Gallbladder stones : Why Female? (From my ward round today)

If you are a medical student, chances are, you've heard of the 5 'F's of Gallbladder stones. They are:

• Female
• Forty
• Fat (Obese)
• Fertile (Taking hormonal pill)
• Fetus (Pregnant)

During ward round today, one of my specialist prompted me to answer what could be the reason why my patient developed Acute Cholecystitis. Prior to this, I managed to take a decent history from the patient which included her past gynecological history.

One of the most important thing we asked in the past gynecological history is if at some point in time in the past, did patient had any problem with her menses. This includes dysfunctional uterine bleed, mennorhagia and irregular menses. The next step is to quantify the estimates of blood loss, anaemic symptoms and duration of this problem.

I was able to obtain the info that patient had seen a gynecologist 3 weeks prior to admission to the hospital with complaints that points towards cholecystitis from stones.

She's been having irregular menses for 1 month but a week after she developed symptoms, she was prescribed oral contraceptive pill to regulate her menses. After just one week of taking the pills, patient developed right hypochondrium pain and other stigmata of acute calculous cholecystitis.

This begged the question; Why the old 5 'F's says those who have 3 or more of these are likely to get gallbladder stones? For this purpose, I'm just going to look at the ones relevant to my patients (Female and Fertile)

The answer to why Female and Fertile is a risk is actually because of Estrogen. Female naturally have high level of Estrogen compared to men and it gets higher following consumption of contraceptive pills. Estrogen stimulates the drainage of bile into the gallbladder, causing more bile to be available in which promotes stasis. Stasis here is important because prolonged stasis can cause the chemical/juice of the bile to form crystals or stones. Hence, that's why Female and Fertile are included in the 5 'F's of Gallbladder stones.

Thank you for reading :) Just a short sharing from my day in the ward today.