Gallbladder basics: what women over 40 should know

Most people don't give their gallbladder a thought until something goes wrong with it. That's a shame, because this small organ is a common source of trouble for women in midlife, and the most important warning signs are more specific than many people assume.

Here are straight answers to the questions women ask most.

What does the gallbladder do?

Your liver makes bile, a fluid that helps digest fat. The gallbladder, a small pouch tucked under the liver on the right side of your upper belly, stores and concentrates that bile. When you eat, especially fat, it squeezes bile into the small intestine.

You can live without a gallbladder. Bile then flows from the liver more continuously instead of being stored between meals.

Why are women more likely to get gallstones?

Gallstones form when substances in bile, most often cholesterol, harden into stones. Risk factors you can't change include female sex, increasing age, ethnic background and family history. Risk factors you can influence include obesity, rapid weight loss and an inactive lifestyle (Stinton and Shaffer, 2012).

Hormones appear to play a role. In two large US randomized trials, 22,579 women aged 50 to 79 took estrogen, estrogen plus progestin, or placebo. Women taking estrogen alone had 78 gallbladder events per 10,000 person-years, compared with 47 on placebo. For estrogen plus progestin, it was 55 versus 35. Estrogen users were also more likely to have their gallbladder removed (Cirillo et al., 2005).

Do weight-loss medications affect the gallbladder?

They may. A meta-analysis of 76 randomized trials with 103,371 participants found that GLP-1 receptor agonists, a class of drugs used for type 2 diabetes and weight loss, were associated with a 37% higher relative risk of gallbladder or bile duct disease. The risk was higher at higher doses, with longer use, and in trials for weight loss (He et al., 2022).

That doesn't mean these medications should be avoided. It means that if you're taking one and notice the symptoms below, you should tell your doctor promptly.

If I have gallstones, will I need surgery?

Not necessarily. Many gallstones are found by chance and never cause trouble. In a population study, 11,229 adults were screened with ultrasound, and 7.1% had gallstones. Most of them, 73%, had no symptoms at the start. After an average of 8.7 years, 78% of those people still had no symptoms (Festi et al., 2010).

Even among people who had symptoms at the start, roughly half or more no longer had them by the end of follow-up. The researchers concluded that watchful waiting remains a valid approach for most people with gallstones (Festi et al., 2010). Your doctor will weigh your own symptoms and risks.

What does a gallbladder attack feel like?

The typical pattern, called biliary colic, is a steady and often severe pain in the upper right or upper middle belly. It can spread to the back or right shoulder and lasts well beyond a passing cramp.

Here's the surprising part. A systematic review found that biliary colic and pain that radiates were consistently linked to gallstones. But 80% of people referred with gallstones had other abdominal symptoms, and there was no evidence that any single symptom other than biliary colic could reliably point to symptomatic gallstones (Berger et al., 2000).

In other words, general bloating, gas and indigestion are common in people with gallstones, but they're common in people without gallstones too. On their own, they're not a reliable sign that the gallbladder is the problem.

Can I lower my risk?

You can't change your age or genes, but you can work on the modifiable factors listed above (Stinton and Shaffer, 2012):

• Aim for a healthy weight, and avoid crash diets that cause rapid weight loss.
• Stay physically active.
• If you're considering hormone therapy or a GLP-1 medication, ask your doctor how your gallbladder risk fits into the decision.

When to get medical care

Get urgent care if you have:

• Severe upper belly pain that lasts more than a few hours
• Fever or chills along with belly pain
• Yellowing of your skin or the whites of your eyes
• Dark urine or pale, clay-colored stools
• Persistent vomiting

Upper belly pain can also come from the heart. Chest pressure, shortness of breath, sweating or pain spreading to your arm or jaw needs emergency care. And see your doctor soon about repeated episodes of upper right belly pain, even if they pass on their own.

Sources

1. Stinton LM, Shaffer EA. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver. 2012;6(2):172-87. PMID 22570746
2. Cirillo DJ, Wallace RB, Rodabough RJ, et al. Effect of estrogen therapy on gallbladder disease. JAMA. 2005;293(3):330-9. PMID 15657326
3. He L, Wang J, Ping F, et al. Association of glucagon-like peptide-1 receptor agonist use with risk of gallbladder and biliary diseases: a systematic review and meta-analysis of randomized clinical trials. JAMA Intern Med. 2022;182(5):513-519. PMID 35344001
4. Festi D, Reggiani ML, Attili AF, et al. Natural history of gallstone disease: expectant management or active treatment? Results from a population-based cohort study. J Gastroenterol Hepatol. 2010;25(4):719-24. PMID 20492328
5. Berger MY, van der Velden JJ, Lijmer JG, de Kort H, Prins A, Bohnen AM. Abdominal symptoms: do they predict gallstones? A systematic review. Scand J Gastroenterol. 2000;35(1):70-6. PMID 10672838

This article is for general information and isn't medical advice. Severe or persistent abdominal pain needs prompt medical attention. Talk to your healthcare provider about gallbladder symptoms and before changing any medication.