Prescribing of Opioids in Menopausal and Postmenopausal Women in the UK: A Population-based Drug Utilization Study

Background: Menopausal and postmenopausal women often experience pains due to fluctuations in the female hormone oestrogen. Opioids are often prescribed to manage chronic noncancer pain arising during menopause and post-menopause. We examined opioid prescribing rates in (post)menopausal women with a diagnosed musculoskeletal condition.

Objective(s): To examine the use of opioids (alone or in combination with HRT) in the United Kingdom (UK) primary care setting among (post)menopausal women with chronic noncancer pains associated with a diagnosed musculoskeletal condition.

Methods: This population-based drug utilisation study described opioid prescribing rates in women aged 50-79 with a newly diagnosed musculoskeletal condition from January 2010 to December 2021 using IQVIA IMRD-UK primary care data (n=380,085). Pain conditions included osteoporosis, osteoarthritis, rheumatoid arthritis, polymyalgia rheumatica, and fibromyalgia. Women receiving palliative care were excluded from the cohort. Women entered the study on the date of pain diagnosis between their 50th and 80th birthdays and were censored at the date of death, practice transfer, or last data collection. Opioids (topical and oral formulations) include codeine, co-codamol, co-dydramol, dihydrocodeine, morphine, tramadol, buprenorphine, oxycodone, and fentanyl. Annual incident prescribing rates were calculated by dividing the number of women aged 50-79 with a first opioid prescription after musculoskeletal diagnosis by person-years-at-risk (PYAR). Annual prescribing prevalence per 100 women was calculated using mid-year population estimates. The average annual percentage change in prescribing rates was assessed using linear regression. Discontinuation rates were computed using survival curves. Specific results were stratified by age, pain indication, and calendar year.

Results: From 2010 to 2021, the rate of new opioid prescriptions remained stable. Incident prescribing rates increased in women aged 50-54 (161.4 [95% CI 149.7-174.0] per 1000 PYAR to 239.6 [95% CI 211.7-271.2] per 1000 PYAR) and in women with fibromyalgia (184.4 [95% CI 163.3 to 208.3] per 1000 PYAR to 259.6 [95% CI 226.4 to 297.8] per 1000 PYAR). Opioid prescribing prevalence decreased from 23% to 14%. The annual proportion of women prescribed both HRT and opioids declined from 2010 (0.44%) to 2021 (0.24%). The average duration of opioid use decreased from 3 years to 1 year post-2017.

Conclusion: Opioid prescriptions for (post)menopausal women with chronic non-cancer pain have remained steady, with increasing rates among younger women ( <54 yrs) and those with fibromyalgia. Despite this, overall opioid prescribing is decreasing, attributed to shorter prescription durations in recent years within this demographic.