Estrogen has a direct effect on bile metabolism.  Even women who do not take estrogen have more gallbladder attacks then men.

Gallbladder disease is not life threatening or relatively common.  However, women with a history of gallbladder attacks may not be good candidates for oral estrogen, which doubles the normal risk of attacks.

Transdermal estrogen bypasses the liver, which is responsible for bile production, so estrogen in patch or cream form may offer an alternative for those women at risk.

Other factors that increase gallbladder disease risk include: