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Gallbladder disease and use of transdermal versus oral hormone replacement therapy in postmenopausal women: prospective cohort study.

Liu B, Beral V, Balkwill A, Green J, Sweetland S, Reeves G, Million Women Study Collaborato - BMJ (2008)

Bottom Line: Among women using oral therapy, equine oestrogens were associated with a slightly greater risk of gallbladder disease than estradiol (relative risk 1.79, 1.72 to 1.87 v 1.62, 1.54 to 1.70; heterogeneity P<0.001) and higher doses of oestrogen increased the risk more than lower doses: for equine oestrogens >0.625 mg, 1.91 (1.78 to 2.04) v <or=0.625 mg, 1.76 (1.68 to 1.84); heterogeneity P=0.02; estradiol >1 mg, 1.68 (1.59 to 1.77) v <or=1 mg, 1.44 (1.31 to 1.59); heterogeneity P=0.003.Results were similar taking cholecystectomy as the outcome.Use of transdermal therapy rather than oral therapy over a five year period could avoid one cholecystectomy in every 140 users.

View Article: PubMed Central - PubMed

Affiliation: Epidemiology Unit, University of Oxford, Oxford OX3 7LF. Bette.Liu@ceu.ox.ac.uk

ABSTRACT

Objective: To determine whether transdermal compared with oral use of hormone replacement therapy reduces the risk of gallbladder disease in postmenopausal women.

Design: Prospective cohort study (Million Women Study).

Setting: Women registered with the National Health Service (NHS) in England and Scotland.

Participants: 1,001,391 postmenopausal women (mean age 56) recruited between 1996 and 2001 from NHS breast screening centres and followed by record linkage to routinely collected NHS hospital admission data for gallbladder disease.

Main outcome measures: Adjusted relative risk and standardised incidence rates of hospital admission for gallbladder disease or cholecystectomy according to use of hormone replacement therapy.

Results: During follow-up 19 889 women were admitted for gallbladder disease; 17 190 (86%) had a cholecystectomy. Compared with never users of hormone replacement therapy, current users were more likely to be admitted for gallbladder disease (relative risk 1.64, 95% confidence interval 1.58 to 1.69) but risks were substantially lower with transdermal therapy than with oral therapy (relative risk 1.17, 1.10 to 1.24 v 1.74, 1.68 to 1.80; heterogeneity P<0.001). Among women using oral therapy, equine oestrogens were associated with a slightly greater risk of gallbladder disease than estradiol (relative risk 1.79, 1.72 to 1.87 v 1.62, 1.54 to 1.70; heterogeneity P<0.001) and higher doses of oestrogen increased the risk more than lower doses: for equine oestrogens >0.625 mg, 1.91 (1.78 to 2.04) v 1 mg, 1.68 (1.59 to 1.77) v

Conclusion: Gallbladder disease is common in postmenopausal women and use of hormone replacement therapy increases the risk. Use of transdermal therapy rather than oral therapy over a five year period could avoid one cholecystectomy in every 140 users.

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Related in: MedlinePlus

Fig 3 Relative risk of hospital admission for gallbladder disease in current users of oral and transdermal hormone replacement therapy compared with never users in various subgroups. Dotted lines represent overall relative risk for all users of oral therapy compared with never users and all users of transdermal therapy compared with never users, respectively. *Relative risk compared with never users stratified by age and hysterectomy and, when appropriate, adjusted for region, socioeconomic group, body mass index, and parity
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fig3: Fig 3 Relative risk of hospital admission for gallbladder disease in current users of oral and transdermal hormone replacement therapy compared with never users in various subgroups. Dotted lines represent overall relative risk for all users of oral therapy compared with never users and all users of transdermal therapy compared with never users, respectively. *Relative risk compared with never users stratified by age and hysterectomy and, when appropriate, adjusted for region, socioeconomic group, body mass index, and parity

Mentions: The relative risk of gallbladder disease in current users of oral and transdermal therapies was also compared with never users in various subgroups of women that had been defined a priori (fig 3).10 18 19 The relative risks differed significantly only by body mass index, decreasing with increasing body mass index: relative risk was 1.88 (1.77 to 2.01) for a body mass index <25 kg/m2 and 1.47 (1.30 to 1.67) for a body mass index ≥35 kg/m2; P=0.001 for trend.


Gallbladder disease and use of transdermal versus oral hormone replacement therapy in postmenopausal women: prospective cohort study.

Liu B, Beral V, Balkwill A, Green J, Sweetland S, Reeves G, Million Women Study Collaborato - BMJ (2008)

Fig 3 Relative risk of hospital admission for gallbladder disease in current users of oral and transdermal hormone replacement therapy compared with never users in various subgroups. Dotted lines represent overall relative risk for all users of oral therapy compared with never users and all users of transdermal therapy compared with never users, respectively. *Relative risk compared with never users stratified by age and hysterectomy and, when appropriate, adjusted for region, socioeconomic group, body mass index, and parity
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2500203&req=5

fig3: Fig 3 Relative risk of hospital admission for gallbladder disease in current users of oral and transdermal hormone replacement therapy compared with never users in various subgroups. Dotted lines represent overall relative risk for all users of oral therapy compared with never users and all users of transdermal therapy compared with never users, respectively. *Relative risk compared with never users stratified by age and hysterectomy and, when appropriate, adjusted for region, socioeconomic group, body mass index, and parity
Mentions: The relative risk of gallbladder disease in current users of oral and transdermal therapies was also compared with never users in various subgroups of women that had been defined a priori (fig 3).10 18 19 The relative risks differed significantly only by body mass index, decreasing with increasing body mass index: relative risk was 1.88 (1.77 to 2.01) for a body mass index <25 kg/m2 and 1.47 (1.30 to 1.67) for a body mass index ≥35 kg/m2; P=0.001 for trend.

Bottom Line: Among women using oral therapy, equine oestrogens were associated with a slightly greater risk of gallbladder disease than estradiol (relative risk 1.79, 1.72 to 1.87 v 1.62, 1.54 to 1.70; heterogeneity P<0.001) and higher doses of oestrogen increased the risk more than lower doses: for equine oestrogens >0.625 mg, 1.91 (1.78 to 2.04) v <or=0.625 mg, 1.76 (1.68 to 1.84); heterogeneity P=0.02; estradiol >1 mg, 1.68 (1.59 to 1.77) v <or=1 mg, 1.44 (1.31 to 1.59); heterogeneity P=0.003.Results were similar taking cholecystectomy as the outcome.Use of transdermal therapy rather than oral therapy over a five year period could avoid one cholecystectomy in every 140 users.

View Article: PubMed Central - PubMed

Affiliation: Epidemiology Unit, University of Oxford, Oxford OX3 7LF. Bette.Liu@ceu.ox.ac.uk

ABSTRACT

Objective: To determine whether transdermal compared with oral use of hormone replacement therapy reduces the risk of gallbladder disease in postmenopausal women.

Design: Prospective cohort study (Million Women Study).

Setting: Women registered with the National Health Service (NHS) in England and Scotland.

Participants: 1,001,391 postmenopausal women (mean age 56) recruited between 1996 and 2001 from NHS breast screening centres and followed by record linkage to routinely collected NHS hospital admission data for gallbladder disease.

Main outcome measures: Adjusted relative risk and standardised incidence rates of hospital admission for gallbladder disease or cholecystectomy according to use of hormone replacement therapy.

Results: During follow-up 19 889 women were admitted for gallbladder disease; 17 190 (86%) had a cholecystectomy. Compared with never users of hormone replacement therapy, current users were more likely to be admitted for gallbladder disease (relative risk 1.64, 95% confidence interval 1.58 to 1.69) but risks were substantially lower with transdermal therapy than with oral therapy (relative risk 1.17, 1.10 to 1.24 v 1.74, 1.68 to 1.80; heterogeneity P<0.001). Among women using oral therapy, equine oestrogens were associated with a slightly greater risk of gallbladder disease than estradiol (relative risk 1.79, 1.72 to 1.87 v 1.62, 1.54 to 1.70; heterogeneity P<0.001) and higher doses of oestrogen increased the risk more than lower doses: for equine oestrogens >0.625 mg, 1.91 (1.78 to 2.04) v 1 mg, 1.68 (1.59 to 1.77) v

Conclusion: Gallbladder disease is common in postmenopausal women and use of hormone replacement therapy increases the risk. Use of transdermal therapy rather than oral therapy over a five year period could avoid one cholecystectomy in every 140 users.

Show MeSH
Related in: MedlinePlus