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PHILADELPHIA -- Female veterans were at higher risk for chronic pain and opioid use during menopause, researchers reported here.

Veterans undergoing the transition of menopause were significantly more likely to be diagnosed with chronic pain (OR 1.85, 95% CI 1.80-1.91, P<0.001) and to have records showing chronic pain diagnoses on multiple, separate occasions (OR 1.78, 95% CI 1.73-1.82, P<0.001), according to lead author Carolyn J. Gibson, PhD, MPH, of the San Francisco VA Health Care System, and colleagues.

Long-term opioid use -- reported among 40% of the cohort -- as well as concurrent opioid and sedative-hypnotic use -- reported among 24% of the cohort -- were also associated with menopausal status among women veterans (OR 1.15, 95% CI 1.12-1.20, P<0.001; OR 1.18, 95% CI 1.14-1.22, P<0.001, respectively).

"The relationship between menopause and chronic pain is not well understood. And the relationship between menopause and chronic pain treatment has not been investigated, so we aimed to address that gap within a high risk group of women veterans," said Gibson during an oral presentation at .

A total of 422,737 women were included in the study collected from national VA administrative data. Utilizing ICD-9 codes and national pharmacy data, the authors identified all of the women who had documented menopause-related diagnoses (6% of cohort). Data was also collected regarding menopausal disorders, hormone therapy use, and hysterectomy history.

Long-term opioid use was considered if the woman had been prescribed an oral opioid treatment for a minimum of 90 days, while concurrent use with a sedative-hypnotic was considered long-term use of opioids and sedative-hypnotics or benzodiazepines.

Chronic pain was categorized as the same category of pain diagnosed at least twice, 90 days or more apart.

Those with chronic pain -- reported in 46% of the cohort -- tended to be a bit older, heavier, and more likely to have a mental health diagnosis or substance or alcohol use diagnosis.

Some limitations to the findings include the reliance on data available within the medical records, which Gibson noted is likely to represent a low estimation of women with a menopause-related diagnosis. And given the study design, it's unclear whether non-veterans experience the same apparent risks.

"[These findings] support the idea that menopause transition may be an under-recognized period of risk for chronic pain, as well as for high-risk opioid use," she said. "We may be able to think of menopause as kind of a sentinel event in some way for more difficulty with experiencing these symptoms, or for management of these symptoms, or kind of just additional needs. And we should consider this when delivering comprehensive care to midlife women -- thinking about what it is that we're really treating and how these treatment decisions affect health in the menopause transition and as women are aging."

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