Scientists who study substance use have discovered that women who use drugs can have issues related to hormones, menstrual cycle, fertility, pregnancy, breastfeeding and menopause. Women themselves describe unique reasons for using drugs, including controlling weight, fighting exhaustion, coping with pain and attempts to self-treat mental health problems.
Female drug users make up a significant share of people who use drugs. Although no firm figures are available on the exact number, it is estimated that in Africa, females count for 10 to 20 per cent of all injecting drug users and that their numbers are growing.
Research has also found out that in Kenya, most women were introduced into drug use by male sexual partners in their teenage years, between the ages of 11 and 17. A key factor in their continued drug use were these, often volatile, relationships.
Female fertility is especially susceptible to disruption and many drugs can disrupt the proper function of the processes involved in conception. With men, it comes down to whether or not they produce viable sperm.
With women, however, many factors and systems that must be working properly, such as: hormone production – multiple hormones from multiple glands (thyroid, pituitary, hypothalamus, adrenals, and ovaries); menstrual cycles; ovulation; the reproductive tract, including the cervix, uterus and fallopian tubes
Even legal drugs can affect fertility in women. In one study, alcohol use was found to decrease women’s fertility by more than 50 per cent and this effect was magnified if they also used caffeine. Even in women who did not drink alcohol, consuming caffeine the equivalent of more than one cup of coffee per day was found to reduce the ability to conceive.
Drug abuse can directly affect fertility by acting on the body systems that are responsible for reproduction. It also has an indirect effect, based on how drug use and addiction can affect health and lifestyle. Besides affecting fertility, drug use can have negative effects once pregnancy does occur. Drugs, including nicotine, can have serious adverse effects on the pregnancy and on the baby.
These negative effects are most likely to happen during the first three months of the pregnancy when the woman might not even realise that she is pregnant. This is a serious problem, given that the unintended pregnancy rate for women with opioid addiction is as high as 86 per cent.
Women can respond to substances differently. For example, they may have more drug cravings and may be more likely to relapse after treatment. Illicit drugs affect women’s fertility in a variety of different ways. For women who use more than one of these drugs (such as someone who smokes, drinks alcohol and uses marijuana), the effects can add up.
Cannabis disrupts the menstrual cycle and decreases ovulation while stimulants, such as cocaine and crystal meth, cause adverse effects at most levels of the reproductive system and cause a high rate of miscarriages. Opioids on the other hand disrupt pituitary and hypothalamus hormone production, causing menstrual irregularities and halting ovulation.
In most countries of the world, the circumstances of women’s lives are very different from those of men. This is also reflected in their experience of substance use problems. Women’s substance use problems are more stigmatised and less likely to be acknowledged than men’s. As a result, much less is known about the prevalence and patterns of women’s substance use, and their treatment needs.
Women with substance use problems also experience significant barriers to accessing treatment, and are believed to be underrepresented in treatment settings. Cultural taboos and stigma mean their substance use problems are often not acknowledged by themselves, their families or helping professionals who could support them in seeking treatment.
Mwangi is manager corporate communications-Nacada
Twala is manager counselling and rehabilitation-Nacada
