For many women, midlife is a period of significant biological, psychological, and social changes. One of the biggest is menopause, and there’s a growing understanding of how these hormonal changes can affect mood, sleep, cognition, and stress response.
One important yet often overlooked factor is the connection between menopause and substance use. Emerging evidence shows that going the menopause transition can influence substance use patterns, including a woman’s risk of escalating substance use and recurrence after a period of recovery.
Recognizing menopause as part of the substance use continuum is critical to improving health outcomes for women.
An Overlooked Window of Risk
For most women, the transition to menopause can last for years. It includes perimenopause, which typically lasts about four years on average but can extend longer, and post-menopause, which begins after 12 consecutive months without a menstrual period and continues for the remainder of life.
Common symptoms include anxiety, depression, insomnia, and chronic pain. Sleep disturbance is especially common and linked to broader health risks among women in midlife. Hormonal changes can intensify emotional distress, and many women also experience other stressful life transitions such as caregiving responsibilities, career changes, and social isolation.
Women may use substances in an attempt to cope with all of 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 increasing among women in midlife, often for relief of such symptoms as sleep disturbance, anxiety or pain.
Impacts on Treatment and Recovery
Lack of awareness of the connection between menopause symptoms and substance use may keep women from seeking care. In addition, substance use and menopause can have a bidirectional relationship, meaning they influence each other over time.
Sleep disruption and mood instability may make it harder to stay in treatment, while co-occurring conditions may complicate diagnosis and care planning. If these symptoms aren’t addressed, 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 menopausal transition, and co-occurring mental health conditions can make people more vulnerable, especially because symptoms can worsen during menopause.
Despite these challenges, menopause is not usually 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 for women in midlife.
Moving Toward Menopause-Informed Care
This May, SAMHSA is sponsoring its first-ever symposium on how menopause symptoms fit into the substance use disorder prevention, treatment, and recovery continuum of care. The goal is to bring together clinicians, researchers, and policymakers to collaborate, share information and evidence-based practices, and identify gaps in screening, treatment, and prevention.
Addressing menopause within substance use disorder prevention, treatment, and recovery requires coordinated strategies. This includes routine screening for substance use disorders across 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 training and public awareness can help ensure that providers are better equipped to recognize and address menopause-related risks. Integrating menopause into prevention, treatment, and recovery efforts can support earlier identification of risk, more tailored care, and improved long-term outcomes for midlife women.
Resources for women experiencing midlife transitions, substance use disorders, or both
If you or someone you know is experiencing challenges related to menopause or substance use, do not wait to seek support. Learning how symptoms such as sleep disruption, mood changes, and stress can influence substance use can help reduce stigma and encourage earlier engagement with care. Sharing resources and supporting community efforts can also help advance more coordinated, person-centered approaches.
The U.S. Department of Health and Human Services (HHS) offers a range 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 information about substance use, resources, and treatment and recovery options for substance use disorders and co-occurring disorders.
- Office on Women’s Health: Menopause – a resource providing clear, reliable information on the stages of menopause, common symptoms, health impacts, and options for symptom management and overall well-being.
- CDC: Menopause, Women’s Health, and Work – a resource providing an overview of menopause, including common symptoms such as sleep disruption 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 explaining 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 providing an overview of menopause as a natural life stage and evidence-based approaches to managing symptoms and improving quality of life.
- HHS Office on Women’s Health: Advancing Women’s Health Through Collaboration – 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 persons seeking treatment for mental health conditions and substance use disorders (operated by SAMHSA).
- 988 Suicide & Crisis Lifeline – a SAMHSA-operated lifeline for individuals in need of support or in crisis. Call or text 988 or chat 988lifeline.org.
