Drugs and alcohol have been shown to have an effect on the endocrine system, in particular on women’s reproductive hormones. Studies on cocaine use have found that abusing the drug can cause increased level of the hormone prolactin. Increased amounts of prolactin can inhibit ovulation which causes irregular or absent periods. This lack of ovulation may also lead to fertility problems (Mello, Mendelson, Drieze, & Kelly, 1990). Opioid use has been shown to interfere with women’s reproductive systems. Opioids seem to interfere with the release of gonadotropins, such as LH and FSH, from the pituitary gland. When the normal release of LH is affected, the menstrual cycle is disrupted. Many opiate users find themselves not having a period at all (Seyfried & Hester, 2012).
Alcohol abuse also disrupts the endocrine system. Studies have shown that alcohol use in premenopausal women is linked to many reproductive disorders including irregular periods, anovulation, increased risk of spontaneous abortions and early menopause. More specifically alcohol use increases estradiol levels which contributes to menstrual cycle irregularity. Even social drinking, less than four drinks per day, can cause anovulatory cycles and more heavy drinking, less than eight drinks per day, causes hyperprolactinemia. Long time alcohol use can also decrease ovarian reserve, the number and quality of a woman’s oocytes. Even a moderate amount of alcohol use, five or less drinks per week, is associated with decreased capacity to conceive (Rachdaoui & Sarkar, 2013).
Interestingly, hormones also play a role in women’s drug use. Studies have found that the positive effects of drugs such as cocaine and methamphetamine are greater during the follicular phase of a woman’s menstrual cycle than during the luteal phase. Other data suggests that the presence of progesterone in the luteal phase (or administered exogenously) suppresses the effects of stimulants and the presence of estrogen in the follicular phase enhances the effect of stimulants (Moran-Santa Maria,Flanagan, & Brady, 2014). Women, especially those with moderate to severe premenstrual symptoms, have also been found to drink more alcohol during the luteal phase as a way to alleviate dysprhoric symptoms (Evans & Levin, 2011).
In our clinical site at a 3 month residential women's recovery program, 71% of residents reported experiencing irregularity in their menstrual cycle while using drugs and/or alcohol. Coupled with 88% not desiring a pregnancy within the next year, we determined unintended pregnancy to be a significant risk in this population. Additionally, only 50% of the residents report using contraception during every sexual encounter, and all of the residents who reported one or more unintended pregnancies (38%) reported that they were unintended. As a result, we formulated an intervention plan for the facility to increase the use of progesterone-only contraceptives to both reduce unintended pregnancy rates and mediate increased drug-using behavior during the low-progesterone follicular phase.
In terms of primary prevention strategies, we propose increasing enrollment in Medi-Cal through counselor-led enrollment seminars and providing maps to local clinics detailing the services that each clinic provides. Medi-Cal fully covers all progesterone-only contraceptives, in addition to barrier methods such as the male and female condom. Additionally, we would like to continue to have nursing students rotate through the facility every 10 weeks to continue educational sessions on reproductive hormone dysfunction resulting from substance abuse. For secondary prevention, we propose educating the clients at the facility on Medi-Cal's coverage of emergency contraceptives (permitted up to once per month and up to 6 packs per year) as well as providing in-house pregnancy tests to residents and alumni. Finally, tertiary prevention would involve monthly Medi-Cal clinic visits to provide prenatal care and screening for pregnant residents.
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