(093) Impact of MHT +/- Testosterone on Opioid Deprescribing in Menopausal Women With Chronic Pain: A Cross- Sectional Study

Abstract Introduction Pain (for example myalgia, arthralgia, and headache) is a common menopausal symptom. Many perimenopausal and menopausal women are prescribed painkillers as a result of their low hormone levels. Many of these medications are associated with side effects and long-term harms including withdrawal and dependency. In recent years, the largest increase in long-term opioid use and opioid-related fatalities has been seen among midlife women. Menopausal hormone therapy (MHT) is usually a more cost-effective and safer option for the treatment of pain due to hormone deficiency. Objective To determine the proportion of women who reduced or discontinued opioid painkillers after starting MHT. Methods This retrospective cohort study was conducted at a UK-based specialist menopause clinic from 1 November 2023 to 31 July 2024. Women were included in the study if they were taking opioid painkillers (for example, codeine, dihydrocodeine, or morphine), at their initial consultation prior to starting MHT. At subsequent follow-up appointments, patients were asked if they had reduced or stopped their painkillers after beginning MHT. Results 736 women reported using opioid painkillers at baseline, prior to commencing MHT. 575 women (78.1%) initiated MHT with testosterone (transdermal oestradiol and testosterone with micronised progesterone) and 161 women (21.9%) initiated MHT (transdermal oestradiol with micronised progesterone) only. Mean duration of follow-up was 9 months. Overall, 457 women (62.1%) reduced or discontinued their painkillers across the 9-month study period. Among women prescribed standard MHT (n = 161), 61 women (37.9%) reduced their medication, and 27 women (16.8%) discontinued it. Among those additionally treated with testosterone (n = 572), 202 women (35.3%) reduced their medication, while 167 women (29.2%) discontinued it. Discontinuation rates between the two groups were significantly different (p = 0.0018): women using testosterone alongside standard MHT discontinued their opioid medication at nearly double the rate compared to those prescribed standard MHT alone. Conclusions These findings suggest that MHT with testosterone is a more effective treatment than estradiol/progesterone (standard MHT) for pain symptoms experienced by some perimenopausal and menopausal women. More research is needed to better understand how Individualised hormone prescribing can enable effective deprescribing of opioid and/or other pain-relieving medication. Disclosure No.