Drugs during the menopause
For a long time, stigma has made it difficult to talk openly about menopause and perimenopause. Learning about our changing bodies empowers us to make informed decisions about the support we need.
How drugs affect women’s bodies
Harm reduction is about having the knowledge to make safer choices. Understanding how drugs might affect your body can help you recognise risks and make informed decisions.
Why do drugs affect women differently?
The reasons below explain why women can experience the effects of drugs differently to men, and how this can shape patterns and behaviours of drug use.
Hormones
Hormones play an important role in reproductive health, mood and wellbeing. Women have a different balance of hormones compared to men, with higher levels of oestrogen and progesterone, and lower levels of testosterone. These hormones influence how the body responds to drugs.
Body fat composition
Typically, women have more body fat and less body water than men. This is because of oestrogen, which plays a key role in fat storage and reproductive functions. These differences affect how the body absorbs, distributes and stores some drugs.
Metabolism
Metabolism is the process the body uses to turn food and drink into energy. Hormones play an important role in this process, so different hormone levels can affect how quickly the body processes drugs and how long their effects last.
Menstrual cycle, pregnancy & menopause
Reproductive health causes natural fluctuations in hormone levels and body functions. These changes affect physical and emotional health, and the way your body processes drugs can feel different throughout your lifetime.
We have dedicated guides to how the menstrual cycle and menopause affect drug and alcohol use.
Reward pathways
Hormones can affect the brain’s reward system, which supports how you experience pleasure and form habits. These changes can potentially affect cravings, mood and the feelings of some drugs.
Trauma & stress
Many women drink alcohol or use drugs to cope with trauma and stress. A woman might use substances to survive harms in her past or threats in her present, such as violence and abuse.
Women often progress from first use to dependence more quickly than men, which is called ‘telescoping’. We may also experience greater physical harms at lower levels of use, while hormonal phases can change how drugs feel and how often we use them.
Alcohol
After drinking the same amount of alcohol, women tend to have higher levels of alcohol in their blood than men. Women generally absorb more alcohol because their bodies take longer to break it down, and we tend to have less body water.
These differences mean women are at higher risk of the long-term negative health effects of alcohol. This includes alcohol-related liver disease and cirrhosis, and alcohol-related cognitive decline and brain shrinkage.
There is also increased risk of cancer, including liver, mouth, head and neck, breast and bowel cancer.
Opioids
Opioids have a strong impact on hormones, including evidence that they can reduce oestrogen and testosterone, cause menstrual irregularities, and lead to the absence of periods. Opioid use might result in reduced fertility, low libido, early menopause, as well as bone loss and related harms.
Women who are reaching menopausal age or experiencing perimenopausal symptoms might experience more severe symptoms such as disturbed sleep, fatigue, mood changes, and increased risk of osteoporosis.
Safer injecting
It is important that we talk about how to inject safely when talking about differences in drugs and bodies.
Women are more likely to face problematic, higher risk injections because of a lack of advice tailored to their bodies, and higher rates of contracting HIV.
Much of the available evidence looking at the risks of injecting has not distinguished between genders. As a result, there is less evidence about what works for women who inject drugs.
Women’s veins are often more difficult to access because they are smaller and less visible, which makes it harder to inject successfully. This can lead to multiple attempts before a successful injection, and can increase the risk of vein damage and collapse, bruising and infection.
As women’s bodies and veins are more susceptible to harm from injecting, this may lead to riskier injecting into parts of the body where there is a greater risk of harm or overdose, such as your neck, groin or breasts. Women are also more likely to be injected second, increasing exposure to blood-borne viruses.
Because it’s harder to inject women’s veins, you may rely on someone else to do it for you. Injecting with another person can create unequal relationships and result in higher levels of dependence.
If you are using drugs and would like advice on safer injecting, please contact WiSE or your local drug and alcohol service.
Free injecting equipment at a needle exchange
If you need access to free needles and other equipment to help reduce reuse and make it safer to inject, visit Exchange Supplies for information about where to find one near you.
Find your local needle exchangeStimulants
Stimulants and oestrogen both affect dopamine levels in the brain, a chemical linked to reward and pleasure. This means changes in hormone levels can affect stimulant use, response and relapse.
Women who use stimulants might experience higher levels of anxiety, weight loss, sleep issues, cardiovascular damage, and disruption to the menstrual cycle.
Menopausal symptoms are often similar to the effects of stimulants. This can lead to them being ignored by women who experience them, and missed by health professionals.
Cannabis
Many women report that cannabis helps relieve symptoms of the menstrual cycle or menopause, or help them cope with emotional challenges.
Research suggests women can become frequent cannabis users more quickly than men, despite using lower amounts.
The risks of cannabis use for women include disruption to the menstrual cycle, reduced fertility, memory issues and forgetfulness, and symptoms of anxiety and panic.
Ketamine
Most studies on ketamine have involved men or animals, so the specific ways it affects women have been overlooked.
Research shows oestrogen and progesterone can influence how ketamine affects people who were assigned female at birth. Women may be more sensitive to ketamine use than men, or respond to lower doses of ketamine with stronger positive feelings. The drug’s effects change throughout the menstrual cycle as hormone levels fluctuate.
Women are more likely than men to report anxiety during withdrawal, urinary symptoms, faster clearance of ketamine from the body, greater increases in blood pressure, and cognitive impairment. Using ketamine regularly may increase the risk of becoming dependent.
Benzodiazepines (“benzos”)
Women are much more likely to be prescribed benzodiazepines and are therefore at greater risk of overuse and dependence. Women may also find during benzo withdrawal and recovery more difficult than men.
Hormones such as oestrogen and progesterone can affect the brain in similar ways to benzos. This means hormonal changes can sometimes mimic benzo withdrawal, making symptoms harder to identify.
Older women may be particularly vulnerable to the effects of benzodiazepines because of age-related changes in how the body processes drugs.
There is little to no evidence on how “street benzos” affect women’s bodies.
Women deserve better
For decades, women’s changing hormone levels have been an excuse to exclude us from research. We have far more evidence of how drugs affect men, and even mice, than how to reduce harm for women. If you believe women deserve knowledge and services that reflect our experiences, please consider supporting the WiSE Project.
Ways to support WiSERecent guides
All guides
Menstrual cycle & drug use
Across your menstrual cycle, you’re likely to experience cravings, different sensitivities to drug use, withdrawal and relapse, and changes in your mood and emotions. Understanding your cycle is important when thinking about how you use drugs and alcohol.