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 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.
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.
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.
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.
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.
Menopause and CBD: What to Know
Share on Pinterest Experts aren’t sure if CBD can help ease symptoms of menopause. Getty Images
- How safe and effective are CBD products for managing symptoms of menopause?
- According to medical experts, the jury is still out.
- But CBD-infused tinctures, bath salts, vaginal suppositories, and personal lubricants are just a few of the products being marketed to menopausal consumers.
Hormonal fluctuations during menopause can cause vaginal dryness, hot flashes, mood changes, and other uncomfortable symptoms.
To help manage the symptoms of menopause, some people use hormone replacement therapy or other conventional treatments.
Other people experiment with less conventional approaches, such as medical cannabis or products that contain the cannabis-derived compound cannabidiol (CBD).
CBD-infused tinctures, bath salts, vaginal suppositories, and personal lubricants are just a few of the products being marketed to menopausal consumers.
But how safe and effective are CBD products for managing symptoms of menopause?
According to medical experts, the jury is still out.
“Despite widespread availability and use of cannabis products such as CBD, they remain an unproven option — lacking adequate clinical trials, safety data, and regulation,” Dr. JoAnn V. Pinkerton, a professor of obstetrics and gynecology and director of the midlife health division at the University of Virginia Health System in Charlottesville, told Healthline.
“Women need to consider these CBD products as ‘buyer beware’ for their medical claims, safety, and the actual ingredients being purchased,” Pinkerton added.
Cannabis is commonly known as marijuana.
It’s a psychoactive plant that contains many types of cannabinoids, a class of chemical compounds that includes the well-known tetrahydrocannabinol (THC) and CBD.
THC is responsible for the high that’s associated with cannabis consumption.
CBD, on the other hand, has negligible psychoactive properties and isn’t intoxicating.
This makes CBD oil and CBD-infused products a popular choice for people who want to experience some of the potential medical effects of cannabis without getting high.
“There is a growing body of preclinical and clinical evidence to support use of CBD oils for many conditions, primarily epilepsy, pain control, and addiction,” Pinkerton said.
“At present, there is little reliable evidence to suggest that CBD oil can treat the symptoms of menopause,” she added.
Although more research is needed to assess the potential effects of cannabis and specific cannabinoids on symptoms of menopause, some people have reported positive effects.
When investigators from the University at Albany surveyed menopausal and postmenopausal women who had used cannabis in the past year, respondents reported that cannabis helped relieve some but not all menopausal symptoms.
“A sample of women told us that joint and muscle discomfort, irritability, sleep disturbance, and depression responded well, but vaginal dryness and bladder problems did not,” Mitch Earleywine, PhD, co-author of the paper and a professor of psychology at University at Albany, told Healthline.
These findings might be explained in part by the physiological effects of CBD and THC.
For example, it’s possible that CBD and THC have anti-inflammatory effects that help relieve joint aches and pains, Dr. Mitchell S. Kramer, chairman of the department of obstetrics and gynecology at Northwell Health’s Huntington Hospital in Long Island, New York, told Healthline.
CBD and THC can also increase the level of certain mood-boosting neurotransmitters in the body, which might help relieve moodiness, anxiety, and sleep troubles.
“Although there are no randomized, double-blinded, prospective studies regarding the efficacy of CBD or THC for the treatment of menopausal syndrome, there are a number of these symptoms that might benefit from their use,” Kramer said.
“I would say that much investigation needs to occur before recommending or stating that CBD or THC has any beneficial potential to help in those areas,” he added.
More research is needed to understand not only the potential benefits of CBD and other cannabis products for treating symptoms of menopause, but also the potential risks.
When scientists studied the use of CBD for the treatment of epilepsy, they found that up to 36 percent of participants experienced adverse effects, such as sleepiness, decreased appetite, and diarrhea. Some also tested positive for signs of liver damage.
It’s also possible that CBD or other cannabis products might interact with certain drugs, such as sleep aids. This poses “potential for harm,” warned Pinkerton, “particularly from oversedation or drowsiness while driving.”
Gaps in regulatory oversight in the cannabis industry raise safety concern, as well.
For example, some cannabis products may contain harmful contaminants, such as pesticides and heavy metals. Research has also found that CBD products sometimes contain more THC than advertised.
Using certain cannabis products may also put people at risk for legal repercussions, particularly if they live in states where those products haven’t been legalized. Cannabis laws vary from one state to another.
If someone is interested in trying CBD or other cannabis products to manage symptoms of menopause, Kramer encourages them to talk to their doctor first.
He suggests that a doctor, pharmacist, or other qualified healthcare professional may be able to help someone determine which products to try and how to use them.
“There are a multitude of products out there, and you want to make sure you are getting a quality product and get what you are paying for,” Kramer said.
“Beware of very inexpensive CBD products. Good quality products are not cheap and should be organic. Don’t buy these products from your local gas station or package store,” he continued.
For people who decide to use raw cannabis flower or bud, Earleywine recommends using a vaporizer to consume it in low doses.
“Those who are contemplating using cannabis should probably focus on vaporized flower, not a vape pen,” he advised.
“Use as low a dose as possible to alleviate the symptoms, and start with a high-CBD strain to keep any cognitive effects to a minimum,” Earleywine added.
Is CBD Legal? Hemp-derived CBD products (with less than 0.3 percent THC) are legal on the federal level, but are still illegal under some state laws. Marijuana-derived CBD products are illegal on the federal level, but are legal under some state laws. Check your state’s laws and those of anywhere you travel. Keep in mind that nonprescription CBD products are not FDA-approved, and may be inaccurately labeled.
CBD-infused tinctures, bath salts, vaginal suppositories, and personal lubricants are just a few of the products being marketed to menopausal consumers. But how safe and effective are CBD products for managing symptoms of menopause?