(93) Perceptions of Fertility among Treatment-Seeking Women with Opioid Use Disorder

Background & Introduction: Women with opioid use disorder (OUD) have higher rates of unintended pregnancies than the general population [1]. At the same time, chronic opioids are known to suppress sex hormones and contribute to menstrual cycle irregularities due to their action on the hypothalamic-pituitary-adrenal (HPA) axis [2,3]. Given such opioid-mediated HPA alterations, many women entering treatment with OUD may believe they are incapable of becoming pregnant during their opioid use [4]. Unfortunately, women have typically been excluded from studies addressing the impact of MOUD on endocrine physiology and fertility, leading to a critical gap in our understanding of the impact of opioid cessation, with and without MOUD, on fertility. To fill this gap in knowledge, national-level real world data is needed to understand women with OUD’s perceptions of fertility and their menstrual cycle characteristics.

Methods: Multi-state data were sourced from the Survey of Key Informants’ Patients (SKIP) Program, a long-running national opioid surveillance study of individuals newly entering treatment with a primary diagnosis of opioid use disorder. Individuals were asked to complete anonymous, self-report surveys, with a response rate of 85%. In January 2024, questions for reproductive-age individuals identifying as female were added, assessing fertility perceptions and menstrual cycle characteristics. We used summary statistics, proportions and means to summarize survey responses stemming from 49 substance use treatment programs in 25 states.

Results: Of 172 respondents, 130 (75.6%) self-identified as being capable of having menstrual cycles. The average age of the sample was 33.9 years (SD 7.24), 57.8% identified as White, 19.5% Black, and 8.6% Native American/Alaskan Native. The most common type of treatment for OUD was buprenorphine (48.0%), followed by psychosocial treatment without medication (45.6%), then methadone (28.0%), and finally extended-release naltrexone (2.4%). While the majority of respondents had a history of at least one pregnancy (80.3%), 39.0% did not currently believe they could become pregnant. Of respondents, 76.8% had at least one menstrual cycle in the past 12 months with 42.7% having irregular cycles and 20.0% having no menstrual cycle in the past 12 months. Of those without a menstrual cycle, 20.0% believed amenorrhea was due to their opioid use (N=25).

Conclusion & Discussion: Almost 40% of treatment seeking women with OUD in the sample did not believe they could become pregnant. Over 40% of respondents experienced irregular menstrual cycles and one in five reported being amenorrheic. These analyses of national data illustrate that women with OUD are in need of evidence-based sexual and reproductive health education and counseling that allows them to understand their fertility in the face of prior opioid use and current treatment for OUD while also informing treatment decisions that are in line with their reproductive goals.

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