Most people do not tend to think of menopause until the time has come to deal with it, and many may not even know that they have begun the process during its early years. However, the symptoms often progress to such a point that many women seek medical or alternative treatments. Fortunately, cannabis may be an all-natural, alternative, and effective treatment option. Cannabis may also be one part of a multimodal or lifestyle plan put together by you and your provider to help ease the symptoms of waning hormones in your life.
The Changes Brought on by Menopause
Menopause is a normal part of aging and signals the end of natural reproductive years in women and female-at-birth people. The process brings about major changes, such as a decline in fertility as well as physical and brain changes. The natural process involved in the permanent end of menstruation is gradual and divided into three stages called perimenopause, menopause, and postmenopause. Many people refer to the process and its three stages simply as menopause. It should also be known that while it is a natural process, it can be initiated by pharmaceutical medication, chemoradiation, primary ovarian insufficiency, and gonadal surgery.
However, people in menopause may still become pregnant by chance or through in-vitro fertilization (IVF). It is important to first speak with your healthcare provider about any health concerns, like missing a period or menopause symptoms and then follow up regularly to rule out other potentially serious causes of such symptoms including pregnancy. Menopause also results in multiple bodily effects requiring more advanced testing and management of subsequent complications and risks affecting the thyroid, bones, heart, and other systems.
||The stage in the process can vary, beginning as early as around 8 to 10 years before the onset of menopause. It can also be as short as months, but typically lasts around 3 or 4 years (2). In this stage, the ovaries gradually begin to produce less estrogen, and usually, it begins in a woman’s 40s. Although, it is not uncommon for it to start in the 30s. In the last one to two years of perimenopause, the reduced production of estrogen accelerates as one begins to experience menopause symptoms.
- Hot flashes
- Breast tenderness
- Reduced sex drive
- Irregular periods
- Vaginal dryness
- Discomfort during intimacy
- Incontinence while coughing or sneezing
- Mood swings
- Increased anxiety
- Trouble sleeping/insomnia
|Menopause is diagnosed once the person has gone a whole year without experiencing a single menstrual period. In this stage, the body is no longer able to have periods and the ovaries have stopped releasing eggs as well as ceasing most of the estrogen production.
||In addition to perimenopause symptoms:
- No more menstrual periods
- Night sweats
- Weight gain
- Slower metabolism
- Thinning hair
- Dry skin
- Loss of breast fullness
- Reduction in bone density/or even bone loss
|During postmenopause, menopause symptoms typically ease up. However, there are a few unfortunate people who continue to experience the symptoms of menopause for a decade or so long after the menopausal transition. Those who reach this stage are at a much higher risk for an array of medical conditions, which may require treatment in order to reduce the risk.
||This stage has similar symptoms to both perimenopause and menopause. Except for the fact that by this stage, there is no possibility of menstrual periods like the menopause stage. Some experience few symptoms and no longer suffer from hormonal fluctuations.
Additionally, it should be understood that the fluctuation of estrogen and progesterone levels across the stages of menopause can lead to increased anxiety and/or stress as well as experiencing depression or mood dysregulation. Having a healthcare provider is essential for managing any concurrent conditions, concerns, or complications.
What Causes the Process that Ends Menstruation?
- Surgical removal of ovaries (Oophorectomy)
- Cancer treatments such as chemotherapy and radiation therapy (radiotherapy)
Women and people born female will naturally enter the process of menopause when they reach a certain stage of maturity. As women age, there comes a change in the balance of the body’s sex steroid hormones. The body reduces the production of estrogen and begins to stop releasing an egg each month. However, women can prematurely enter menopause and in most cases, there is no clear reason but the removal of ovaries, chemotherapy, and other underlying conditions that contribute to the onset of premature menopause.
The Expert Opinion of Dr. Michelle Sexton
We had the opportunity to speak with Dr. Michelle Sexton, a Naturopathic Doctor who specializes in integrative and functional medicine. Dr. Sexton is also an Assistant Adjunct Professor in the Department of Anesthesiology at UC San Diego. She has 27 years of experience in Women’s Health and 13 years of experience with treating patients using medical cannabis across the lifespan. Through her UCSD affiliation, she works primarily with patients who have underlying chronic pain and opioid dependence. Dr. Sexton spoke at length about the anxiety which is so often associated with perimenopause.
Veriheal: Perimenopause and menopause await all women. How does the condition impact women throughout their lives?
Dr. Sexton: Perimenopause is the time before menopause that can sometimes start really early for women. (Menopause is marked by a full year without a menstrual cycle.) At the end of fertility, when our female hormones are ramping down, I felt like I was in a similar position as my daughter who was 15-years-old, in terms of the effects of hormonal fluctuation such as emotionality and PMS. These symptoms can begin sometimes in women’s 40s, sometimes even in the early 30s. Some women experience menopause at 50, some not until 58.
The ovaries are no longer responding to the follicle-stimulating hormone (FSH) from the brain. This raises the level of FSH, which can have off-target effects on the adrenal glands. Thus, the anxiety. I think FSH is also probably sort of psychoactive, so that and other fluctuating hormones affect thought processes. I used to call this type of “cycling” – cyclic-chosis, because some women have very intense experiences around hormonal times and report feeling almost “psychotic.”
For me, the post-menopause time has been the best time of my life, because it’s like wow, I can’t believe how much hormones messed up my entire life. You’re just living it, and have been since adolescence, so you don’t always realize hormones are to blame.
Veriheal: Benzodiazepines (or anti-anxiety medications) are commonly administered to aid with symptoms of insomnia and anxiety during perimenopause and menopause. Can you tell us about how medical cannabis has helped your patients?
Dr. Sexton: I have seen cases where benzodiazepines make people almost like zombies, when taken several times a day or when they have been on them for a while. You see the same thing in the pediatric epilepsy population. I’ve seen older women similar to this who are kind of numbed out, like a flat affect. There’s no personality there.
To watch women come off of these drugs is almost like watching them come back to life when they start tapering these drugs with the help of cannabis. Even cannabis is not a perfect answer, as you can’t always just add cannabis and get off of benzos easily.
I saw one patient who underwent a two-year taper off of a benzodiazepine drug. She finally got off, and then about a month later, her insomnia recurred with racing thoughts at night. She started using cannabis again at night, and now she’s sleeping like a baby. She previously had no personality…five months later when she came for her follow up, she was like an entirely different person.
Seeing women regain their function, a sense of themselves is extremely rewarding.
Veriheal: Many patients struggling with anxiety turn to medication to alleviate it. What are their lives like once they begin to come off of anti-anxiety drugs?
Dr. Sexton: It totally depends on the patient. As I mentioned with the previous patient, her personality returned to the point that she was socializing again, and her friends all noticed the difference. Sometimes coming off of medications can initiate a healing crisis, where whatever they may have been dealing with at the time in their life when they were put on medications resurfaces. This can provide a transitional healing moment in women’s lives; it’s a time when a therapeutic relationship with a trained professional can be very beneficial.
Patients may be referred to my clinic for pain management and then they may also ask me to help them get off of other drugs. Cannabis comes in as a useful tool specifically for [support while coming off of] opioids, but it has utility for some other drugs as well…I often think of cannabis as a palliative tool.
I rarely see cannabis cure anything, but it can be a means for people with chronic, ongoing conditions to improve quality of life. For my patient with chronic post-surgical knee pain, the pain will likely never be resolved. Patients such as her shouldn’t be expected to use opioids for the rest of their lives as the side effects and risk of overdose are substantial. Additionally, that patient couldn’t tolerate any of the other non-opioid pain medications…which is where cannabis came in as a useful tool.
The Endocannabinoid System & the Challenges of Menopause
Let’s explore in more detail how cannabis may be an effective tool for women experiencing the symptoms of menopause. Thanks to the endocannabinoid system (ECS), the primary target of THC and other cannabinoids, we can experience benefits often associated with medical cannabis.
The cannabinoids include the most abundant compounds, tetrahydrocannabinol (THC) and cannabidiol (CBD), but there are other minor cannabinoids (typically found in lower concentrations) in the cannabis plant, each with its own potential pharmacologic contribution.
Neuroscientist Dr. Michelle Ross has been curious about whether there is a link between the onset of menopause and endocannabinoid deficiency in the body due to the fact that estrogen levels have a clear relationship to the ECS. Further research is needed to determine if cannabis may be used as an alternative to Estrogen Replacement Therapy (ERT).
Additionally, cannabis may be used to alleviate the following symptoms associated with menopause thanks to cannabinoids and their relationship with the ECS. Keep in mind that further research is necessary in all of the following areas to determine any clear benefits, and that established treatments may already exist for you to speak with your healthcare provider about first.
- Hot Flashes: Anandamide is a cannabinoid found in humans that is very similar to THC. It is naturally produced in our bodies and works to assist with regulating body temperature. According to a study published by NIH, since the action of THC is similar to anandamide, it could be used to assist in the regulation of temperature, essentially offering a “cooling” effect. While hot flashes and cannabinoids have not yet been formally studied for efficacy, nearly 30% of respondents reported using cannabis for such symptomatic relief as per a recent VA study presented at a conference of the North American Menopause Society (NAMS).
- Weight Gain and Slower Metabolism: Tetrahydrocannabivarin (THCV) is another cannabinoid found in cannabis that was found to be effective in suppressing appetite. Cannabis as a whole stimulates metabolism, which means it increases metabolism rates. Chronic cannabis users were shown to have a lower Body Mass Index (BMI) than non-users. This is also supported by a 2019 study found in the International Journal of Epidemiology.
- Effects on Bone Density: Cannabinoids have been shown to assist in the regeneration of bone and to impact bone mass. This is possible because bone cells contain cannabinoid receptors, and thus, may help tip the balance of bone-building over bone destruction. Clinical studies should be done to determine the details and evidence behind such a potential future therapy.
- Mood Swings: Matthew Hill and his coauthors assessed the interaction of estrogen and the endocannabinoid system. They found that in mice, estrogen altered the expression of the cannabinoid-metabolizing enzyme FAAH, leading to elevation of anandamide, which could impact emotional behavior and anxiety. Research into blocking FAAH, or conversely by increasing endocannabinoid tone, is necessary to evaluate the impact of cannabinoids on mood swings.
- Reduced sex drive: The cannabinoids found in cannabis can be used to boost intimacy in relationships by enhancing emotional bonding and helping partners release sexual inhibitions that may be caused by anxiety from other areas of their lives. Dr. Becky Lynn’s research in 2019 explored the relationship between cannabis use and sexual function. Read more about it here. In addition, cannabis has been shown to increase libido when taken in lower doses. Larger doses may actually inhibit sexual desire, however. This is why it is important to experiment with doses to figure out what works well for your body in particular. More studies are needed on exactly how cannabis can improve sexual health in women and female-born individuals, but the anecdotal evidence is promising.
- Trouble sleeping/insomnia: Anecdotal evidence supports that cannabis aids individuals who have trouble getting a good night’s rest. Though more research in this area focusing on cannabis available to the public is needed, there is evidence that supports the use of the cannabis-based prescriptions nabiximols and nabilone for sleep apnea and insomnia, according to a JAMA Network systematic review. When looking to consume cannabis for better sleep, it is important to understand its impact as well as what strains would work best. Indica dominant strains typically work best for improving sleep as they promote relaxation throughout the body.
- Anxiety: There is an ever-increasing amount of research support for cannabis as a potential treatment for alleviating stress and anxiety. Cannabis is known for its ‘euphoric’ effect, or potential for elevating mood, which contributes to its ability to alleviate anxiety, and the ECS has been found to be a modulator of anxiety and mood. When it comes to anxiety, it is best to focus on looking for strains that contain larger amounts of CBD as opposed to THC. A study focusing on social anxiety disorder from Neuropsychopharmacology showed promising results in patients who received CBD for anxiety over the placebo. It is important to note that this study was very small, and more research is needed in order to determine clear clinical usages as well as dosages. It should be known that consuming cannabis products with high potency may lead to increased anxiety, which is why it is important to track the doses of cannabis you took as well as the results in order to determine what works best for you.
- Endocannabinoid Deficiency: Cannabis may theoretically assist with treating, what has been proposed to be clinical endocannabinoid deficiency, based on its ability to reduce the expression of fatty acid amide hydrolase (FAAH), which is an enzyme that breaks down anandamide. In other words, by suppressing FAAH, cannabidiol (CBD) may ‘enhance’ endocannabinoid tone and provide a medical benefit. Additionally, check out our article on how to boost endocannabinoids in your body naturally.
As you can see, although there is little research relating to cannabis and menopause, cannabis may be effective in alleviating the symptoms of the stages of menopause. As research progresses, such as the investigation into cannabis as an alternative to Estrogen Replacement Therapy (ERT), we may one day find more and more reasons to consider medical cannabis for those suffering from insomnia and anxiety, and other symptoms associated with perimenopause and menopause. We would like to thank Dr. Sexton for assisting us with our interview and lending her expertise.
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