Long-Term Opioid Use Can Mess With Women's Sex Hormones
Whether you are prescribed opioid medication for back pain, or any chronic pain, opioids relieve pain. But they come with hidden dangers. One major risk that is rarely discuss is that they mess with the endocrine system in men and especially in women. Doctors have ignored this problem for decades. However, over the past 10 or so years, doctors have gradually acknowledged how long-term opioid therapy affect testosterone levels in men. These men who have been diagnosed can receive testosterone supplementation to address this deficiency. I know of NO PHYSICIAN who is addressing the hormone imbalances in women who take opioids. I aim to change that for women on chronic pain medications and those dealing with opioid addiction.
Understanding Key Hormones
Before we explore opioids' effects, let's understand the key players. These are the hormones that are affected with taking chronic opioid medications.
DHEA: The "Mother" Hormone
DHEA is crucial. Your adrenal glands produce it. It's a building block for other sex hormones including estrogen and testosterone. However, DHEA does more than make sex hormones. It's involved in:
Maintaining muscle mass
Supporting brain function
Boosting immune system
Improving insulin sensitivity
Enhancing mood and well-being
Supports sexual function
Supports testosterone production
When DHEA drops, these functions suffer. The drop is very subtle and the symptoms may be blamed on other things. You might feel weak, foggy, more prone to illness, and your metabolism might slow down.
Estrogen: Not Just for Reproduction
Estrogen is vital for women's health. It regulates menstrual cycles. Keeps bones strong. Affects mood and energy. It even influences skin health and cognitive function.
Estrogen's role goes beyond periods and pregnancy. It affects:
Cardiovascular health
Bone density
Skin elasticity
Cognitive function
Mood regulation
Vaginal health
Urinary tract function
Cholesterol levels
Low estrogen impacts all these areas. It's not just about the hot flashes and mood swings that perimenopausal and menopausal women complain about.
How Long-Term Opioid Cause Female Hormone Problems: LH and FSH, The Cycle Regulators
Gonadotropin-releasing hormone (GnRH) is made in the hypothalamus. GnRH is responsible for stimulating the pituitary gland to release Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH). In males, LH stimulate the testes to make testosterone. In females, LH stimulate estrogen and progesterone production, and ovulation. FSH stimulates egg production in women and sperm production in men. These hormones work in a delicate balance. They rise and fall throughout your menstrual cycle. Opioids can disrupt this dance.
How Opioids Lead To Hormonal Abnormalities
When you take an opioid, it binds to mu-opioid receptors in the brain and spinal cord. Some receptors are found in the hypothalamus. When these receptors are activated, they suppress the release of gonadotropin-releasing hormone (GnRH). The drop in GnRH release decreases LH and FSH. Hormone production slows down. DHEA drops, testosterone and estrogen follows. The whole system breaks down.
The Numbers Tell the Story
Research shows alarming trends. A recent study found:
Testosterone, estradiol, and DHEAS were 48-57% lower in opioid users.
LH and FSH were 30% lower in premenopausal opioid users.
LH and FSH were 70% lower in postmenopausal opioid users.
These differences are significant. They show how dramatically opioids can impact hormone levels. Did your pain doctor, family physician, or obstetrician say anything to you about your opioid meds?
The Consequences of Hormone Disruption
When hormones drop, the effects can be wide-ranging and severe.
Effects of Low DHEA
DHEA reduction causes:
Fatigue
Weakness
Depression
Decreased libido
Muscle mass loss
Reduced bone density
Impaired cognitive function
Impacts of Low Estrogen
Low estrogen leads to:
Irregular periods
Infertility
Hot flashes
Night sweats
Mood swings
Low sex drive
Vaginal dryness
Bone loss
Increased risk of heart disease
Cognitive changes
Urinary tract infections
Weight gain
The study found 92% of women taking opioid pain medications reported sexual dysfunction. That's a staggering number.
Consequences of Low LH and FSH
Low LH and FSH compound these issues. They can cause:
Anovulation (lack of ovulation)
Infertility
Menstrual irregularities
Early onset of menopause
The study found no pregnancies during sustained-action opioid use. This suggests a significant impact on fertility. Any woman on long-term opioids is at risk. Remember, beyond the typical opioid medications, these include methadone, buprenorphine (Suboxone), heroin, and fentanyl. Legal or illegal, they are still opioids. Higher doses increase the problems. So does longer use.
High-Risk Opioids in Chronic Pain Patients
Long-acting opioids are particularly risky. Think:
Fentanyl patches
Sustained-release oxycodone
Methadone
Sustained-release morphine
Intrathecal opioids such as pain pumps
These maintain constant opioid levels in your system. This means constant hormone suppression.
Recognizing the Warning Signs
Subtle changes can signal problems. Look out for:
Increased fatigue
Irregular periods
Mood changes
Decreased sex drive
Night sweats
Vaginal dryness
Difficulty concentrating
Unexplained weight gain
Hair thinning
Dry skin
Joint pain
Frequent urinary tract infections
Don't ignore these symptoms. They're not just stress or aging. They could be your hormones crying out for help.
Long-Term Health Consequences
Opioid Caused Female Hormone Problems aren't just uncomfortable. They can have serious long-term effects.
Osteoporosis Risk - the study found more osteoporotic fractures in opioid users. Low estrogen weakens bones. This puts you at risk for fractures such as hip and vertebral compression fractures. Even if you're young.
Cardiovascular Health - low estrogen can affect heart health. It may increase your risk of heart disease. This is especially concerning for postmenopausal women.
Mental Health - Hormone imbalances can affect your mood. They may contribute to depression. Opioids themselves can cause mood changes. The combination can be challenging.
Diagnosing Hormone Imbalance Through Laboratory Testing
Laboratory tests to consider include:
DHEA-sulfate
Estradiol
LH
FSH
Testosterone (yes, women need this too!)
Thyroid function tests
Prolactin levels
Cortisol levels
In addition to lab testing, there are some questionnaires that do not cost money and can be a quick way to evaluate your symptoms.
Preventing Hormone Disruption
If you're on long-term opioids, be proactive. Get regular checkups. Request blood tests to check sex hormone levels. Monitor your hormone levels closely. If opioids are the cause, you have options. Consider hormone replacement therapy. Or explore non-opioid pain management. You may consider alternative non-opioid pain managements such as:
NSAIDs (like ibuprofen)
Acetaminophen
Gabapentin for nerve pain
Cognitive behavioral therapy
Mindfulness meditation
Yoga or tai chi
Acupuncture
Physical therapy
Biofeedback
Treatment Options For Patients on Long-Term Pain Medications
There are many options if opioid treatment must continue:
Gradually tapering opioid doses
Nutritional support
Exercise programs
Alternative pain management strategies
Regular hormone level monitoring
Psychological support
Be patient. Hormone levels don't normalize overnight. It can take weeks or even months.
Balancing Pain and Hormonal Health
Managing chronic pain is challenging. Opioids can provide relief. But at what cost? It's about finding balance. Effective pain control shouldn't sacrifice your hormonal health.
Call 918-518-1636 For Your Appointment Today
We are conveniently located in Tulsa, Oklahoma. However, we also serve South Carolina, Texas, and Florida through telehalth. We take a holistic approach knowing that you are unique and the hormone treatment for you must be safe, effective, and affordable. Before starting bioidentical hormone therapy, we begin the process with a thorough detailed assessment that identifies your symptoms and the hormone deficiencies involved. Then, we order extensive laboratory testing and present you a specialized treatment plan.
Daniell, H. W. (2008). Opioid endocrinopathy in women consuming prescribed sustained-action opioids for control of nonmalignant pain. The Journal of Pain, 9(1), 28-36. doi:10.1016/j.jpain.2007.08.005.
Daniell, H. W. (2006). DHEAS deficiency during consumption of sustained-action prescribed opioids: Evidence for opioid-induced inhibition of adrenal androgen production. The Journal of Pain, 7(12), 901-907. doi:10.1016/j.jpain.2006.04.011.
*Disclaimer: This blog post is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of your doctor or other qualified health provider with any questions you may have regarding your health or a medical condition before making any changes.
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