SAN FRANCISCO—Unrecognized by many in healthcare is that the greatest increases in long-term opioid use and opioid-related overdose mortality in recent years have been among women in midlife, according to a new study.

The article in the Journal of General Internal Medicine discussed how common menopausal symptoms broadly affect health and health care utilization in midlife, pointing out that their contribution to chronic pain management has been unknown, however.1

San Francisco VA Health System researchers and colleagues sought to examine relationships between menopausal symptoms and long-term opioid prescription patterns among midlife women with chronic pain.

To do that, they conducted a cross-sectional analysis of national VHA medical and pharmacy records (2014-2015). Participants were nearly 105,000 women veterans age 45-64 with one or more outpatient visits and chronic pain diagnoses spanning 90 or more days.

In terms of outcomes, researchers focused on:

  • Long-term opioids (prescribed oral opioids for ≥ 90 days),
  • High-dose long-term opioids (> 50 mg average morphine equivalent daily dose), and
  • Long-term opioids co-prescribed with central nervous system depressants (benzodiazepine and nonbenzodiazepine sedative-hypnotics, gabapentin/pregabalin, muscle relaxants).

Of the participants, 17% had evidence of menopausal symptoms, 51% were prescribed long-term opioids, 13% were prescribed high-dose long-term opioids, and 35% were co-prescribed long-term opioids and central nervous system depressants.

After multivariable analyses, results indicated that women with menopausal symptoms had increased odds of long-term opioids (OR 1.21, 95% CI 1.18-1.26), high-dose long-term opioids (OR 1.08, 95% CI 1.02-1.13), and long-term opioids co-prescribed with central nervous system depressants (sedative-hypnotics OR 1.25, 95% CI 1.22-1.30; gabapentin/pregabalin OR 1.23, 95% CI 1.20-1.27; muscle relaxants OR 1.24, 95% CI 1.20-1.28).

“Among midlife women veterans with chronic pain, evidence of menopausal symptoms was associated with potentially risky long-term opioid prescription patterns, independent of known risk factors,” the study authors concluded.

1. Gibson CJ, Li Y, Huang AJ, Rife T, Seal KH. Menopausal Symptoms and HigherRisk Opioid Prescribing in a National Sample of Women Veterans with Chronic Pain.J Gen Intern Med. 2019 Aug 14. doi: 10.1007/s11606-019-05242-w. [Epub ahead ofprint] PubMed PMID: 31414358.