OUD + menopause

Anyone can be affected by opioid use disorder (OUD) at any point in their life. Opioid use disorder in older adults doesn’t receive the attention this population deserves, especially regarding older women with OUD.

Current or previous opioid use can affect women’s experiences during perimenopause and menopause. Read on for a better understanding of the relationship between perimenopause, menopause, and opioids, ensuring women can access OUD treatment tailored to their unique needs. 

Changes women experience in perimenopause + menopause

Perimenopause marks the transitional phase between a woman’s reproductive years and menopause. This stage typically starts in a woman’s 40s (eight to 10 years before menopause). Perimenopause can last four to eight years¹.

During menopause, the body starts producing significantly less progesterone and estrogen². Menopause is the period in a woman’s life when her menstrual periods stop, and she is no longer able to get pregnant. On average, this transition begins at age 52 in the United States and lasts for several years². You know you have entered menopause when you have not had a menstrual period or spotting for 12 consecutive months without another cause. 

During perimenopause, it’s common for women to have heavier or lighter periods than normal as well as missed or irregular periods. The symptoms of menopause³ include:

• Dizziness
• Numbness
• Increased heart rate
• Hot flashes
• Night sweats
• Depression
• Urinary incontinence
• Vaginal atrophy
• Irritability
• Sleep disturbances
• Brain fog
• Hair thinning

These symptoms can range from mildly uncomfortable to painful and might last up to eight years². It’s important to note that many perimenopause and menopause symptoms overlap, including mood changes, hot flashes, and night sweats. 

Because women go through significant physical and even emotional changes during menopause, it can be challenging to determine whether menopause or another factor is causing the symptoms they experience. A woman using opioids might not be able to tell whether her symptoms are from menopause, opioids, or the interaction between the two. 

How opioids affect women

Women are prescribed opioids for pain relief more often than men⁴, and are more likely to develop OUD⁵. In recent years, middle-aged women have seen the largest increases in opioid-related fatal overdoses and long-term opioid use⁶. And yet, substance-use research primarily focuses on men⁷. 

Compared to men, women are more likely to start opioid use with prescription opioids⁵. They might transition into using opioids like heroin and fentanyl, which leaves them navigating the world of illicit drugs. These environments might increase their risk of experiencing sexual and physical abuse, possibly driving them toward more opioid use⁵.

During perimenopause or menopause, women might seek relief for their painful symptoms through opioids. This transition and the difficult changes it brings might make older women more vulnerable to opioid addiction. Older women are already at a higher risk of prescription drug abuse than other groups⁸. Menopausal symptoms are associated with possibly risky long-term opioid prescriptions⁶. Long-term opioid use can disrupt the endocrine system, so it’s important to consider how opioids and hormones interact in menopausal women. 

Emotional distress before or during menopause might also drive opioid use in women⁹.

Symptoms of perimenopause, menopause and OUD

There is some overlap among the symptoms of perimenopause, menopause, and opioid use dependency. For example, symptoms of irritability, agitation, and depression could stem from opioid use disorder, menopause, or both. Opioid use is associated with mood symptoms in menopause¹⁰. 

Other symptoms of OUD include:

• Drowsiness
• Decreased libido
• Sleep changes
• Flu-like symptoms
• Weight loss

As the above OUD symptoms can overlap with those of perimenopause or menopause, perimenopausal and menopausal women with OUD might struggle to recognize their opioid dependency. Or, they might not realize they’re also experiencing perimenopause or menopause. 

If women stop opioid use and go into drug withdrawal, they will experience new symptoms. In early withdrawal, they might feel anxiety, muscle aches and pain, and trouble sleeping, all of which are easy to mistake for menopausal symptoms. During peak withdrawal, 24 to 72 hours after the last opioid use, symptoms like cramps, fatigue, and depression are common. Withdrawal symptoms tend to taper off within three to five days after the last opioid use.  

Each woman is different, so one woman’s experience during opioid addiction and perimenopause or menopause can be distinct from another’s. There are interventions and treatments for individuals struggling with perimenopause and menopause symptoms, so reach out to women’s health practitioners for assistance.   

How to manage symptoms during OUD treatment

Plenty of conventional advice for managing perimenopause and menopause symptoms still works during OUD treatment. And, starting OUD treatment can help women address their opioid dependency and reduce unpleasant symptoms even more over time. 

Mental health symptoms

If you’re dealing with symptoms of depression, for instance, your care team might prescribe antidepressants. If you’re on Suboxone® as part of your OUD treatment (important safety information), it might also help improve your mental health. There is some evidence that Suboxone® can increase serotonin levels, helping to improve your mood.

Be aware that Suboxone® can interact with certain medications, including some antidepressants. Your care team needs to know exactly what medications you’re on before starting new prescriptions to avoid any unpleasant drug interactions. Always consult your medical providers first before changing medications or doses. 

Pain

Many women experience pain during perimenopause¹¹ and menopause, including muscle aches, pelvic floor pain, and headaches or migraines¹². While prescription opioids are a common option for treating chronic pain, they’re generally not suitable for patients in OUD treatment. You still have other pain management options, though, even while taking Suboxone®.

Over-the-counter pain relievers like NSAIDs (ibuprofen, aspirin) and acetaminophen (Tylenol®) have no known interactions with Suboxone®. You might also consider trying topical analgesics like lidocaine. You can target pain in specific areas with topical analgesics by applying the medicine directly to the skin. Joint pain is a common symptom of menopause¹¹. Menopausal women dealing with joint pain in their knees, for example, might benefit from topical analgesics.  

Difficulty sleeping

Trouble sleeping is another symptom of both OUD and perimenopause/menopause. If you’re struggling to get to sleep or stay asleep at night while on Suboxone®, your care team might recommend adjusting your dosing schedule or might prescribe medications to aid with sleep. 

Try sticking to a consistent bedtime routine and avoiding screens for at least an hour before your head hits the pillow¹² to have an easier time falling asleep. Before taking any sleep aids, check with your care team to make sure there are no negative interactions between the drug and your existing medications. 

OUD treatment tailored to your needs

Every patient deserves OUD treatment that is personalized for them. After all, a treatment plan that works for one person might not be ideal for someone else. Working with a care provider that customizes your OUD treatment plan to fit your lifestyle, goals, and medical history gives you the best chance of success. And that’s what Ophelia does. 

Ophelia offers medication-assisted treatment (MAT) to patients across the country who are managing OUD. Each treatment plan is entirely private and personalized. Through telehealth appointments, you can meet with your dedicated care team to develop and adjust your OUD treatment plan as needed. You have 24/7 access to high-quality, real-time care. Contact Ophelia to explore your OUD treatment options.