Women prescribed long-term vs short-term opioids for chronic musculoskeletal pain may be at increased risk for menopause and abnormal menstruation, according to a study published in European Journal of Pain.

Whereas many studies have suggested that long-term opioid therapy can harm the male reproductive system, little has been reported on the association between opioid prescription and reproductive dysfunction in women. Investigators conducted a matched cohort study of 44,260 women (median age, 43 years) who were prescribed opioids for musculoskeletal pain between 2002 and 2012.

Using data from the Clinical Practice Research Datalink, researchers examined the effects of long-term and short-term opioid therapy on reproductive function. Median follow-up was 39 months, and primary outcomes were altered or absent menstruation, menopause, decreased libido, and infertility.

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Abnormal menstruation was found to occur at a higher rate in women taking long-term vs short-term opioid therapy (209.5 per 10,000 person-years vs 186.2 per 10,000 person-years, respectively). Menopausal symptoms were more common in women on long-term vs short-term opioid therapy (393.7 per 10,000 person-years vs 330.0 per 10,000 person-years). Low libido had comparable incidence in women on long-term and short-term opioid therapy (27.7 per 10,000 person-years vs 22.6 per 10,000 person-years, respectively) and infertility (19 per 10,000 person-years vs 16.4 per 10,000 person-years, respectively).

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Study limitations include the lack of a group with women not taking opioids.

“It is recommended that clinicians undertake regular reviews of patients prescribed long-term opioids to assess the effectiveness of the medication [and] to raise the possibility of adverse effects including reproductive adverse effects as patients may not volunteer these symptoms,” concluded the study authors.

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Richardson E, Bedson J, Chen Y, Lacey R, Dunn K. Increased risk of reproductive dysfunction in women prescribed long-term opioids for musculoskeletal pain: a matched cohort study in the Clinical Practice Research Datalink [published online June 6, 2018]. Eur J Pain. doi: 10.1002/ejp.1256