Menopause is a natural phase, typically occurring between the ages of 40 and 58. During this transition, hormonal changes can lead to a variety of symptoms that affect both physical and emotional well-being. Enter cannabis—a plant that has piqued interest for its potential therapeutic effects. It has been cultivated and used by humans for over 6000 years, and has more than 60 cannabinoid compounds. Let’s explore how cannabis may alleviate some common menopause symptoms.
The Role of THC and CBD
Delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) are two key components of cannabis, with somewhat opposing effects. THC is the psychoactive compound responsible for the “high” feeling, while CBD is not psychoactive. THC can be anxiety provoking while CBD can help ease anxiety. Studies have explored the benefits of both compounds in managing menopause symptoms. However, it’s essential to note that these studies often rely on self-reported data and survey formats, which cannot definitively establish clinical benefits.
Self-medication with Cannabis
Due to limitations in researching cannabis for medical use, we do not have robust data for its use in menopause. However, a large number of people experiencing menopause do choose to self-medicate with cannabis. Dr. Lauren Streicher conducted an informal study of her followers' use of cannabis, and she reported the results on Ep 103 of her Inside Information Podcast. According to Dr. Streicher's survey of menopausal women, 27% of women were using cannabis to help cope with menopause symptoms. 77% of the respondents said that cannabis "helped a lot", while another 20% said that it "helped a little". Only 2% said it did not help at all.
If you're wondering what women use cannabis to treat, a 2023 survey of 1485 perimenopausal and postmenopausal women living in Alberta, Canada, answered this question. They found that 34% of women reported currently using cannabis. The women reported using it for sleep (65%), anxiety (45%), and pain relief (33%). 74% of the respondents stated that cannabis was helpful for their symptoms.
Since cannabis is legal in Washington State, I strive to understand the evidence behind cannabis and its uses in menopause, so that I can best guide my patients as to its safety and efficacy.
Sleep Disturbance
Sleep disturbances are a hallmark of menopause. Cannabis, particularly cannabidiol (CBD), has been reported to improve sleep quality for some individuals. In contrast to the above surveys showing that a majority of cannabis users self-report improvement in sleep, the evidence is not conclusive.
A 2022 review of the data on cannabis for sleep found minimal to no impacts on sleep disorders and also noted negative impacts on some individuals. They reported a case study of an individual who developed significant insomnia after withdrawing from cannabis use. However, most of the studies in the review were observational studies and the authors conclude that further research is warranted.
Another 2022 systemic review and meta-analysis found that cannabis may improve sleep in particular for those with chronic pain, but the effect size was small.
If you decide that a trial of cannabis for sleep is right for you, you can consider the recommendations from cannabis expert Ellen Scanlon, as interviewed on Ep 103 of Dr. Streicher's Inside Information Podcast "Can Cannabis Help you Sleep".
She reports the "anecdata" that many people experiencing menopause have found THC products to be most helpful for falling asleep and hot flashes, while CBD products help best with anxiety, staying asleep, or with falling back asleep in the middle of the night. Ms. Scanlon does agree with Dr. Streicher's findings that about 20-30% of people will not respond to CBD.
The following are her recommendations for sleep:
CBD oil tincture under the tongue or CBD infused honey in chamomile tea at bedtime.
For help falling and staying asleep, try a 3:1 CBD:THC gummy 90 minutes before bed. Look for a 6mg:2mg dose. You can start with 1/2 of a gummy and titrate from there.
If you only need help falling asleep, try a THC 1-3 mg tincture below the tongue 15 minutes before bed or 1/4 to 1/2 of a 5 mg edible 90 minutes before bed. Titrate as needed. She reports that edibles kick in more strongly when taken with food.
She reports that CBD oil tincture under the tongue for 30-60 seconds helps with any THC hangover feeling the next day, and that it is also helpful if you wake up in the middle of the night and can't fall back asleep.
Look for products with third party testing.
It is best to use the least amount of cannabis products necessary, both because higher doses of THC can be anxiety-provoking, but also because cannabinoids interact with many other medications, including antidepressants.
Anxiety
A 2020 review found that CBD may indeed have anxiety-busting effects. They report that so far, there is no evidence in humans for abuse or dependence on CBD. Unfortunately, they also report that most studies of CBD for anxiety have been conducted in men, leaving a significant data gap for its use in perimenopausal and menopausal women or gender diverse AFAB folks.
The recommended dose of CBD for anxiety is 100 mg three times a day, which is cost prohibitive for many. Its side effects include dry mouth, daytime sleepiness, dizziness, fatigue, and nausea.
Chronic Pain
If you suffer from chronic pain, this is the symptom with the most compelling evidence for cannabis use. This may be due to the anti-inflammatory effects of both THC and CBD. A 2024 systemic review and meta-analysis of over 20,000 patients found that cannabis is similarly as effective as opioids for chronic non-cancer pain. The expert recommendation is to use a CBD-centric approach and to start at 5mg cannabis, titrating up to 40mg daily as needed.
For those who prefer to avoid cannabis, consider a 2023 meta-analysis looking at palmitoylethanolamide (PEA) for chronic pain. PEA is a non-cannabis supplement that also works on the endocannabinoid system. This study found significant improvements in pain, quality of life, and functional status for PEA users compared with controls, with no major side effects.
Genital Use
Although 23% of respondents with chronic pelvic pain reported using cannabis as an adjunct to their treatment in one 2021 survey, there have not been robust studies on the use of topical cannabis on the genitals. Another 2023 survey found that 3 out of 4 respondents suffering from chronic pelvic pain would consider a vaginal or vulvar application of cannabis. Studies have shown that CBD is absorbed more readily through the skin than THC.
If this is something you'd like to try, consider a company like Pacific Roots that undergoes third party testing of their suppositories and lubricants. The Medical Director of Pacific Roots, Charity Hill, MD, has found that vaginal and/or anal CBD helps about 75-80% of her patients with chronic pelvic pain according to this webinar, including those living with endometriosis, fibroids, adenomyosis, menstrual cramps, and abdominal cramps from irritable bowel syndrome. She also finds that full-spectrum CBD products (with <0.3% THC) are typically more effective than broad-spectrum CBD.
Hot Flashes
A 2021 systematic review found no compelling evidence to suggest for or against using cannabis for hot flashes due to the lack of high-quality data. More research is needed.
Future Directions
Endocannabinoid receptors are found in the bladder, and there is some evidence that cannabis can help with neurogenic overactive bladder. Cannabis likely helps with neuropathic pain, but has not been specifically studied for pelvic neuropathic pain disorders such as pudendal neuralgia. CBD in particular has been found to have anti-cancer properties as well, including in breast cancers. See the 2020 review "Cannabidiol (CBD) as a Promising Anti-Cancer Drug".
Cannabis is a complex plant with over 400 chemical compounds. Other compounds of interest include:
Cannabinol (CBN) may with sleep and insomnia, and further studies are underway.
Cannabigerol (CBG) may improve anxiety, depression, pain, and sleep.
Tetrahydrocannabivarin (THCV) may suppress the appetite and reduce fasting blood glucose.
Cannabichromene (CBC) may help with pain and inflammation.
Conclusion
While cannabis shows promise in alleviating menopause symptoms, it’s crucial to consult with a healthcare provider before incorporating it into your wellness routine. As research continues, we hope to gain a deeper understanding of how cannabis interacts with menopause-related changes. Remember that individual experiences may differ, and what works for one person may not work for another. Cannabis frequently causes side effects such as dry mouth, daytime sleepiness, dizziness, fatigue, and nausea. Cannabis may interact with other medications, such as blood thinners and antidepressants. Cannabis use is discouraged in people with severe psychiatric, heart, kidney, or liver disorders.
Disclaimer: This blog post is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before making any health-related decisions.
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