Nearly two thirds of perimenopausal and menopausal women taking opioid painkillers were able to reduce or stop them after starting hormone treatment, new research has found.

An analysis by Newson Research suggests hormone replacement therapy (HRT) – particularly when combined with testosterone – could play a significant role in easing chronic pain and reducing reliance on drugs such as codeine and morphine.

Pain-related symptoms, including muscle aches, joint stiffness and headaches, are common during perimenopause and menopause. Many women are in appropriately prescribed strong painkillers, despite known risks including dependency and withdrawal.

In recent years, midlife women have seen the sharpest rise in long-term opioid use and opioid-related deaths.

Reduced reliance on opioids

In research presented at the International Society for the Study of Women’s Sexual Health annual meeting in California, researchers analysed records from 736 women attending the Newson Clinic between November 2023 and July 2024. All were taking opioid painkillers when they first sought treatment.

The women were prescribed HRT to replace declining hormone levels. Most received HRT plus testosterone, while a smaller group received standard HRT alone. Patients were followed for an average of nine months.

By the end of the study, 62% had reduced or stopped theiropioid medication.

Other findings included:

• The biggest improvements were seen in women who received testosterone alongside HRT. Almost 30% of this group stopped opioids completely
• This compared with about 17% of those on HRT without testosterone
• Overall, women taking testosterone were nearly twice as likely to discontinue opioids as those not prescribed this hormone treatment
• Many others were able to lower their dose, highlighting that hormone treatments improved symptoms enough to reduce their need for painkillers.

More effective approach

The authors say the findings highlight the importance of recognising perimenopause and menopause as a potential driver of chronic pain.

Rather than treating symptoms in isolation, addressinghormone deficiency directly offers a safer and more effective approach for some women.

While opioids are known to carry significant long-term risks, hormone treatments are the first-line treatment for perimenopause and menopause-related symptoms. The hormones progesterone, estradiol and testosterone are known to modulate pain receptors as well as altering the way the body responds to pain.

Individualised care is key

The study was observational and based on clinic follow-ups, meaning it cannot prove cause and effect. The authors say larger, controlled trials are needed to confirm the results and determine which women are most likely to benefit.

They also emphasise the importance of personalised perimenopause and menopause care, with treatment tailored to individual symptoms rather than a one-size-fits-all approach.

Download a poster summarising Newson Research’s findings below.