Re: Gallbladder disease - was Increasing E

[Guest guest]

I don't know how long you've been on exogenous estrogen therapy but

gallbladder disease and stones are one of the major adverse reactions

from estrogen -- as just one example here's an abstract and intro

from a recent study. Google estrogen and gallbladder and see all the

stuff that comes up.

Warnings about gallbladder disease abound in all the estrogen inserts

given with normal prescription estrogen products -- how does WP get

away with not having to given out the warnings given with every other

estrogen and progesterone product on the market anyway??

Breast pain also is a known effect of too much estrogen.

I recently went to the UCLA biomed library in search of literature on

ERT before it was routinely combined with progestins -- and it was very

revealing. I scanned the pharmaceutical insert that came with estrogen

back in 1975 but it turned into jpg files instead of test files --

could send it to anyone who wants to see it.

Namaste, Liz

JAMA. 2005 Jan 19;293(3):330-9.

 

Effect of estrogen therapy on gallbladder disease.

Cirillo DJ, Wallace RB, Rodabough RJ, Greenland P, LaCroix AZ, Limacher

MC, Larson JC.

Department of Epidemiology, College of Public Health, University of

Iowa, Iowa City, USA.

CONTEXT: Estrogen therapy is thought to promote gallstone formation and

cholecystitis but most data derive from observational studies rather

than randomized trials. OBJECTIVE: To determine the effect of estrogen

therapy in healthy postmenopausal women on gallbladder disease

outcomes. DESIGN, SETTING, AND PARTICIPANTS: Two randomized,

double-blind, placebo-controlled trials conducted at 40 US clinical

centers. The volunteer sample was 22,579 community-dwelling women aged

50 to 79 years without prior cholecystectomy. INTERVENTION: Women with

hysterectomy were randomized to 0.625 mg/d of conjugated equine

estrogens (CEE) or placebo (n = 8376). Women without hysterectomy were

randomized to estrogen plus progestin (E + P), given as CEE plus 2.5

mg/d of medroxyprogesterone acetate (n = 14,203). MAIN OUTCOME

MEASURES: Participants reported hospitalizations for gallbladder

diseases and gallbladder-related procedures, with events ascertained

through medical record review. proportional hazards regression was

used to assess hazard ratios (HRs) and 95% confidence intervals (CIs)

using intention-to-treat and time-to-event methods. RESULTS: The CEE

and the E + P groups were similar to their respective placebo groups at

baseline. The mean follow-up times were 7.1 years and 5.6 years for the

CEE and the E + P trials, respectively. The annual incidence rate for

any gallbladder event was 78 events per 10,000 person-years for the CEE

group (vs 47/10,000 person-years for placebo) and 55 per 10,000

person-years for E + P (vs 35/10,000 person-years for placebo). Both

trials showed greater risk of any gallbladder disease or surgery with

estrogen (CEE: HR, 1.67; 95% CI, 1.35-2.06; E + P: HR, 1.59; 95% CI,

1.28-1.97). Both trials indicated a higher risk for cholecystitis (CEE:

HR, 1.80; 95% CI, 1.42-2.28; E + P: HR, 1.54; 95% CI 1.22-1.94); and

for cholelithiasis (CEE: HR, 1.86; 95% CI, 1.48-2.35; E + P: HR, 1.68;

95% CI, 1.34-2.11) for estrogen users. Also, women undergoing estrogen

therapy were more likely to receive cholecystectomy (CEE: HR, 1.93; 95%

CI, 1.52-2.44; E + P: HR, 1.67; 95% CI, 1.32-2.11), but not other

biliary tract surgery (CEE: HR, 1.18; 95% CI, 0.68-2.04; E + P: HR,

1.49; 95% CI, 0.78-2.84). CONCLUSIONS: These data suggest an increase

in risk of biliary tract disease among postmenopausal women using

estrogen therapy. The morbidity and cost associated with these outcomes

may need to be considered in decisions regarding the use of estrogen

therapy.

Here's the introduction to the article:

CHOLELITHIASIS, OR GALLstone

disease, is estimated to

affect between 10% and 15%

of the US population, with 1

million new diagnoses yearly.1 Symptoms

arise in about one third of individuals

with gallstones, with about 80%

of symptomatic patients experiencing

biliary colic.2 Furthermore, cholecystitis

usually arises from obstruction in

the cystic duct due to gallstones.3 Cholecystectomy

procedures can be a good

proxy indicator for symptomatic gallstone

disease in clinical research.4 In

2002, there were 432000 inpatient cholecystectomies

performed,5 and the estimated

total number of cholecystectomies,

including laparoscopic

procedures, numbered as high as

770000 in 1996,6 which has been associated

with an expense of more than

$2 billion annually.7

Gallstone formation is thought to rely

on 3 factors: supersaturation of biliary

cholesterol due to hepatic hypersecretion,

nucleation of cholesterol monohydrate

crystals, and gallbladder hypomotility.

7,8 The liver has estrogen

receptors, and the presence of endogenous

estrogens causes cholesterol saturation

in the bile, inhibition of chenodeoxycholic

acid secretion, and

increased cholic acid content.9 Progestins

inhibit gallbladder contraction,

encourage bile stasis, and have been

shown to decrease the gallbladder’s response

to cholecystokinin.9 One study

found that exogenous estrogens, given

either transdermally or orally, affected

physiologic markers in a pattern that favored

gallstone formation.10

Observational evidence suggests that

estrogen therapy, including the use of

oral contraception and postmenopausal

estrogen therapy, is an important risk factor for gallbladder disease.

8 Observational studies indicate up

to a 2.5-fold increased risk of biliary

tract conditions related to estrogen

therapy.11-16 To our knowledge, the only

previous randomized trial examining

biliary tract outcomes after estrogen

therapy in postmenopausal women was

the Heart and Estrogen/progestin Replacement

Study (HERS), which included

women with known cardiovascular

disease. HERS data revealed a 38%

increased risk for biliary tract surgery

in the estrogen therapy group.4 Thus,

limited clinical trial evidence is available

to provide unbiased estimates of

the true effects and risks of estrogen

therapy in postmenopausal women.

The Women’s Health Initiative

(WHI) postmenopausal hormone trial

consisted of 2 randomized components,

in which women with hysterectomy

were randomized to receive estrogen

alone or placebo, and those

without hysterectomy received either

a combination of estrogen and progestin

(E+P)or placebo.17 The major findings

of these trials have been previously

reported.18,19 Together, these trials

represent the largest randomized,

double-blind study of hormone use in

postmenopausal women, and offer the

most reliable and current documentation

of the full risk/benefit profile of the

use of hormone therapy in postmenopausal

women. This report provides

new evidence on the effect of estrogen

therapy, with or without progestin, on

gallbladder disease incidence and gallbladder

surgical outcomes.

> Dear beth -  

>

> When I had the ultrasound to check endomentrium they found

> gallstones.  This shocked me as I have no symptoms.  None.  The

> Gastroenterologist I saw said it was likely from having lost so much

> weight.  Whatever, his " solution " was that we wait for one of the

> stones to get stuck and give me a fever, infection and jaundice and

> then the take out the whole organ.  Now, THAT is a medical solution!!!

>  I was stunned and a bit miffed, let's say.  So I spent ages checking

> natural remedies for gallstones on the web.  There's a great site:

>  kitchendoctor.com; she has something she calls " Stone Free " made of

> mainly tumeric, I believe that I'm going to try when I get some of

> this other stuff worked out.  Meanwhile, she also discusses doing a

> gallbladder/liver flush that will expel the stones.  Also going to do

> this, trying to deal w/ one issue at a time instead of my usual doing

> it all at once style.  It sounds quite gross, but I know people who

> have done it very successfully w/ gallstones outside the body to show

> for it.

>

> Gallstones are mainly made of cholesterol and since that plays such a

> key role in all the hormones we're smearing, I wouldn't be surprised

> if it's all related.  My non medical thought.

>

> I'm happy to hear of all the symptoms you're not having - like

> flashing, mood improvement, etc.  It was all of that that made me

> realize I was home when I got on the protocol. Gives you a little

> faith, no?  I was surprised at how dry I was when I woke up after I

> began WP.  Was so accustomed to sweating at night I didn't realize it

> could be another way!!

>

> Unless someone gives me a good reason not to I'm still going to

> double the P - starting yesterday - trying to create enough E

> receptors to get it on board.  My boobs are sore for the first time

> since I had periods (13 yr +), so it'll be interesting to see what the

> high P dose does to that.  According to Dr. Lee, sore boobs are a

> symptom of E dominance; we'll see what all the P does!

>

> Take care and keep the faith.

>

> Kathy

>>

>>

>> Reply-To: rhythmicliving

>> Date: Sat, 29 Jan 2005 19:13:32 -0800

>> To: rhythmicliving

>> Subject: Increasing E

>>

>

>> Hi Kathy,

>>

>> My P number on Day 21 have never been above 5.8 which was when I had

>> the E in the 300's. But my E on that cycle of Day 21 was in the

>> 800's! Freaked me out! I felt the worse I have ever felt during that

>> P phase.  I have been looking at my notes and see that during that

>> time I seemed to be having low E symptoms so talk about being

>> confused. I felt pretty good when my numbers were at the 300 level

>> but still felt that I was not even close to being there. I suspect my

>> thyroid and/or adrenals are messed up.

>>

>> BUT even with my low numbers, I do feel better in many ways. I sleep

>> better, ZERO hot flashes, mood more even, vaginal dryness much

>> better, brain fog less, and the list goes on. I have developed gall

>> bladder stuff which is not fun but I'm hoping that will even out to

>> once things get to higher blood levels.

>>

>> I'm not sure how I will play with the P on this next cycle but I will

>> create a peak, even if it's a small one.  I'm hoping I will have my

>> Day 12 results back before I start on the P or at least the day

>> after. I don't seem to do well in the P part.

>>

>> I too, will stop all supplements, except some liquid magnesium and

>> Gold Coin Grass tincture (for gall bladder)

>>

>> beth

>>

>>

>> From: Kathleen McLees

>> Sent: Saturday, January 29, 2005 6:54 PM

>> To: rhythmicliving

>> Subject: Re: Increasing E

>>

>> Hi -  Re reading the text.  It struck me that if P creates

>> the receptors for E then it makes sense to up the P @ equivalent % so

>> there's a place for the E to go when the E only part of the cycle

>> begins again and I'm smearing that much on.  Does that make sense to

>> you?  I also decided to quit all my supplements except armour thyroid

>> for a while.....giving all receptors a chance to become E ones, if

>> I'm understanding how it works.  Do you have any ideas, thoughts on

>> this?

>>

>> In spite of low numbers, how are you feeling?

>>

>> Thanks, and take care.

>> Kathy

>>>

>>>

>>> Reply-To: rhythmicliving

>>> Date: Fri, 28 Jan 2005 17:26:59 -0800

>>> To: rhythmicliving

>>> Subject: Increasing E

>>>

>>

>>> Hi Kathy,

>>>

>>> TAH/BSO- means total abdominal hyst & bilateral- oophrectomy (sp)

>>> which means both ovaries removed. I'm not sure why my numbers

>>> aren't up. I did have one cycle where my E was at 350ish but since

>>> then downhill.

>>>

>>> I'll keep you posted!

>>>

>>> beth

>>> TAH/BSO

>>> 4/99 (age 39)

>>> Endometrial cancer

>>> Medicine Shoppe

>>> 11 cycle

>>>

>>>

>>>

>>> From: kathleenmclees

>>> Sent: Friday, January 28, 2005 10:25 AM

>>> To: rhythmicliving

>>> Subject: Re: Increasing E

>>>

>>>

>>>

>>>

>>> Hi

>>>

>>> I'm new to the discussion and am just hopping in. I too,  have had

>>> low

>>> numbers and even after 15 mo on protocol have had no period.  After

>>> absorbing as much info as I have been able for the last few days

>>> (more info

>>> than E, apparently) I am going to follow pretty much what you

>>> outlined -

>>> although I had decided on it before I read  your post.  I have been

>>> at this all

>>> alone until this week and am so relieved to  have some interaction

>>> on all this.  

>>> Nevertheless, I have a great, openminded physician who is willing to

>>> prescribe THAT MUCH and continue to work it out for myself.  Since

>>> info was

>>> turning to dust in my head, I hadn't taken the peaky-ness issue

>>> sufficiently into

>>> consideration; since I'm just past E peak, I'll jack up the P for

>>> the second

>>> phase and hope for the best.  In any case I'm willing to go all the

>>> way to

>>> increasing E by 100% at the beginning of the next cycle.  My

>>> pharmacy,

>>> although I offered to let them fire me, is fabulous and is getting

>>> in touch w/ Neil  

>>> in order to get their end set up according to Wiley which should

>>> take care of

>>> creme base/ absorbtion problems, don't you think?  Please let me

>>> know how it

>>> goes for you.  Keeping my fingers crossed and anxiously awaiting

>>> apoptosis.

>>>

>>> Are you having periods or did you have a hysterectomy - or is that

>>> what TAH/

>>> BSO is about and I'm just too green to know?

>>>

>>> Kathy

>>> on WP 15 mo

>>> 58 y/o

>>> became postmenopausal at 45 w/FSH @210

>>> Cincinnati

>>>

>>>

>>> click here for our webpage http://rhythmicliving.com/

>>>

>>> **The group information is educational in nature and is not

>>> intended as medical advice. Anyone wishing to actively use this

>>> educational material for personal health improvement is advised to

>>> consult with the qualified health care provider of their choice

>>> before attempting to use the information.**

>>>

>>>

>>>

>>>

>>>