Hormonal Contraceptives and Gallstone Risk

Introduction to Risk Factors

The hormonal effects of contraceptives are similar to those seen in pregnancy, where hormonal changes lead to decreased gallbladder motility and lithogenic bile 1

Women with baseline risk factors, such as obesity and high prepregnancy BMI, face compounded risk when using hormonal contraceptives, with an estimated incidence of gallstone-related disease of 0.5-0.8% in the general pregnant population 1, 2
Oral contraceptives can be used in patients with non-advanced liver disease, but regular monitoring of serum liver tests every 6 months is advisable, as recommended by the Journal of Hepatology 3

The U.S. Preventive Services Task Force concluded that postmenopausal hormone replacement therapy increases risk for cholecystitis, with current HRT users showing a 1.8-fold increased risk and long-term users showing a 2.5-fold increased risk compared to nonusers 4, 5, 6
Combined estrogen-progestin therapy increased biliary tract surgery risk by 48% over 6.8 years of follow-up, and also increases risk for cholelithiasis, according to the Annals of Internal Medicine 4, 5, 6, 7

Women with symptomatic cholelithiasis should undergo laparoscopic cholecystectomy before pregnancy to prevent recurrent symptoms and complications, and multidisciplinary counseling should be provided for all women of reproductive age with cholelithiasis who are planning pregnancy, as recommended by the American College of Obstetricians and Gynecologists, though not directly cited here, the recommendation is supported by 8