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Liver

Total bilirubin in women: the pill, menstruation and what an abnormal level means

Bilirubin is a yellowish substance that according to MedlinePlus is made when old red blood cells are broken down, and that ends up in bile, the digestive fluid the liver makes. According to MedlinePlus, a healthy liver removes most bilirubin through the bile ducts, the tubes that carry bile away from the liver.

According to MedlinePlus, when the liver is damaged or the bile ducts are blocked, bilirubin can leak into the blood and cause jaundice, a yellow colour of the skin and eyes. According to MedlinePlus, a level that is too low may be due to medicines, including birth control pills, and is usually not a cause for concern. Only a blood test makes visible whether bilirubin is too high or too low.

Star-SHL gives 3 to 19 µmol/l for women older than 18, and 4 to 24 µmol/l for men older than 18. The lower upper limit for women fits the NVKC's finding that bilirubin is slightly higher in men.

Doctor's Assessment Included

Bilirubin is the yellow breakdown product of red blood cells, which the liver processes and removes through the bile. For adults, Star-SHL and Certe use an upper limit of 24 µmol/l for men and 19 for women, Unilabs and Diagnostiek voor U 20 for everyone.

  • Total bilirubin is the sum of an unprocessed (indirect) form and a form processed by the liver (direct); a raised unprocessed form is usually due to red cell breakdown or Gilbert's syndrome, a raised processed form usually to liver disease or blocked bile ducts.
  • For an isolated raised bilirubin, with otherwise normal liver tests, the British Society of Gastroenterology (BSG) advises repeating the liver tests on a fasting sample, with a full blood count and direct and indirect bilirubin; in Gilbert's syndrome, total bilirubin then rises further.
  • A bilirubin result depends strongly on the measuring method, which is why limits differ between laboratories.

Reference Ranges

See the value that applies to you:

Choose male or female — this range differs by sex.

Enter your age — this range changes with age.

This range also depends on context such as cycle phase or sample material; the highlighted rows apply to your group.

Your reference range
umol/l
2 22 umol/l
Reference ranges by group, in umol/l
Female · 1–5 years 2–10 umol/l
2 10
Female · 6–12 years 3–16 umol/l
3 16
Female · 13–18 years 3–22 umol/l
3 22
Female · 19 years and older 3–19 umol/l
3 19
2 22 umol/l

Source: NVKC Reference population: Dutch general-practice population (NUMBER, n = 7,574,327)

Reference ranges may vary between laboratories. When you order a test, a BIG-registered doctor assesses your personal results in context. For treatment decisions, discuss your results with your GP.

Check your own value

Bilirubin (Total): what Dutch laboratories use

Reference ranges by group, in umol/l
Star-shl · Female · 19 years and older 3–19 umol/l
3 19
Unilabs · Everyone · 0–115 years 3–20 µmol/l
3 20
Certe · Female · 18 years and older · a limit, not a range < 19 umol/L
19
Diagnostiek voor U · Everyone · 0 years and older 3–20 µmol/L
3 20
0 22 umol/l

Source: Star-shl

Source: Unilabs

Source: Certe

Source: Diagnostiek voor U

Each value as the laboratory itself publishes it, retrieved in 2026.

Bilirubin (Total): what this test measures

A total bilirubin test measures in micromoles per litre (µmol/l) how much bilirubin is in the blood, in the form the liver still has to process and in the form the liver has already converted. According to MedlinePlus, normal values can vary with the laboratory, the sex and whether the test is done on a baby, a child or an adult.

Certe gives an upper limit of 19 µmol/l for women older than 18 and an upper limit of 12 µmol/l for girls and boys aged 15 to 18.

Bilirubin (Total): why this value matters

According to MedlinePlus, a raised bilirubin can point to haemolytic anaemia, in which the body breaks down red blood cells faster than it makes them, to liver disease or to a blockage of the bile ducts. The NVKC names gallstones in adults and older children as a condition for which bilirubin is measured.

In Gilbert's syndrome, an inherited condition with a mildly raised bilirubin, periods with a higher level occur among other times around menstruation, according to MedlinePlus Genetics.

Bilirubin (Total): how the blood test works

Referral
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Where
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Bilirubin (Total): when is testing worthwhile?

According to the NVKC, a bilirubin test is usually part of a set of liver function tests, which a doctor requests when yellow skin, yellow whites of the eyes or another sign points to liver problems. According to MedlinePlus, the test is also used to monitor a known liver disease or to see how well a treatment is working.

According to MedlinePlus, the doctor who orders the test should know about every medicine someone takes, and no one should stop a medicine unless the doctor says so.

Bilirubin (Total): symptoms of a high or low value

Low Levels

According to MedlinePlus, a low bilirubin level may be due to birth control pills, and also to antibiotics, sleeping pills or medicines for seizures. According to MedlinePlus, a low bilirubin level does not usually need to cause concern. Star-SHL sets the lower limit for women older than 18 at 3 µmol/l.

High Levels

In adults, according to the NVKC, a raised bilirubin goes together with gallstones, an inflammation of the liver, damage to the liver tissue and breakdown of red blood cells, among other things. According to the NVKC, infections and large bruises can also give a slightly raised bilirubin.

According to MedlinePlus, too much bilirubin can cause jaundice, with yellow skin and yellow eyes. According to MedlinePlus, jaundice together with dark urine, clay-coloured stools or stomach pain could point to hepatitis, an inflammation of the liver, or another liver disease.

Bilirubin (Total): causes of a low or high value

What lowers the value

  • Certain medicines

    A low bilirubin is usually not a cause for concern, but may be due to medicines such as antibiotics, birth control pills, sleeping pills and medicines for seizures.

What raises the value

  • Gilbert's syndrome

    The most common cause of an isolated raised bilirubin is Gilbert's syndrome, an inherited trait that 5 to 8 percent of people have and that is not linked to liver disease.

  • Breakdown of red blood cells

    A slightly raised bilirubin is found when red blood cells break down, as in haemolytic anaemia, and with large bruises.

  • Liver disease

    Hepatitis, damage to the liver tissue, long-term alcohol use or poisoning by medicines can raise bilirubin.

  • Blocked bile ducts

    Gallstones, a tumour of the bile ducts or pancreatic cancer that blocks the flow of bile can raise bilirubin.

  • Strenuous exercise

    Bilirubin can rise after strenuous exercise.

Bilirubin (Total): lifestyle and this value

According to MedlinePlus, an abnormal bilirubin result does not always mean there is a condition that needs treatment. That result is one to discuss with your GP, who according to MedlinePlus may ask for further tests when a red blood cell disorder or liver disease is suspected.

Bilirubin (Total): frequently asked questions

Can the pill lower bilirubin?

Yes, according to MedlinePlus birth control pills are on the list of medicines that can cause a low bilirubin level, together with antibiotics, sleeping pills and medicines for seizures. According to MedlinePlus, a low bilirubin level is usually not a cause for concern.

Why do newborn babies often get jaundice?

According to MedlinePlus, many healthy newborn babies get jaundice because their liver has not developed enough to get rid of bilirubin, and that jaundice is usually not harmful and clears up within a few weeks. According to the NVKC, if bilirubin in a newborn stays very high, brain damage can occur, which is why newborns are often placed under a UV lamp.

Can menstruation affect bilirubin?

In women with Gilbert's syndrome, bilirubin can rise around menstruation according to MedlinePlus Genetics, because periods of a raised level mainly occur when the body is under stress. According to MedlinePlus Genetics, these periods are usually mild.

Bilirubin (Total): sources

  1. den Elzen WPJ, Brouwer N, Thelen MH, Le Cessie S, Haagen I-A, Cobbaert CM. NUMBER: standardized reference intervals in the Netherlands using a 'big data' approach. Clin Chem Lab Med 2018;57(1):42-56. (retrieved 2026) doi.org
  2. Unilabs, Bepalingenklapper (referentiewaarden per bepaling), bepalingenklapper.nl, geraadpleegd 2026-10-01 (retrieved 2026) bepalingenklapper.nl
  3. Diagnostiek voor U, eLabgids (Referentiewaarden DvU), diagnostiek.getincontrol.eu, geraadpleegd 2026-10-01 (retrieved 2026) diagnostiek.getincontrol.eu
  4. Star-shl, Labbepalingen (referentiewaarden per bepaling), star-shl.nl, geraadpleegd 2026-10-01 (retrieved 2026) star-shl.nl
  5. Certe, Bepalingenwijzer (referentiewaarden per bepaling), bepalingenwijzer.certe.nl, geraadpleegd 2026-10-01 (retrieved 2026) bepalingenwijzer.certe.nl
  6. MedlinePlus, Bilirubin Blood Test, U.S. National Library of Medicine, geraadpleegd 2026-10-13 (retrieved 2026) medlineplus.gov
  7. Newsome PN, et al. Guidelines on the management of abnormal liver blood tests. Gut 2018;67(1):6-19. (retrieved 2026) pmc.ncbi.nlm.nih.gov
  8. NVKC, Alles over testen: Bilirubine, allesovertesten.nl, geraadpleegd 2026-10-13 (retrieved 2026) allesovertesten.nl

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