The Overlapping Symptoms of Perimenopause and Opioid Withdrawal: When Hormone Therapy is "Even more Important for My Recovery than My Methadone".

Hot flushes, or vasomotor symptoms in menopause, are prevalent in both menopause and opioid withdrawal. While our understanding is limited, the physiology and mechanisms behind vasomotor symptoms in menopause and opioid withdrawal hot flushes are likely similar. Both types of hot flushes are associated with an increase in norepinephrine production and dysregulation of β-endorphin levels. In this case, we present the case of a 46-year-old perimenopausal female who misattributed menopausal hot flushes to opioid withdrawal. She initiated methadone; however, her symptoms of hot flushes did not improve. After being referred to a gynecologist, she started hormone therapy, which completely resolved her symptoms. We discuss the potential implications for clinical care given the overlapping physiologic pathways that lead to symptoms of menopause and opioid withdrawal.