Hormonal therapy and cholelithiasis.

This report is to alert the abdominal surgeon to a new factor responsible for a rising incidence of cholelithiasis in the younger woman. The cause of cholelithiasis has been explained on the basis of biochemical changes with mechanical obstruction. The role of estrogen-progesterone elevation in pregnancy with associated hypercholesteremia is well-known. Little known are reports (more common in non-American literature) that female hormones effect a sluggishness of gallbladder function. Thus, a chemical change with a functional type of obstruction in the biliary tree predisposes toward cholelithiasis. A survey of 1346 cholecystic operations from 1969 through 1973 showed the expected greater incidence in women. Women under 40 years of age who received hormonal medication were younger when operated upon than a comparable group not receiving hormonal therapy. The incidence of gallbladder disease in young women using hormonal therapy should be expected to increase in the coming years. Cholelithiasis should be suspected in the young female taking birth control medication. X-ray study is indicated and early surgery is desirable to prevent morbidity, mortality and the complications of cholecystic disease.