Menstruation is NOT a Contraindication to Cholecystectomy
Menstruation is not listed as a contraindication to elective or emergent cholecystectomy in any current surgical guidelines, and there is no evidence-based reason to delay surgery based on menstrual cycle phase. 1
Established Contraindications to Laparoscopic Cholecystectomy
The actual contraindications to laparoscopic cholecystectomy are limited to critical patient conditions and include:
- Septic shock or hemodynamic instability 1
- Anesthesiologic contraindications 1
- Severe coagulopathy or bleeding disorders 2
- Advanced cholecystitis with abdominal sepsis in select cases 2
Notably absent from this list is any mention of menstruation or menstrual cycle phase.
Evidence Regarding Menstrual Cycle and Surgical Outcomes
One research study specifically examined whether menstrual cycle phase affects outcomes after laparoscopic cholecystectomy 3. This randomized trial of 127 women found:
- No difference in acute postoperative pain scores between follicular and luteal phases (VAS 1.5 vs 1.4 cm at 24 hours, p=0.57) 3
- No difference in opioid consumption during the first 24 hours postoperatively 3
- While persistent pain at 1-3 months was slightly more common in the follicular phase, the magnitude was clinically insignificant (VAS 1.6-1.8 cm) 3
- The authors explicitly concluded that results "do not support scheduling operations to target particular phases of the menstrual cycle" 3
Current Guideline Recommendations
Multiple high-quality guidelines from 2019-2024 comprehensively address contraindications and special populations for cholecystectomy, yet none mention menstruation:
- WSES 2020 Guidelines detail contraindications and address special populations including pregnancy, cirrhosis, and elderly patients, but make no mention of menstrual cycle considerations 1
- AGA 2024 Guidelines on pregnancy-related GI disease discuss timing of cholecystectomy in pregnant women but do not reference menstrual cycle 1
- WSES 2019 Guidelines on elderly populations similarly omit any menstrual cycle considerations 1
Clinical Bottom Line
Proceed with indicated cholecystectomy regardless of menstrual cycle phase. The decision to perform cholecystectomy should be based on:
- Severity of symptoms (biliary colic, acute cholecystitis) 4
- Risk of complications without intervention 1
- Patient's overall medical condition and comorbidities 1
- Presence of actual contraindications (septic shock, coagulopathy) 1, 2
Delaying surgery due to menstruation has no evidence-based justification and may expose patients to unnecessary risks of recurrent symptoms, complications, or progression of disease 1, 5.