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Despite advances in medicine, mortality rates for middle-aged white men and women have increased over the past decade while death rates have fallen for nearly every other racial and ethnic group. Experts are still trying to figure out why this is happening, but drug abuse and depression appear to be common themes.

For the latest installment in its “Unnatural Causes” series, the Washington Post examines death rates in middle-aged white women and proposes a sad but interesting theory: Changes in menopause treatments may have led some women to abuse prescription drugs and alcohol.

First, a look at the scope of the problem. The Post determined that opiate overdoses in middle-aged white women went up 400 percent between 1999 and 2014. White women are not only more likely to be prescribed opioid painkillers than women of other races, but they’re also more likely to take a combo of opioids and anti-anxiety drugs known as benzodiazepines (e.g., Xanax, Valium, Klonopin, Ativan). White women are five times more likely than white men to be prescribed this combination.

Both opioids and benzos can depress the central nervous system, slowing the heart rate and breathing, and combining them can be fatal — people might go to sleep and never wake up. Adding alcohol to the mix is even riskier. Today, federal health officials announced required warning labels on all opioids and benzodiazepines to alert people that taking them at the same time could be deadly.

Where does menopause fit in? Because of the controversy over the risks of hormone replacement therapy, or HRT, for menopausal or perimenopausal women. A large 2002 study found that women treated with estrogen and progesterone had higher risks of heart attack, stroke, blood clots, and breast cancer.

Many doctors hit the breaks on HRT after that study and their patients “white-knuckled” their way through menopausal side effects like worsened mood, increased anxiety, sleep problems, incontinence, and decreased sex drive. Some women may have sought out alcohol, anxiety meds, and painkillers to cope.

Beyond the dangers of mixing these substances, the cruel irony here is that long-term opioid use makes women’s hormone situations worse, says Beth Darnall, a Stanford University professor who specializes in pain-psychology research.

“When women go through menopause, there are big changes with pain, anxiety and depression. There is a hard body of research on this,” Darnall said. “Opioids, taken long term, reduce the level of hormones in the body. This can lead to a greater sensitivity to pain. And it can feed into this dose-escalation cycle.”

HRT is now believed to be safe for healthy women under 60. While the temporary shift in menopause treatment certainly isn’t the only reason why more women are addicted to painkillers (and suffering overdoses), it’s a theory that’s worth discussing.