For many women, middle age is an important time biological, psychological and social changes. One of the biggest is menopause, and there is a growing understanding of how these hormonal changes can affect mood, sleep, cognitive functionand stress response.
An important but often overlooked factor is the connection between menopause and substance use. Emerging evidence suggests that the menopausal transition may influence substance use patternsincluding a woman’s risk of escalating substance use and relapse after a period of recovery.
Recognizing menopause as part of the substance use continuum is critical to improving health outcomes for women.
A neglected window of danger
For most women, the the transition to menopause can take years. It includes perimenopause, which typically lasts about four years on average, but can be longer, and postmenopause, which begins after 12 consecutive months without a period and continues for the rest of life.
Common symptoms include; anxiety, depression, insomnia and chronic pain. Sleep disturbance is particularly common and are associated with wider health risks among middle-aged women. Hormonal changes can intensify emotional distress, and many women also experience other stressful life transitions, such as care responsibilities, career changes and social isolation.
Women may use substances in an attempt to cope with all these difficult changes. Some women may drink alcohol or use other substances to manage symptoms such as insomnia or mood changes. Others may increase existing use as symptoms intensify. Cannabis use is on the rise among women in middle age, often to relieve symptoms such as sleep disturbance, anxiety or pain.
Implications for treatment and recovery
Lack of awareness of the relationship between menopausal symptoms and substance use may prevent women from seeking care. In addition, substance use and menopause may have a bidirectional relationship, meaning that they influence each other over time.
Sleep disorder and mood instability can make it difficult to stay in treatment, while co-existing conditions can complicate diagnosis and care planning. If these symptoms are not treated, the risk of returning to substance use may increase.
Women in recovery may also face a higher risk of returning to substance use during the menopause transition, and co-existing mental health conditions may make people more vulnerable, especially as symptoms may worsen during menopause.
Despite these challenges, menopause is typically not considered in substance use disorder prevention, screening, treatment, or recovery programs. This gap highlights the need for more awareness, better guidance for providers, and care that is tailored to women in midlife.
Moving towards informed menopause care
This May, SAMHSA is sponsoring its first symposium on how menopausal symptoms fit into the continuum of substance use disorder prevention, treatment, and recovery care. The goal is to bring together clinicians, researchers, and policy makers to collaborate, share information and evidence-based practices, and identify gaps in screening, treatment, and prevention.
Addressing menopause in the context of substance use disorder prevention, treatment, and recovery requires coordinated strategies. This includes routine screening for substance use disorders in primary care, OB/GYN, and behavioral health settings, as well as trauma-informed care approaches. Strengthening collaboration between behavioral health and women’s health providers is also essential.
Expanding workforce education and public awareness can help ensure that providers are better equipped to recognize and address menopause-related risks. Integrating menopause into prevention, treatment, and rehabilitation efforts can support early risk recognition, more tailored care, and improved long-term outcomes for midlife women.
Resources for women coping with midlife transitions, substance use disorders, or both
If you or someone you know is experiencing challenges related to menopause or substance use, don’t wait to seek support. Learning how symptoms such as sleep disturbance, mood changes, and stress can affect substance use can help reduce stigma and encourage early engagement with care. Sharing resources and supporting community efforts can also help promote more coordinated, people-centered approaches.
The US Department of Health and Human Services (HHS) offers a number of resources for individuals, families, providers and communities:
- Substance Use – a comprehensive resource on SAMHSA’s website where you can learn about substances, prevention, treatment and recovery.
- SAMHSA: Substance Use Disorder Treatment – a comprehensive resource with substance use information, resources, and treatment and recovery options for substance use disorders and co-occurring disorders.
- Office on Women’s Health: Menopause – a resource that provides clear, reliable information about the stages of menopause, common symptoms, health effects and options for symptom management and overall well-being.
- CDC: Menopause, Women’s Health, and Work – a resource that provides an overview of menopause, including common symptoms such as sleep disturbance and mood changes, along with guidance on managing symptoms and understanding their impact on daily life and workplace functioning.
- National Institute on Aging: What is Menopause? – a resource that explains menopause as a natural stage of aging, including information on hormonal changes, common symptoms and their impact on overall health and well-being.
- Agency for Healthcare Research and Quality: Menopause – a resource that provides an overview of menopause as a natural stage of life and evidence-based approaches to managing symptoms and improving quality of life.
- HHS Office on Women’s Health: Advancing Women’s Health through Partnership – a resource highlighting a federal partnership to improve awareness, education, and evidence-based care for postmenopausal health conditions.
- FindTreatment.gov – a confidential and anonymous resource for people seeking treatment for mental health conditions and substance use disorders (administered by SAMHSA).
- 988 Suicide & Crisis Lifeline – a lifeline operated by SAMHSA for people who need support or are in crisis. Call or text 988 or chat988lifeline.org.
