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.
The One Thing That Finally Cured My Hot Flashes and Insomnia
Could it work for you, too?
Natalie Gillespie sighed in frustration as she felt beads of sweat trickle down the back of her neck. “Not again!” she huffed, blasting her car’s air conditioner and hoping she wouldn’t be drenched by the time she finished driving carpool.
Since starting menopause, the 52-year-old Florida mom had been experiencing hot flashes, night sweats, fatigue, and headaches. But she never imagined a new job — and an unconventional treatment — would be the answer to her prayers.
When Natalie was first offered the position of editor-in-chief of a website called God’s Greenery, a free online resource for Christians to explore cannabidiol (CBD) — a chemical derived from cannabis claimed to have healing benefits —she was very hesitant to accept. As a devout Christian, she felt it would be going against her beliefs. She had a strong conviction against the recreational use of marijuana and wasn’t sure if CBD was the same thing. But after reflection and prayer, Natalie realized that many other Christians may have the same questions, and by taking the job, she could help clarify the facts.
Determined to learn everything she could about CBD, Natalie began scouring scientific studies and quickly discovered that CBD is legal and just one of many chemicals in the cannabis plant. In fact, THC, which causes a high, is a completely different substance. She also read that when used by itself, CBD actually helps disorders like anxiety, depression, heart disease, and pain.
But Natalie was even more surprised when she asked her Christian friends their thoughts — and some had already tried it. One friend, who’d suffered from severe psoriasis, had done everything her doctors suggested without relief. But after using CBD for three weeks, her skin completely cleared. Amazed, Natalie found herself thinking about her own menopausal symptoms. And after praying about it a bit more, she decided it was worth a try.
Relief at Last
Last April, after buying a type of CBD oil, Natalie began putting a few droplets under her tongue before bed. She was shocked when after just two nights, her night sweats had stopped. Over the next week, her hot flashes eased, she felt less anxious and more energetic, and she experienced fewer headaches. Natalie continued using CBD nightly, and soon all of her menopausal symptoms vanished — and have stayed at bay! “At first, I dismissed CBD, but I am so grateful that I did the research and tried it,” she says. “It has changed my quality of life and made me feel like myself again!”
CBD Questions — Answered by an MD
We asked Mary Clifton, M.D., a board-certified internal medicine physician, an expert on medical use of cannabidiol (CBD), and a consultant for cannabisMD.com, to address our biggest concerns about CBD. Her insights:
How does CBD work? “Derived from the cannabis plant, CBD stimulates the body’s endocannabinoid system,” explains Dr. Clifton. “This helps keep all the body systems — immune, respiratory, digestive, etc. — balanced and working together.”
What conditions does it help? “CBD helps reduce inflammation, which lowers pain and anxiety and improves sleep,” she says. “And new research indicates CBD may calm menopause symptoms, such as night sweats and hot flashes.”
Is it safe? Does it make you ‘high’? “It is very safe, and CBD won’t create a ‘high’ like THC. It’s FDA approved for treating epilepsy, and research continues to validate its use for multiple conditions. The caveat: CBD doesn’t work for 20% of those who try it.”
What do I look for? “Try a CBD tincture under the tongue. Results should happen within 10 minutes, so you’ll know if it’s working. Also, choose a product that’s had third-party testing, which should be clearly displayed on the label.”
This story originally appeared in our print magazine.One woman was struggling with regular hot flashes at night that prevented her from sleeping. Then, she discovered a miracle cure. ]]>