How to Prevent Gallstones in Menopause

By Treacy Colbert, Women’s Health Access

Gallstones (rock-like deposits inside the gallbladder) occur in one out of five women by the age of 60, twice as often as they affect men. Women with gallstones gave rise to the unkind diagnostic cliché, “female, fat, and forty.” Here are hints on avoiding the unwelcome category.

How Things Work
The gallbladder is a collection pouch that accumulates green bile fluid as it drains from the liver. The purpose of bile is to help with digestion, particularly of fats. Cholesterol and bilirubin (a byproduct from the breakdown of red blood cells) are also found in bile.

When cholesterol or bilirubin particles begin to cluster, gallstones start to form. In most cases, they do not cause problems. However, when they become caught in the gallbladder outlet, symptoms including pain, belching, gas, nausea, and decreased appetite can occur. While not a pretty image, think of your gallbladder as a pond, say Larrian Gillespie, M.D., author of The Menopause Diet, and  You’re Not Crazy, It’s Your Hormones.” When the ratio of progesterone to estradiol changes in women, the gallbladder becomes sluggish and doesn’t drain bile as well,” she says. “The bile stagnates and looks like green algae.”

Diagnosis
An x-ray will usually not detect gallstones, but they can be seen on ultrasound or CT scan. If gallstones e found and your symptoms correspond to this condition,you may also have blood tests to rule out liver or pancreas involvement.

Complications
Pain from gallstones occurs when the muscle walls of the gallbladder contract to help empty bile into the intestines. When the muscle contracts against a gallstone, or if a gallstone blocks the bile from draining, a strong, deep ache can occur. If the bile duct is blocked, bile can build up and serious infection in the gallbladder, liver, or pancreas can occur.

Gallbladder Surgery
When gallstones form to the point where pain is persistent, surgical removal is the best treatment option, says William S. Richardson, M.D., chief of laparoscopic surgery at Ochsner Clinic in New Orleans. “Unlike heartburn or gastric reflux where weight loss, over-the-counter preparations, or a change of diet may help, with gallstones pain continues in at least 30 percent of cases. Other therapies are not nearly as effective as removal of the gallbladder.”

The surgery is done through a laparoscopic incision in the navel, where the fluid and stones are removed, followed by the gallbladder itself. Patients rarely spend even one night in the hospital, says Dr. Richardson. The recovery period lasts from one to two weeks.

Prevention
Better yet, stay out of the operating room with these preventive steps.

Start with one tablespoon of unsalted butter a day. If you have avoided butter or fat in general, this may sound surprising. But we’re talking about one tablespoon a day, eaten in one serving.

“That contains 10 grams of saturated fat and causes complete emptying of the gallbladder,” says Dr. Gillespie, noting that two studies support this strategy. “The tablespoon of butter can’t be poly or monounsaturated fat, and has to be eaten all at once.” Doling out a third of a tablespoon three times a day won’t achieve he same gallstone prevention step by putting the butter on a generous serving of vegetables.

Second, be aware of changes in your estradiol, advises Dr. Gillespie. Low-dose estradiol therapy can be part of maintaining a healthy gallbladder, among other important health objectives. The studies showing an association between hormone replacement therapy (HRT) and an increase in gallbladder disease reflect the use of synthetic hormone preparations, in particular the synthetic progestin, Provera®, she says. If you choose hormone replacement therapy, select a natural preparation, one that is identical to the hormone your body produces.

While Dr. Richardson points out that losing weight won’t remedy a gallstone problem, keeping your weight in a healthy range may decrease the likelihood of developing the problem. Incidences of gallstones are higher in women who have higher body fat ratios. And, if you’re trying to lose weight, take it slowly and sensibly. Sudden and extreme weight loss can also trigger gallbladder problems.


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About Larrian
Larrian Gillespie is a gynecologic urologist who received her medical degree from the University of California at Los Angeles School of Medicine and practiced Urology and Urogynecology in Beverly Hills for 15 years before retiring.With an ability to translate “doctor speak” into terms anyone can understand, Larrian has been featured in over 75 magazine stories and numerous television shows, including Good Morning America, CBS Woman to Woman News, and CNN. She has served on the medical advisory board of SHAPE Magazine, Prevention Books, Readers Digest Books,Oxmoor Books, Low Carb Energy and been a frequent source for numerous other publications, including WebMD.

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