Hot flashes, night sweats, insomnia, fatigue, bloating, irritability, depression, and anxiety are all common signs of perimenopause and menopause. For those of us at or approaching midlife, this natural phase of aging is unavoidable, and the effects of menopause can significantly impact our quality of life. While menopause hormone therapy (MHT) remains the gold standard to treat these vasomotor symptoms, use has decreased approximately 80 percent in the last two decades (Martin & Barbieri, 2022) due to its association with side effects such as fatigue and mood swings as well as a potential increased risk for developing breast cancer.
According to a survey conducted by Dahlgren et al. (2022)
women may be turning to cannabis to relieve the taxing symptoms of menopause. The analysis included 258 individuals, 131 were perimenopausal and 127 were postmenopausal. Highlights of this cross-sectional, observational survey include the following.
- Most participants reported at least one lifetime use of cannabis.
- 83.5% reported a history of regular cannabis use (at least once a month).
- 86.1% reported current cannabis use.
- 51.5% of current cannabis users reported mixed medical/recreational use.
- 30.8% reported recreational use only.
- 17.7% reported medical use only.
- For those that reported at least one lifetime use of cannabis, 78.7% stated they used cannabis at some point to treat menopause-related symptoms such as:
- Sleep disturbance 67.4%
- Mood/anxiety 46.1%
- Libido 30.4%
- A variety of forms of cannabis were used, the most common include smoking (84.3%), edibles (78.3%), and vaping oils (52.6%).
- The survey was limited in demographics. Participants were primarily White, non-Hispanic, educated, middle-aged women of middle-class status or above and were employed at least part-time.
Can Cannabis Impact Menopause Symptoms?
The endocannabinoid system (ECS) consists of CB1 and CB2 receptors throughout the body that respond to cannabinoid (CB) molecules, either natural (derived from the cannabis plant) or synthetic (developed in a laboratory). The ECS also produces endogenous cannabinoids as needed and influences physiologic responses such as body temperature, anxiety, depression, hunger, and sleep (Dahlgren, 2022; Klein & Clark, 2022). CB1 receptors are distributed throughout the central nervous system and affect cognition, emotions, pain regulation, memory, and motor control (Dume & Lammers, 2020). CB2 receptors are found in the immune system and moderate inflammation and the immune response to infections.
There are over a hundred varieties of CB, of which delta-9 tetrahydrocannabinol (THC) and cannabidiol (CBD) are the two most used for medicinal purposes (Dume & Lammers, 2020). THC is an agonist at the CB1 and CB2 sites and has a high binding affinity to CB1 receptors in the brain and central nervous system causing euphoria ad psychoactive effects. CBD contains no psychotropic component, has a low binding affinity to CB1 and CB2 and is employed mostly for its therapeutic properties. Medical cannabis use varies from state to state but generally is prescribed to treat pain, cancer, posttraumatic stress disorder, seizure disorders, and nausea/vomiting (Klein & Clark, 2022). Regarding menopause, administration of cannabinoids may result in vasorelaxation and help alleviate vasomotor symptoms, such as hot flashes and night sweats however, additional clinical trials are required to prove efficacy as the survey responses did not indicate an improvement in these symptoms (Dahlgren et al., 2022). Studies are also needed to assess the risks and benefits of cannabis treatment for menopause-related symptoms.
As of the writing of this blog, twenty-three states along with the District of Columbia, Guam and the Northern Mariana Islands have legalized the recreational use of marijuana and thirty-eight allow the medicinal use of cannabis products (Reuters, 2023a). With the expansion of legalization, numerous cannabis-based products have been developed. Consumers must remember that these products are not federally regulated, therefore contents and dosages may differ across products resulting in varying efficacies, responses, and side effects (Dahlgren et al., 2022). In addition, THC is currently classified as a schedule I drug under the Controlled Substances Act which means it has a high potential for abuse and no accepted medical use, and therefore remains illegal at the federal level. Last August, the U.S. Department of Health and Human Services (HHS) recommended reclassifying marijuana as having moderate to low potential for dependence and abuse (Reuters, 2023b). This change could offer researchers more flexibility to conduct randomized controlled studies to thoroughly test efficacy and allow for broader acceptance of these therapies.
If you work in women’s health or primary care, understanding the nuances of this emerging trend will help prepare you for the questions that will arise around cannabis use to treat menopausal symptoms.