May 10 2021 . 11 min read
Not Your Mother’s Menopause
Not Your Mother’s Menopause
Women are increasingly turning to cannabis to get relief from menopause
Women are increasingly turning to cannabis to get relief from menopause
I’m 51 years old. That makes me the average age to begin menopause in the U.S. So I speak from experience when I tell you that with the onset of perimenopause and menopause come a litany of side effects that make it a less than coveted experience. Night sweats, hot flashes, mood swings, insomnia, pain, low libido, fatigue, brain fog, and osteoporosis are the headline symptoms of going through this chapter of life.
As more states, current count is 17, and Washington, D.C. legalize cannabis for recreational use it has become an increasingly popular choice for treating the effects of menopause. In a study released in September, 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. Those numbers are much higher than the 19 percent of women who reported using traditional methods such as hormone therapy.
This makes sense, especially if you consider the symptoms of menopause. Cannabis has properties that can prove helpful for many of the effects resulting from menopause but there is a lot more to it than that. Considerations include bringing homeostasis back to the body’s endocannabinoid system, utilizing the right cannabinoids to regulate hormones, and even adding healing terpenes to the mix.
DOES CANNABIS HELP WITH MENOPAUSE?
“Yes, depending on what the symptoms are,” confirms Dr. Junella Chin of MedLeafRx. “It’s a little bit tricky. Menopause and perimenopause bring on a whole set of symptoms. But it’s not as cut and dry. It really depends on what your symptoms are, what you’re trying to treat, and then what your previous health history is.”
“When you look at all the symptoms that women experience in menopause, it’s no big surprise,” Dr. Felice Gersh of Integrative Medical Group says of cannabis as an elixir for menopause. “I can’t give specific amounts and directions for how best to use it, but look at the issues that medical marijuana has shown to benefit such as various types of pain, sleep, and different things with mood. If you look at what women in menopause experience, they have high rates of pain; women experience far more pain than men do. They’re going to have more compression of their vertebrae, falls, and fractures, which cause lots of pain. And they make up the higher percentage of people suffering from osteoarthritis. Women have more mood disorders then men, more sleep problems, more digestive problems. So when you think about mood and sleep, particularly depression, insomnia, all those pain issues—it’s no surprise that women are turning to medical marijuana for some relief.”
Let’s look at insomnia. “A lot of menopausal women just can’t get to sleep and then they can’t stay asleep,” explains Dr. Chin. “Cannabis is a nice thing to take for insomnia. When you have it occasionally, you’re basically nipping it in the bud. So if you have trouble falling asleep, you could take something that’s fast-acting, and that’s usually in the form of an inhaled version, like a vape pen, bud or flower. If you have trouble staying asleep and are getting up at 2 a.m. or 3 a.m. and 4 a.m. that’s when you use something like an edible or an oil tincture or a gel cap.”
As for treating hot flashes and night sweats with cannabis, Dr. Gersh says data for those symptoms “is scant and conflicting. There’s some data that suggests that using cannabis will make vaginal dryness worse or won’t have a benefit on hot flashes or can even make them worse, and other studies show the opposite.”
Dr. Chin agrees and recommends patients who flash and suffer from night sweats take natural supplements to help balance out hormones. “Basically, it’ll help you fall asleep and relax so you won’t notice the hot flashes as much if that makes sense. It doesn’t help you with the actual flashing, but patients slept through the night. Their sheets are still wet and they’re still sweating but they slept through it. I actually recommend other plant-based supplements like passionflower, lavender, bergamot, Melissa essential oil to help balance out hormones naturally.”
THE ROLE OF THE ENDOCANNABINOID SYSTEM
The body’s endocannabinoid system is one piece of the puzzle. It interfaces with all the other systems in your body. “Your lymphatic system, your immune system, your respiratory system, your nervous system, your fight or flight response, your relaxation…it also puts you to sleep, helps you eat and digest—all of that interfaces with the endocannabinoid system. There’s actually nothing in your body that doesn’t interface with the endocannabinoid system. That’s how important it is,” explains Dr. Chin.
Menopause disrupts the endocannabinoid system which has cannabinoid receptors throughout the female reproductive system. “There’s an incredible relationship between our natural endocannabinoid system and estrogen and progesterone,” says Dr. Gersh. “A lot of people don’t know the endocannabinoid receptors are in the uterus, fallopian tubes, ovaries, and, in fact, the endocannabinoid system is critical for fertilization and embryo implantation.
“When you’re in menopause your nervous system changes because the hormones are changing. So you might feel like you’re in a fight or flight mode more often than not so that adrenaline feeling that causes heart palpitations, the flashing or even just the pain and fatigue,” Dr. Gersh explains of how changing hormones effect the body. “Some women don’t get any of that, but they just feel slow like they’re moving through molasses, like they have brain fog. When you take cannabis it helps balance the endocannabinoid system, which in turn is sort of like this waterfall effect that helps balance your nervous system. We can go into more complicated science behind it, but basically it works on GABA receptors, serotonin receptors, and dopamine receptors.”
CANNABINOIDS & TERPENES
It’s been theorized that the use of cannabis during menopause may help bolster the endocannabinoid system’s functions that are struggling to work without high levels of estrogen. “When you’re in full blown menopause there is no progesterone and there is no estrogen produced. That’s why the best candidates, in my opinion for using something like marijuana or any of these hemp products, is really menopausal women because you don’t have to worry about messing with their hormones because they aren’t making any,” explains Dr. Gersh.
“There’s a lot of data that when you go through menopause you get the sort of metabolic chaos that comes along with menopause—you get inflammation, you get insulin resistance, and you get all these inflammatory processes in your vascular system, your bones, your joints and all of that. Taking predominantly CBD can help because you end up having an overstimulation of the endocannabinoid system,” Dr. Gersh continues, “There’s also data that for the brain you might be doing some good by taking small amounts of THC for both sleep and cognition. There’s just so much more research that we need to do because we know that sleep and cognitive issues are definitely problems for women as they age. There’s a real balance between a little bit of THC and then a heavier amount of CBD.”
There is one vital thing to know when adding THC to your menopause regimen. “What’s interesting is women are very sensitive to THC, and it’s because of our estrogen,” imparts Dr. Chin. “So estrogen actually amplifies THC. You might notice your husband and your friends who are male can smoke more weed than you can and it’s because our estrogen makes us much more sensitive to it. So a little goes a long way. Women just can’t tolerate THC. It makes them feel jittery or like they want to crawl out of their skin. So then they look at cannabinoids like CBD or CBN (cannabinol). CBN is a cannabinoid that makes you sleepy, but it’s not THC.”
Or you can skip cannabinoids and try a supplement called inositol that helps with sleeping. “Inositol is really great to help with evening out the blood sugar and getting a better night’s sleep. And then if you don’t want to take a pill, beans have a lot of inositol in them. So have some lentil soup, red beans, chickpeas, things like that,” explains Dr. Chin.
In addition to cannabinoids, terpenes also factor into the healing properties of the cannabis plant. Terpenes are basically essential oils. “Terpenes are found in your kitchen. Rosemary, thyme, lavender, passionflower, bergamot —those are terpenes and are really great for balancing female hormones naturally,” details Dr. Chin. “And cannabis, luckily enough, has terpenes in it. So certain terpenes that are rich in certain cannabis strains might be lavender (linalool), it might help you sleep better. There’s limonene which is lemon and is a little more uplifting and so that’s really great for menopausal patients who just can’t focus. They may not want to add medication, but have a hard time focusing so they’ll take a cannabis strain with a little more limonene in it.”
HOW TO START
If you are interested in trying cannabis for treating symptoms of menopause, Dr. Gersh stands by the mantra of starting low and going slow. As for ingestion formats, she has used it all: gel caps, sublingual drops, salves, and vaginal suppositories. “I have quite an array of different types of hemp-based CBD and the full entourage, the full spectrum kinds of products and I use them liberally, especially in my postmenopausal women.”
Dr. Chin starts women with more CBD-heavy doses if they’re cannabis novices. “That way they can get some cannabinoids in their body and not have to worry about feeling sedated or altered. I start with CBD first and then I start introducing THC in micro amounts to the CBD,” she explains, recommending a capsule or a quick dissolving tablet. She also suggests oral dissolvable strips, similar to breath freshening strips, made of CBD oil. “They come in one milligram, two milligrams and you can just pop a strip in and it dissolves under the tongue and you’re done. If you don’t mind that earthy, sort of cannabinoid taste you could use a tincture too.”
Dr. Chin points out that one of the advantages to using cannabis is it’s not all or nothing. “You can use it occasionally. You use it on the days that you need it and then on the days you don’t, you could just back off. It’s not like there’s a withdrawal period, or you have to wait six to eight weeks for it to work like a prescription medication such as an anti-psychotic or anti-depressant.
“You’re dialing it in as you go. You might be having a really stressful time so sleep is really erratic and you’re flashing a lot so you might just use cannabis for that week a little more heavily and then you back off. If you’re on vacation and unplugged, for example, you might be sleeping great and might not need to use cannabis at all,” she finishes.
The easiest way to proceed is by treating your symptoms. If you are suffering from insomnia, take a 5 mg indica gummy, a CBD sparkling soda, or inositol before bed. If you are having brain fog, then seek out some remedies to help you focus, whether that’s lemon essential oil or finding a cannabis strain with limonene or pinene. Maybe you are anxious about all the changes happening to your body, then seek out a tincture with linalool and put a few drops under your tongue or try using lavender essential oil.
Dr. Gersh concurs, “Basically I’m prescribing cannabis for symptom relief, but I think that there could be some real underlying health benefits that go beyond just symptom improvement. But that’s where we definitely and desperately need more data because we know that women have all these problems. Women die from heart attacks as their number one cause of death. Women have high rates of dementia, almost three times that of males. Women have a lot of vaginal atrophy and pain and prolapse. So it would be nice to know what mechanisms are being affected by these cannabis products and are they going to potentially change how the body is working in ways that can be helpful for the long-term health of the woman, not just helping her feel better in the moment? I think that the answer will be yes for postmenopausal women, but I would love more data.”
To which this 51-year-old says, “Ditto.”