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The Risk of Gallbladder Disease After Menopause

Posted by Deborah Graefer, L.Ac., MTOM on

If you’re over 40 and you’re starting to experience irregular periods, mood changes, unexplained weight gain, hot flashes, and night sweats, you need to start thinking about “the M word” – menopause.

Menopause is the permanent cessation of menstruation, indicating the end of fertility. The mean age for menopause is 50 years old but there are individuals who experience the symptoms much earlier. Menopause is usually preceded by a phase called perimenopause wherein various symptoms, like the ones stated above, are experienced. Transition can be as long as 8-10 years. Menopause is considered official after 12 consecutive months without a period. At this point, the ovaries have stopped releasing eggs and producing the hormone estrogen. The years after menopause are referred to as the post-menopausal stage.

Although it is a natural phase every female goes through as part of aging, it is still very natural to have some concerns about it. Aside from being a biological reminder of years passing by so quickly, menopause can bring about an overwhelming number of physical, emotional, and cognitive changes. It is therefore important to know all the possible risks involved during this turning point. One aspect that we at GallbladderAttack would like to emphasize, is the impact of menopause on biliary and gallbladder health.

Gallbladder Diseases during Menopause

The probability of developing gallbladder diseases, especially gallstones, increases as we age. Unfortunately, the risk for women in their child-bearing and post-menopausal age is much higher. And here are some reasons why:

  • Hormone imbalance
  • Hormone Replacement Therapy (HRT side effects)
  • Delay in gallbladder emptying
  • Menopause and weight gain as well as metabolic disorders
  • Impaired detoxification

Hormone Imbalance

There are more than 50 different hormones involved in maintaining proper gallbladder function. Many of these hormones are reduced or impaired during the menopausal period or as we grow older. Of course, this takes its toll on our health, affecting our digestion and the bile. Below are examples of hormones that are affected by menopause:

a. Estrogen and progesterone

Gallbladder disease is more common in women than in men because of the difference in sex hormones. Estrogen is called the ‘female hormone’ because is more abundant in women’s bodies than in men. Progesterone, on the other hand, is another hormone abundant in females as it is essential for fertility, and pregnancy. Both estrogen and progesterone have the ability to change the composition of bile acids and influence the motility of the biliary tract. In fact, the gallbladder itself has estrogen and progesterone receptors explaining the sensitivity of gallbladder tissues to this hormone. Sex hormones are also made from cholesterol, derived from the liver or from food. Cholesterol is pregnenolone, and pregnenolone is converted to progesterone. Progesterone is then converted to estrogen through the action of some enzymes. It is believed that post-menopausal women have 90% less estrogen and progesterone than those who haven’t had their menopause.

During pregnancy, when the levels of both hormones are through the roof, women are more at risk of developing gallstones. Cholesterol synthesis in the biliary tract is also abnormally increased, leading to an increase in cholesterol saturation of the bile. In the same way, the body’s cessation of estrogen creation messes up the biliary system. Among its effects are the lifelong increase of the luteinizing hormone and follicle stimulating hormone levels, contributing to various symptoms like hot flashes, and mood swings, also called pre-menopausal syndrome. During menopause, progesterone levels may also decline.

b. Thyroid

Levels of estrogen also impact thyroid hormones. This means that during menopause, when estrogen levels drop, there is an increased risk of thyroid dysfunction affecting cholesterol metabolism as well as bile production, composition and flow. Thyroxine also induces inhibition of Sphincter of Oddi contractions, resulting in delayed gallbladder emptying and prevalence of stone formation in the common bile 

c. Melatonin

Melatonin, also referred to as the ‘sleep hormone’ is affected by menopause. This is the reason why a lot of peri- and postmenoposal women experience difficulty of initiating or maintaining a good night’s rest. Chronic sleep deprivation causes gastrointestinal problems, erratic metabolism, and increased inflammation. As discussed in our previous blog “Circadian Clock: The Link between Sleep and Digestion”, there is also a relationship between sleep and bile acid synthesis.

d. Cortisol

During the transition period to menopause, cortisol levels rise and tend to be erratic. This increases the risk of developing metabolic syndromes, heart disease, cognitive symptoms, and depression. All these in turn, contribute to a greater probability of gallbladder disease development.

e. Motilin

Motilin is a hormone released by cells found in the intestine as a response to fat intake or intestinal acidity. It initiates gallbladder contraction and bile emptying. The decrease of motilin during pregnancy contributes to a slow-moving gastrointestinal tract and gallbladder diseases. There is not enough evidence to conclude that motilin production is reduced during menopause. However, there have been studies that prove motilin supplementation benefits for the gallbladder function of post-menopausal women.

Hormone Replacement Therapy (HRT side effects)

For example, one study by the Canadian Medical Association concluded that there is an increased risk of cholecystectomy among women exposed to menopausal hormone therapy. Another study in the European Journal of Cancer Prevention concluded that although menopause is associated with a decreased risk of biliary tract cancers, late menopause and HRT tended to increase the risk. Similarly, a study from Digestive Diseases and Sciences on the alterations in gallbladder emptying and bile retention in postmenopausal women on HRT concluded that estrogen replacement in postmenopausal women and estrogen therapy for prostate cancer is related to increased risk of cholesterol gallstones.The sudden drop of estrogen levels causes the female body to go haywire. That is why millions of people are prescribed hormone replacement therapy during or after the perimenopausal period. However, the effects vary from one individual to another. There have been studies saying that hormone replacement therapy creates a higher risk of developing gallstones.

One plausible explanation for these findings is that while estrogen therapy alters the composition of bile by decreasing bile acid synthesis, progestins found in HRT inhibit gallbladder motility. Other HRT side effects go beyond digestion and biliary function.

Delay in Gallbladder Emptying

Sex hormones, specifically estrogen and progesterone, affect gallbladder emptying. It is therefore not surprising that there is a notable decrease in gallbladder emptying as the perimenopausal period begins. There are many possible problems and complications that may arise because of this.

Firstly, there may not be sufficient bile release during digestion, thereby impairing the breakdown of food and assimilation of nutrients. Secondly, if bile sits in the gallbladder for a long time, it may cause gallstone formation. Thirdly, abnormal gallbladder contraction and emptying may encourage the formation of biliary sludge, affecting bile flow and increasing the risk of gallstones.

Menopause and Weight Gain (and other metabolic disorders)

It is not uncommon for women in their perimenopausal and menopausal stages to gain a few pounds. Decreased estrogen levels are attributed to alterations in lipid profile, body mass index, and insulin levels. Menopause and weight gain are very much related. Even body fat distribution is affected as we age. The loss of estrogen is believed to contribute to an increase in central fat – both in the belly area (contributing to a muffin top) and the hip region (making a person look pear-shaped). For others, the weight changes are more drastic and noticeable, leading to obesity and other metabolic disorders. Unfortunately, the repercussions of menopause and weight gain don’t stop there. Metabolic alterations contribute significantly to gallstone formation in menopausal women. It also worsens systemic inflammation and may aggravate any pre-existing inflammatory conditions.

Impaired Detoxification

The accumulation of toxins in the body is one of the many reasons why we develop gallbladder diseases. When it comes to detoxification and menopause, it is a chicken and egg scenario. There are some claims that reactive oxygen species (ROS) and lipid peroxide contribute to menopause. At the same time, there are studies supporting the concept that menopause reduces antioxidant gene expression. This is because antioxidant genes are partly controlled by sex hormones.

This complex and interesting relationship between detoxification and hormones led to a number of studies yielding similar results. Estrogen deprivation and replacement affect glutathione balance, antioxidant enzymes, and oxidative stress. To make matters even worse, there is increased production of free radicals in the body after menopause brought about by sudden changes in hormonal status. Aside from making things difficult for the liver, this mechanism disturbs the blood redox- homeostasis, which may increase the risk of bilirubin oxidation. Bilirubin a pigment that is formed in the liver from the breakdown of hemoglobin in red blood cells. It is a waste product that is excreted in the bile. Excess amounts of bilirubin in the body coupled with oxidative stress increases the risk of gallstone formation.

What to do before or after Menopause to Decrease Gallbladder Risk

1. Menopause Diet

Improving the diet is always, always, our first recommendation for any condition. And in watching one’s diet, the first rule is “do not overeat”. This is especially important for menopausal women and the elderly. As we grow older, our metabolism declines. More often than not, many individuals also become sedentary. It is therefore important to take only the food that you will need to effectively function for the day.

As for the specific menopause food list, you will see a lot of free recommendations online about the menopause diet, a list of what to eat and what not to eat. Some may be similar to the Gallbladder Diet, our very own food guide for gallbladder care. Whatever menopause diet food guide you use, here are important things to consider:

  • Go natural and organic as much as possible
  • Avoid sweets and processed food
  • Avoid alcohol, caffeine, and sugary drinks
  • Avoid dairy
  • Avoid gluten
  • Know your food allergies and stay away from them

2. Vitamins for menopause

When it comes to post-menopausal care, not all supplements are created equal. Below are some of the more important vitamins for menopause that you should load up on:

  • Vitamin B6 – Vitamin B6 is for the maintenance of adequate GSH/GSSG ratio since health loss during old age is greatly associated with the progressive oxidation of glutathione and other thiolic compounds. For more information about B vitamins, read our complete post here.
  • Vitamin D – In our blog post, “Don’t Ditch Your Daily Dose of Vitamin D”, we have enumerated a long list of benefits including improved muscle absorption, better cognitive performance, reduced inflammation, restored immune function, and reduced risk of cardiovascular diseases. Vitamin D3 coupled with K2 in the form of MK-7 is also especially helpful for bone health.
  • Vitamin E – Vitamin E is good for the skin and could greatly benefit older or menopausal women. Aside from its aesthetic benefits, it also boosts the body’s normal detoxification process.
  • Vitamin C – Just like vitamin E, C is an effective antioxidant. It also helps boost the immune system, may help battle high blood pressure, reduce blood uric acid levels, and prevent gout.
  • Supplements to support bone loss – While calcium is the standard recommended fix for this, I have a different protocol since most people cannot efficiently absorb all the calcium that they need. I also recommend the inclusion of stem-cell-enhancing supplements such as Spirulina. Call us if you need more information about this protocol.

3. Detoxify

There are many meanings behind the word detoxify. When given the tools required to detoxify the liver does this quite naturally. The problem is most of us don’t provide that. A diet that includes lots of raw green foods, cooked kale and Brussels sprouts, sparing amounts of meat, absence of refined foods such as flour and sugar is the perfect menopause diet for natural detoxification. You can also add natural antioxidants to your diet like blueberries and black currants. And supplements such as resveratrol and turmeric (curcumin) are not only good for detox, they also have anti-oxidant and anti-inflammatory properties. 

Lifestyle changes may also include getting more sleep and rest, exercise, better stress management, fasting, or meditating. Whatever works for you, do it. We all have different stressors so it is important to take the route most suitable to your needs. There are also great herbal supplements available to support detox and adaptogens to support stress.  

References:

Ansar, S., & Tayef Alhefdhi, A. M. A. (2015). Status of trace elements and antioxidants in premenopausal and postmenopausal phase of life: a comparative study. International journal of clinical and experimental medicine, 8(10), 19486.

Bellanti, F., Matteo, M., Rollo, T., De Rosario, F., Greco, P., Vendemiale, G., & Serviddio, G. (2013). Sex hormones modulate circulating antioxidant enzymes: impact of estrogen therapy. Redox biology, 1(1), 340-346.

Carr, M. C. (2003). The emergence of the metabolic syndrome with menopause. The Journal of Clinical Endocrinology & Metabolism, 88(6), 2404-2411.

Dhiman, R. K., Sarkar, P. K., Sharma, A., Vasishta, K., Kohli, K. K., Gupta, S., ... & Chawla, Y. (2004). Alterations in gallbladder emptying and bile retention in the absence of changes in bile lithogenicity in postmenopausal women on hormone replacement therapy. Digestive diseases and sciences, 49(7-8), 1335-1341.

Gallus, S., Negri, E., Chatenoud, L., Bosetti, C., Franceschi, S., & La Vecchia, C. (2002). Post‐menopausal hormonal therapy and gallbladder cancer risk. International journal of cancer, 99(5), 762-763.

Jehan, S., Jean-Louis, G., Zizi, F., Auguste, E., Pandi-Perumal, S. R., Gupta, R., ... & Brzezinski, A. (2017). Sleep, Melatonin, and the Menopausal Transition: What Are the Links?. Sleep Science, 10(1), 11.

Kolovou, G. D., & Bilianou, H. G. (2008). Influence of aging and menopause on lipids and lipoproteins in women. Angiology, 59(2_suppl), 54S-57S.

Lobo, R. A. (2008). Metabolic syndrome after menopause and the role of hormones. Maturitas, 60(1), 10-18.

Mason, A. S. (1976). The events of the menopause. Royal Society of Health journal, 96(2), 70-71.

Miquel, J., Ramírez-Boscá, A., Ramírez-Bosca, J. V., & Alperi, J. D. (2006). Menopause: a review on the role of oxygen stress and favorable effects of dietary antioxidants. Archives of Gerontology and Geriatrics, 42(3), 289-306.

Racine, A., Bijon, A., Fournier, A., Mesrine, S., Clavel-Chapelon, F., Carbonnel, F., & Boutron-Ruault, M. C. (2013). Menopausal hormone therapy and risk of cholecystectomy: a prospective study based on the French E3N cohort. Canadian Medical Association Journal, cmaj-121490.

Singletary, B. K., van Thiel, D. H., & Eagon, P. K. (1986). Estrogen and progesterone receptors in human gallbladder. Hepatology, 6(4), 574-578.

Tavani, A., Negri, E. L. V. C., & La, C. V. (1996). Menstrual and reproductive factors and biliary tract cancers. European journal of cancer prevention: the official journal of the European Cancer Prevention Organisation (ECP), 5(4), 241-247.

Velkeniers, B. (2001). Hormones after menopause?. Acta Clinica Belgica, 56(2), 113-121.

Woods, N. F., Carr, M. C., Tao, E. Y., Taylor, H. J., & Mitchell, E. S. (2006). Increased urinary cortisol levels during the menopause transition. Menopause, 13(2), 212-221.

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