Guideline No. 443a: Opioid Use Throughout Women’s Lifespan: Fertility, Contraception, Chronic Pain, and Menopause

To provide health care providers with the best evidence on opioid use and women’s health. Areas of focus include general patterns of opioid use and safety of use; care of women who use opioids; stigma, screening, brief intervention, and referral to treatment; hormonal regulation; reproductive health, including contraception and fertility; sexual function; perimenopausal and menopausal symptoms; and chronic pelvic pain syndromes. The target population includes all women currently using or contemplating using opioids. Open, evidence-informed dialogue about opioid use will lead to improvements in patient care and overall health. Exploring opioid use through a trauma-informed approach offers the health care provider and patient with an opportunity to build a strong, collaborative, and therapeutic alliance. This alliance empowers women to make informed choices about their own care. It also allows for the diagnosis and possible treatment of opioid use disorders. Use should not be stigmatized, as stigma leads to poor “partnered care” (i.e., the partnership between the patient and care provider). Therefore, health care providers and patients must understand the potential role of opioids in women’s health (both positive and negative) to ensure informed decision-making. A literature search was designed and carried out in PubMed and the Cochrane Library databases from August 2018 until March 2023 using following MeSH terms and keywords (and variants): opioids, illicit drugs, fertility, pregnancy, breastfeeding, and aging. The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). All health care providers who care for women. Opioid use can affect female reproductive function; health care providers and patients must understand the potential role of opioids in women’s health to ensure informed decision-making. 1.Opioid use by women is problematic in Canada and leads to addiction (high).2.Overprescribing of opioids contributes to the opioid epidemic; women are prescribed opioids for pain relief more frequently than men and misuse of prescribed opioids is their primary pathway to addiction (high).3.Opioids should be prescribed for pain relief only when all other evidenced-based treatments have failed and should be prescribed in the lowest possible dose