Current, prior substance use tied to hot flashes, other bothersome menopause symptoms

Key takeaways:

• Heavy alcohol, tobacco and marijuana use were all associated with higher vasomotor symptom frequency.
• Current opioid use was associated with mood and musculoskeletal symptoms in menopause.

Current and prior heavy alcohol, tobacco, marijuana or opioid use were all independently associated with vasomotor, mood or musculoskeletal symptoms experienced during menopause, researchers reported.

“Potential confounders of the relationship between substance use and menopausal symptoms include socioeconomic disadvantage, mental health conditions, self-reported stress and histories of childhood sexual abuse or neglect — experiences that are common among people who use substances and which are also associated with increased vasomotor symptoms,” Andrea K. Knittel, MD, PhD, assistant professor in the department of obstetrics and gynecology at the University of North Carolina at Chapel Hill School of Medicine, and colleagues wrote in Menopause. “Women with current and/or prior experiences of substance use may warrant guidance and/or referral to specialty care to address symptoms and maximize quality of life during the menopausal transition.”

Knittel and colleagues evaluated self-reported menopause symptoms and substance use from 1,949 women from biannual perimenopausal, late perimenopausal or postmenopausal Women’s Interagency HIV Study (WIHS) visits from 2008 to 2020. Most participants identified as Black (66%), approximately 73% of participants had HIV and 21% of women reported childhood trauma. Substance use since last visit or lifetime cumulative use included tobacco, alcohol, marijuana, crack/cocaine and opioids. Heavy alcohol use was defined as more than seven drinks per week.

Overall, 72% of women reported ever using tobacco, 75% reported heavy alcohol use, 73% reported marijuana use, 50% reported crack/cocaine use and 31% reported opioid use. Reports of menopause symptoms ranged, with 22% to 43% of women reporting frequent vasomotor, 18% to 28% reporting mood and 25% to 34% reporting musculoskeletal symptoms.

Current heavy alcohol use was associated with an increased odds of higher vasomotor symptom frequency (OR = 1.24; 95% CI, 1.08-1.42) and mood symptoms (OR = 1.2; 95% CI, 1.04-1.39). For tobacco use, each additional pack-year of cumulative use was associated with increased odds of higher vasomotor symptom frequency (OR = 1.06; 95% CI, 1.01-1.12). Both current daily marijuana use (OR = 1.19; 95% CI, 1-1.42) and each year of cumulative daily marijuana use (OR = 1.15; 95% CI, 1.01-1.32) were associated with higher vasomotor symptom frequency.

In addition, current opioid use was associated with mood (OR = 1.13; 95% CI, 1.01-1.25) and musculoskeletal (OR = 1.11; 95% CI, 1-1.23) symptoms.

Researchers observed no association between vasomotor symptom frequency and current tobacco, crack/cocaine or opioid use and cumulative heavy alcohol or crack/cocaine use.

“These findings have plausible neurocognitive underpinnings and build upon existing literature on the effects of substance use on menopausal symptoms. However, many of the relationships tested were null and some of the associations were small,” the researchers wrote. “Future research may benefit from gathering more granular data focused on the effects of specific substances and determining whether people who use or used substances receive counseling or treatment during the menopausal transition.”