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Everything You Always Wanted to Know About Cannabis and Menopause

How it works, what to avoid, and where to legally acquire it

With Melanie Bone MD

Seeing a menopause and cannabis savvy healthcare practitioner is one way to make sure your foray into this alternative treatment is both safe and effective.

Just about every one of us going through the stages of menopause or perimenopause knows someone who swears cannabinoids, whether CBD or THC, have made her feel so much better. Maybe you’ve even been experimenting yourself. But does cannabis really help? Or is it all just wishful thinking and clever marketing? The short answer is, it’s complicated.

How cannabinoids work

We all have an endocannabinoid system composed of cell receptors throughout the body that help maintain homeostasis. These respond to endocannabinoids, the cannabinoids your body produces, as well as to external cannabinoids.

There are 113 cannabinoids found in marijuana and hemp flowers. Non-psychoactive compound CBD (cannabidiol) is most often extracted from hemp flowers, which also contain trace amounts of (0.3 percent) THC (tetrahydrocannabinol). Marijuana flowers contain much higher concentrations of THC. We are still learning more about other compounds such as CBG, CBN, and CBC.

Estrogen is important to the endocannabinoid system because it regulates fatty acid amide hydrolase (FAAH), which breaks down certain endocannabinoids. So, if there are lower (or fluctuating) levels of estrogen in your body, this can affect your endocannabinoid system, which in turn may partly explain some of the effects of perimenopause such as depression, anxiety, mood swings, lower libido, and difficulty sleeping. So, it would make sense that doses of cannabinoids would help out with those symptoms. If only it were that simple.

The thing is, we’re still learning about how cannabis works in the human body. Conducting clinical research is challenging, especially because marijuana is still illegal in many states. Thus far there have been no peer-reviewed clinical studies of cannabis with menopausal humans. Research into CBD is still in early stages as well (for example, CBD has been found to address depressive symptoms, but so far only in mice).

That said, preliminary research looks promising for a number of issues associated with perimenopause and the post-menopause years.

Sleep disorders and cannabis

Ob-Gyn and medical marijuana provider Dr. Melanie Bone says sleep disorders, whether falling asleep, staying asleep, or both, are very common among women during the menopause years. When treating patients, she first rules out any other possible medical reasons (such as sleep apnea), then she tailors her treatment according to the type of insomnia her patients are struggling with.

“I think women have trouble turning off their thoughts at night and this causes insomnia,” says Dr. Bone. Sound familiar? “Either they ruminate and can’t fall asleep, or they wake to use the bathroom, and they immediately start thinking about the next day’s to-do list and can’t fall back asleep.” She says cannabis can be very helpful treating these issues. “I usually recommend a higher THC product to fall asleep, but a lower THC product to stay asleep (for if they wake up in the middle of the night).”

Preliminary research backs this up. Certain combinations of CBD and THC may provide relief for conditions such as pain and sleep disorders. One study showed that people with PTSD who smoked 5mg of THC twice a day improved their sleep. And a new 2019 study on CBD and sleep/anxiety concluded that it could be helpful, but that more research was needed.

Cannabis for hot flashes?

THC can mimic some aspects of anandamide, an endocannabinoid that helps regulate body temperature. Can it quell hot flashes?

Dr. Bone says that while hot flashes are best treated with HT (Hormone Therapy), their most common triggers can be treated with cannabinoids. Take one of the biggest triggers, anxiety. “When a woman finds herself in a high-stress moment, she may start to sweat and flash,” says Dr. Bone. “This is often ameliorated with cannabis. I find that higher-CBD products are best to reduce anxiety, but years of practicing have taught me that every patient is unique and there are women who respond best to higher doses of THC to help mitigate anxiety.”

The link between cannabis and sexual function

A meta-analysis of 12 human studies and 8 animal studies concluded that cannabinoids may have an effect on female sexual function, but it’s unclear whether that’s positive or negative, and more studies are needed. As for vaginal/vulvar dryness, that can be partly managed with topical cannabis, Dr. Bone concedes, “but I get better results using a combination of local (vaginally applied) hormones and cannabis.”

The entourage effect

Doctors and researchers are finding that when we use all parts of the cannabis plant, the cannabinoids, terpenes, and flavonoids seem to work together synergistically for maximum effect; and this is called the entourage effect. (Leaving those trace amounts of THC in a CBD product makes it more effective than without.)

That also goes for the complex issues of the menopausal transition, according to Bone. While she doesn’t usually recommend replacing HT with cannabinoids, she says they can be used in conjunction with hormones for best results. “I do see a dose reduction in hormones in a lot of women who use cannabinoids,” she says.

“There is no one-size-fits-all approach,” Dr. Bone cautions. It depends on what you’re treating. “If you have a day-in and day-out set of symptoms such as hot flashes, it is helpful to recommend a form of cannabis that treats for longer duration without impairment.” This could be sublinguals, suppositories, lube, edibles, or infused drinks. It can take a little experimenting to find the right dosage. Vaping and smoking work quickly, but Dr. Bone finds them less than ideal because they would necessitate multiple doses during the day and carry their own cardiovascular risks that many menopausal women are wise to want to avoid.

What cannabis products are best for menopause?

Doctors generally don’t recommend smoking or vaping cannabis because that can damage your respiratory system. Infused food and drinks (edibles), tinctures (liquids in a dropper), or sublinguals (tabs you dissolve under your tongue), and lube are generally considered safer delivery systems.

Sublinguals

Sublinguals are growing in popularity because they are almost as quickly absorbed in your body as smoking/vaping, but without the deleterious health effects. You can take most tinctures sublingually unless otherwise specified.

Your body distributes cannabinoids from sublinguals, smoking, and vaping differently than from edibles, which go through your digestive system. Paradoxically, while we absorb more THC from smoke/vape/sublinguals, edibles are more likely to create a stronger body high, often referred to as the “couch lock.” This is not so bad if you just want to go to sleep, but not too helpful if you want to remain awake and social.

Topicals

Topical CBD in the form of suppositories, lubes, oils or creams can reduce inflammation where applied, and, because your skin has cannabinoid receptors, can temporarily relieve pain from conditions such as arthritis, vaginal irritation during sex, or cramping during perimenopause. But cannabis applied topically will not reach your bloodstream, so it will not address other issues such as anxiety or insomnia, and you will not get high from any amount of THC in the product when it is applied topically, if that is a concern.

Dosing

Effective dosing varies widely by individual and condition. For CBD, most experts recommend starting with 20mg and waiting 90 minutes (especially for edibles) to gage the effects of that dose before taking more. Start low and slow. As for THC products, microdosing (2.5-5mg) is gaining in popularity because it can be highly effective without the psychotropic effects, and a good way to try out cannabis without risking feeling too altered. Remember, you can always add more, but you can’t lower the dose once you have taken it, so start small, particularly if you are just beginning experimenting with these therapies.

If you’re using either or both as a sleeping aid, for best results use in concert with other sleep-supportive strategies such as having a regular routine, avoiding stimulants in the afternoon, and limiting electronics before bedtime. Think of cannabinoids as supporting or enhancing your other health-promoting practices, not replacing them.

How to read cannabis product labels

Familiarize yourself with these terms:

Full spectrum CBD

This means the product includes all the cannabinoids in the hemp flower, giving you the entourage effect.

Broad spectrum CBD

This means nearly the same thing, but with the trace amounts of THC removed.

THC products come in full spectrum as well. Some people prefer isolates, in which specific cannabinoids are extracted for intended results.

Flower not seed

The active ingredient of a CBD product should be listed as hemp extract, CBD cannabidiol, hemp oil, full spectrum hemp, or PCR (phytocannabinoid rich) hemp extract. This tells you it comes from the flower. Do not buy “hemp seed oil” as this is simply oil extracted from the seed, not the flower, and contains no CBD.

Third-party testing

This means a lab independent from the cannabis company analyzed the product and vouched for its ingredients. This is how you know it’s safe and reliable. There should be a CoA (Certificate of Analysis) either in the packaging or online, which you can access via a QR code on the label.

Origin

Products made from cannabis grown in the USA tend to be safer and more trustworthy.

Method of extraction

CO2-based extraction is a very clean kind of extraction because no solvents are used. Also, look for cannabis-infused products. Some edibles are simply sprayed with a solution, which makes them less reliable and effective.

What to be wary of:

Specific health claims

Take any claims about intended effects (sleep aid, reducing anxiety, etc.) in the marketing or packaging with a grain of salt. As cannabis and CBD supplements are not regulated, none of those claims can be substantiated.

Where to buy legal cannabis

If you live in a state where THC is legal, your best bet is a dispensary. As CBD is legal in more states, it’s more widely available in places from yoga studios to boutiques, but just because it’s legal doesn’t mean it’s legal in all forms. According to the FDA, it’s not legal to sell food or beverages containing CBD (you will find them everywhere anyway). For CBD products, it’s especially important to read the labels and buy from trusted sources, e.g. not from a multi-level marketing company.

Two reputable companies that sell legal, high-quality CBD products online and only offer THC if it is legal in your state (so you don’t have to worry about it if it is not) are Lord Jones and Foria.

Cannabis website Weedmaps updates their searchable maps of local dispensaries.

Online magazine Leafly tracks cannabis laws by state (see also their CBD laws by state).

Project CBD is a nonprofit created by journalists who compile the latest research.

Cannabis education platform Nice Paper has a comprehensive guide to dosing CBD.

Information on marijuana and menopause, according to doctors of the medical marijuana network.

How it works, what to avoid, and where to legally acquire it.

Why Some Experts Say Cannabis Can Be Effective in Treating Menopause Symptoms

Share on Pinterest A new survey reports that over one in four female veterans use cannabis to treat menopause symptoms. LightFieldStudios / Getty Images

  • A survey indicates that more women may be using cannabis to treat menopause symptoms.
  • Some experts say cannabis can be effective in treating menopause while others express concerns about the drug’s side effects.
  • One expert recommends using hemp-based products as an alternative.

Over one in four female veterans say they’ve used cannabis to address symptoms of menopause.

That’s even more than the percentage who report using more traditional types of menopause symptom management, such as hormone therapy, according to a study being presented today during the 2020 Virtual Annual Meeting of the North American Menopause Society (NAMS).

“This study highlights a somewhat alarming trend and the need for more research relative to the potential risks and benefits of cannabis use for the management of bothersome menopause symptoms,” said Dr. Stephanie S. Faubion, NAMS’s medical director and a clinician who specializes in women’s health.

Other experts, however, said there’s good science behind the connection between menopause symptoms and the body’s natural endocannabinoid system, even if direct research on cannabis’s effectiveness in addressing menopause is currently lacking.

In the new study, researchers examined data on a sample of 232 women in Northern California who took part in the Midlife Women Veterans Health Survey.

About half of the women, whose mean age was about 56 years old, reported menopause symptoms such as hot flashes and night sweats (54 percent), insomnia (27 percent), and genitourinary symptoms (69 percent).

Of these, 27 percent said they currently use cannabis (in any form) to manage their menopause symptoms or have done so in the past.

Cannabis products were most often used to address hot flashes and night sweats, researchers said.

“These findings suggest that cannabis use to manage menopause symptoms may be relatively common,” said Carolyn Gibson, PhD, a psychologist and health services researcher at the San Francisco Veterans Administration (VA) Health Care System and lead author of the study.

“However, we do not know whether cannabis use is safe or effective for menopause symptom management or whether women are discussing these decisions with their healthcare providers — particularly in the VA, where cannabis is considered an illegal substance under federal guidelines.”

The study didn’t differentiate between use of cannabis products containing the full spectrum of cannabis ingredients, including psychoactive tetrahydrocannabinol (THC), and those containing therapeutic doses of cannabidiol (CBD) and other cannabioids but not THC.

An additional 10 percent of the female veterans expressed an interest in trying cannabis to manage their symptoms.

By comparison, just 19 percent said they used hormone therapy or other, more mainstream interventions to manage their menopause symptoms.

“This is disturbing because hormone therapy is the most effective therapy we have for menopause symptoms, and the benefits typically outweigh the risks for women in their 50s and within 10 years of menopause,” Faubion told Healthline. “Cannabis, on the other hand, is not a proven therapy for menopause.”

Cannabis use for menopause symptoms was consistent across demographic categories, including age, race and ethnicity, socioeconomic status, and mental health conditions.

Smoking cannabis or consuming gummies or other products containing the full spectrum of cannabis ingredients, including psychoactive THC, could have mixed results for women seeking relief from menopause.

“Cannabis is known to have a sedating effect, so it may have a positive effect on sleep disturbance and reduce symptoms of anxiety, but there is also evidence that cannabis use can result in lethargy, increased anxiety, and can provoke serious psychiatric illness,” Samantha Miller, spokesperson for Drug Helpline, told Healthline.

“Menopause is associated with cognitive changes, feelings of ‘brain fog’ and difficulty concentrating. These are also side effects of cannabis use, so using cannabis might actually make these symptoms worse,” she explained.

“Mood changes and irritability are often prominent features during the menopause, which may be counteracted by the euphoric feelings produced by cannabis use. However, there is evidence of a higher incidence of depression in cannabis users.”

Miller also pointed out that there are “no reliable clinical studies looking at cannabis use to aid menopausal symptoms.”

She notes that cannabis products may be illegal in some jurisdictions and are unevenly regulated.

“It would be advisable to obtain these products from a reliable source and start at a low dose to assess any adverse effects,” she said.

Anecdotally, however, many women have found cannabis products to be effective in treating menopause symptoms — particularly insomnia and hot flashes — according to Dr. Junella Chin, the chief medical advisor at CannabisMD.

“Hot flashes are due to the hormonal ups and downs of menopause,” Chin told Healthline. “Estrogen is involved with the body’s endocannabinoid system, and CBD binds to those receptors.”

She added that both CBD and THC are known for their sedative effects, which could explain their reported effectiveness against insomnia.

“It makes sense that some women find relief with plant-based therapy,” said Chin.

Dr. Felice Gersh, an OB-GYN and medical director of the Integrative Medical Group of Irvine, California, told Healthline that beyond hormone replacement therapy, mainstream medicine offers little in the way of relief to women suffering from menopause symptoms other than opioid or NSAID-class painkillers and anti-inflammatory drugs.

“Cannabis products do offer an alternative to what’s out there,” she said.

A new survey indicates more women may be using cannabis to treat menopause symptoms such as hot flashes.