Whether it’s feeling depressed in the days leading up to your period, experiencing painful cramps during menstruation or lying in bed awake due to hot flashes—pain, mood swings and insomnia are symptoms that women of all ages experience due to their complex and nuanced reproductive systems. When we think of women’s health and cannabis, we often think of these symptoms and their associated conditions: premenstrual syndrome (PMS), dysmenorrhea and menopause. Fortunately, cannabis—with its varied therapeutic properties—can offer many avenues of relief.
PMS or premenstrual syndrome encompasses a wide range of unpleasant symptoms including: bloating, fatigue, headaches, cramping, lower back pain, breast swelling and tenderness, constipation, diarrhea and change in mood. These symptoms usually occur one to two weeks before menstruation, typically lasting six days. The cause of PMS is unknown, but it’s thought that hormone changes play a role.
A majority of women have experienced a painful period at some point in their lives—this type of menstrual pain has a medical term: dysmenorrhea. Symptoms typically include cramping or pressure in the abdomen as well as pain in the hips, back and inner thighs. Menstrual cramping is caused by strong contractions of the uterus that briefly cut off oxygen to the organ, resulting in pain. There are two types of dysmenorrhea: primary and secondary.
Primary dysmenorrhea is what women typically associate with being on their period—pain that can begin one to two days before the period starts and that lasts up to 72 hours. Pain can be mild to severe and can be accompanied by nausea, fatigue and diarrhea. Dysmenorrhea typically improves with age, especially if the woman has a baby.
Secondary dysmenorrhea is pain due to a disorder in the reproductive organs—examples include endometriosis, adenomyosis and uterine fibroids. With secondary dysmenorrhea, pain usually begins earlier in the menstrual cycle and typically lasts longer than pain associated with primary dysmenorrhea.
Menopause begins when a woman hasn’t had a period for 12 months. At this point, a woman’s ovaries stop producing estrogen and progesterone, leading to a host of symptoms including hot flashes, vaginal dryness, trouble sleeping, night sweats, slowed metabolism and mood changes—the severity of these symptoms depends on the individual. Menopausal women are also at greater risk for certain medical conditions like osteoporosis and heart disease.
The majority of women will experience PMS in their lifetimes, but clinically significant PMS—symptoms that are moderate or severe enough to affect a woman’s day-to-day functioning—occurs in about 20% to 30% of women. PMS tends to worsen as a woman approaches menopause, typically in her late 30s to 40s. A more severe form of PMS, PMDD—premenstrual dysphoric disorder, affects 3% to 8% of menstruating women.
Dysmenorrhea is a common menstrual disorder that usually occurs within the first year of a girl’s menstrual period. More than 50% of women who menstruate experience some kind of pain for one to two days each month. The prevalence of secondary dysmenorrhea is more difficult to determine because there are various conditions that can cause this type of pain. Typical causes of secondary dysmenorrhea, such as endometriosis, adenomyosis and uterine fibroids are common in the U.S. with more than 200,000 new cases of each condition being diagnosed each year, according to the Mayo Clinic.
Menopause refers to the transition that all women will experience as they age. Interestingly, the onset of menopause can vary depending on the country—for women in Western societies, the typical age of onset is between 40 to 61 years old, with an average of 51 years of age. Women with certain reproductive disorders, who experience premature ovarian failure, or who’ve had surgery to remove reproductive organs may experience menopause earlier than normal.
The endocannabinoid system likely plays a role in all aspects of female reproduction. However, the exact mechanisms of how it does this still needs further study. What we do know is that cannabis anecdotally (and in some cases scientifically) can help with the many symptoms women experience due to PMS and dysmenorrhea—among them abdominal pain, gastrointestinal issues, nausea and mood changes.
Levels of anandamide (AEA)—one of our body’s own cannabinoids that’s associated with emotional responses—are influenced by levels of progesterone and estrogen in women’s bodies. Moreover, research suggests that AEA itself can be produced in the ovary and is under hormonal control. These findings have implications for menopausal women, whose ovaries become less active and stop producing estrogen and progesterone, thereby causing a disruption in levels of AEA in the body. This imbalance may be tied to why women undergoing menopause are anecdotally finding relief with cannabis.
Marijuana is also known to ease the symptoms that many women experience during menopause such as insomnia, mood swings and decreased sex drive; it may also play a role in the treatment of diseases that menopausal women are more susceptible to such as osteoporosis and heart disease.
For PMS and dysmenorrhea, traditional approaches to reduce abdominal cramping include taking over-the-counter (OTC) NSAIDs for pain, hormonal birth control to stop ovulation or antidepressants to help with mood changes. Some women find that cannabis’s multifaceted properties can supplement or even replace these OTC or prescription drugs.
Hormone replacement therapy (HRT) is commonly used to treat the symptoms of menopause, but its use is associated with a higher risk for blood clots, breast cancer and even Alzheimer’s disease. Additionally, some women aren’t good candidates for this type of therapy if, for example, they have a current or past history of certain female cancers.
While not much research has been done on the use of cannabis as a supplement or even replacement to HRT, existing studies pointing to cannabidiol’s (CBD) and tetrahydrocannabinol’s (THC) anti-proliferative actions on cancer cells, higher levels of “good” cholesterol in the blood as well as lower insulin levels in cannabis users, have led some women to augment or even replace their HRT regimen with marijuana.
There are no set cannabis dosages to alleviate the symptoms of PMS, dysmenorrhea and menopause, but a good place to start is with a product or strain that has a high CBD to THC ratio, due to CBD’s anti-inflammatory and mood-balancing properties. Since CBD doesn’t affect the brain in the same way as THC does, it can be a good tool for daytime use. For help with insomnia or severe pain, strains or products with a higher THC content may prove more successful than just CBD alone.
Vaping, ingestion of edibles and the use of topical salves are usually recommended methods of cannabis consumption for women with these conditions. Many women are advised not to smoke cigarettes if they’re on birth control, as smoking can increase the risk for stroke and heart attack. As well, smoking is known to decrease estrogen levels in men and women—a finding that’s especially important for menopausal women who already lack estrogen. Therefore, it’s generally recommended that women on birth control or those experiencing menopausal symptoms avoid smoking cannabis as a precaution.
Photo credit: Tanja Heffner