with obesity have a higher prevalence of cholesterol stones because of a higher concentration of cholesterol in their bile.11 “Weight loss is really the key preventive step to avoid gallstone disease if someone has extra weight,” Dr. Spaniolas says, “but there’s a caveat: very rapid weight loss can actually cause gallstone formation.”
While it seems counterintuitive, he explains that “losing weight too quickly can cause your liver to secrete a surge of cholesterol into your bile, which can cause gallstones.” Weight loss surgery can also increase risk. The solution: Experts recommend that people who are overweight or have obesity aim for a weight loss of 5 to 10 percent of starting weight over a period of six months.12
Whether as part of a weight loss plan or as part of an overall commitment to a healthy diet, Dr. Spaniolas recommends including healthy fats, like fish oil and olive oil, as another step toward preventing gallbladder disease. “Healthy fats don’t elevate your cholesterol but still ‘exercise’ the gallbladder by causing it to contract and empty regularly,” he notes.
Common Sense Conclusion
Ultimately, as with so many common health concerns, a prevention prescription that calls for a focus on a healthy diet, exercise, and consistent weight maintenance will be a positive, proactive step toward your overall well-being.
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References
1. Gallstones in Women. American College of Gastroenterology website. Available at: https://gi.org/topics/gallstones-in-women/#:~:text=Gallstones%20occur%20in%20up%20to,to%20develop%20gallstones%20than%20men.&text=What%20is%20the%20gallbladder%20and,the%20liver%20and%20stores%20bile. Accessed June 1, 2021.
2. Definition & Facts for Gallstones. NIH National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/digestive-diseases/gallstones/definition-facts. Accessed June 1, 2021.
3. Gallstones. Johns Hopkins Medicine website. Available at: https://www.hopkinsmedicine.org/health/conditions-and-diseases/gallstones. Accessed June 1, 2021.
4. Gallstones. theGIconnection website. Available at: http://thegiconnection.com/types-of-cancer/gallstones/gallstones-overview/. Accessed June 1, 2021.
5. Gallstones in Women. American College of Gastroenterology website.
6. Definition & Facts for Gallstones. NIH National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/digestive-diseases/gallstones/definition-facts. Accessed June 1, 2021.
7. Gallstones in Women. American College of Gastroenterology website.
8. Ibid
9. Ibid
10. Ibid
11. Erlinger S. Gallstones in obesity and weight loss. Eur J Gastroenterol Hepatol. 2000 Dec;12(12):1347-52. doi: 10.1097/00042737-200012120-00015. PMID: 11192327.
12. Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society [published correction appears in Circulation. 2014 Jun 24;129(25 Suppl 2):S139-40]. Circulation. 2014;129(25 Suppl 2):S102-S138. doi:10.1161/01.cir.0000437739.71477.ee
