In medical school we were taught that if we saw the 4 F’s consider gallstones. The 4 F’s are Female, Forty, Fat and Fertile. What it meant that if a woman was of childbearing years and was carrying extra weight we had to consider the formation of gallstones if she came in complaining of abdominal pain.
Gallstones are small gravel or pebble-like substances that are found in the gallbladder. Under normal circumstances the liver produces a substance called bile, which is by our digestive system to breakdown fats. Once it is produced in the liver it is stored in the gallbladder until we need it in the digestion of fats.
During digestion, bile is released from the gallbladder into the small intestine whenever there is presence of fatty foods. According to the National Digestive Disease information Clearinghouse (NDDIC) a division of NIH, bile contains water, cholesterol, fats, bile salts, proteins, and bilirubin. There are a few different types of gallstones including cholesterol and pigment gall stones. Cholesterol-based gallstones can be created if there is too much cholesterol in the body. Other reasons for cholesterol stones include too much bilirubin which is a waste product from red blood cell destruction, insufficient bile salts or problems with gall bladder emptying. Scientists are not sure why pigmented stones are created, however they seem to be associated with disease, heredity or infection in the liver or gallbladder.
NDDIC reports that excess estrogen seems be a contributing factor to the development of gallstones. Examples when a woman’s body may have excess estrogen include excess body fat form being overweight or obese causes increases in extrogens. Excess weight also decreases the bile salts in bile. Women who take hormone replacement therapy or birth control pills are adding estrogens to their body as part of the treatment and increase circulating estrogen. This increases the cholesterol levels in bile and decreases gallbladder movement which are precursors for gallstones. Cholesterol lowering drugs cause an increase in the amount of cholesterol excreted into bile which is a risk factor for gallstones.