Cannabis and Menopause, and the Endocannabinoid System

Supporting women during a challenging time of life

Menopause is finally getting its moment in the spotlight after being largely ignored by the medical profession or at best talked about in lowered voices and euphemisms. In the last couple of years it suddenly seems like every female social media influencer between 45-55 is talking candidly about their own personal struggles brought on by plummeting estrogen levels with many highlighting how CBD and cannabis products have helped manage their debilitating symptoms. In addition to these anecdotal reports, recent scientific data also suggests how increasingly women are using cannabis to make the anxiety, sleep disruption, and night sweats typical of this time of life more bearable.

If you’re male, or a woman under 40, menopause probably seems like some abstract concept. For me it’s telling that despite almost certainly being in perimenopause when I wrote The CBD Book three years ago, I only dedicated a few short paragraphs to the subject. Whereas now when I can officially declare myself truly hormonally challenged, I would probably be able to extend this to an entire weighty tome.

That’s because when perimenopause takes hold and our estrogen levels crash and burn, it’s like an unwanted guest has entered the building. Where once there was good health, balanced mood, a decent night’s sleep, and a clear head, there now resides a rumbling state of anxiety, rage-filled out-of-the-body experiences, deep troughs of depression, sleep disrupted by pools of sweat, and a mind so cloudy that thinking becomes like wading through treacle.

With all this turbulence and dysregulation going on, it shouldn’t be much of a surprise to hear that the body’s master homeostatic regulator, the endocannabinoid system (ECS), is also going through significant changes as women move from their reproductive years towards menopause and beyond. It’s even posited that the ECS may play a role in the health problems commonly experienced by women post-menopause, such as cardiac conditions, osteoporosis, and certain types of cancer.

FROM PERIMENOPAUSE TO MENOPAUSE

It’s important to point out that menopause is not a disease. It is a natural process when thanks to declining levels of hormone production in the ovaries – primarily estrogen and progesterone – periods gradually cease (on average at the age of 51). For many women, though, perimenopause, the period of transition when hormone levels begin to fluctuate, can actually be more challenging than menopause itself.

“Your hormones can go through changes in a 24 hour period or over a period of months. So, it’s really a tough time. The most common time suicide will occur in a woman’s life is during perimenopause. You just don’t know if you’re coming or going,” explains Genester Wilson-King MD, a Board-Certified Obstetrician, Gynecologist and Founder of the Victory Rejuvenation Center in Florida. She is also currently vice president of the Society of Cannabis Cliinicians.

Most women benefit from the protective and mood-enhancing nature of normal estrogen levels until they enter perimenopause. When their estrogen dips, some women who’ve never been prone to low mood or anxiety may experience it for the first time. Or others with a history of mental health issues find their symptoms worsen significantly.

For Julie Durrans in the UK, not only did her existing anxiety disorder worsen during perimenopause, but the hormonal changes also ushered in a general deterioration in her overall health. “As I hit menopause, my joints really started to get aggravated and inflamed, and the dislocations started increasing,” she says referring to the Ehlers Danlos Syndrome that was diagnosed during this period. “The migraines were quite debilitating, three or four a week, and my [general practitioner] put me at serious risk of stroke at that point.”

It’s not uncommon for plummeting estrogen to cause women’s preexisting health conditions to worsen during perimenopause, and for new ones such as fibromyalgia to be diagnosed.

Cannabis and Menopause

In addition to the night sweats, disturbed sleep, and increased migraines in the two weeks leading up to her period, Colleen Fisher Tully, 44, a Canadian women’s health writer, suddenly started experiencing vulvodynia – intense pain in her vulva.

“They call it fibromyalgia of the vulva,” says Colleen. “It is just the most horrific thing.”

With this unpleasant plethora of symptoms, it’s hardly surprising that women often experience low libido during both the perimenopause and menopause phases. In between night sweats, insomnia, anxiety, migraines, heart palpitations, and vaginal dryness, swinging from the chandeliers in passionate love-making can lose its appeal.

ESTROGEN AND THE ENDOCANNABINOID SYSTEM

At her clinic in Florida, Dr. Genester Wilson-King tends to recommend cannabis to her patients if hormone treatment isn’t suitable or when some residual symptoms, such as low-level anxiety, remain even after hormone therapy.

“I’ve seen patients throughout most of the hormonal transitions. And I have seen cannabis be very, very helpful,” she says. While Wilson-King is quick to point out that only hormone therapy will actually facilitate balance during the perimenopause/menopause phase, we shouldn’t underestimate the role that the endocannabinoid system plays in women’s hormonal health.

“The endocannabinoid system is very active in the female reproductive tract,” she explains. “The human ovary actually produces the endogenous cannabinoid anandamide, such that in healthy women throughout the menstrual cycle the amount of anandamide circulating is high during the follicular phase from your menstrual period until ovulation. And then the levels are highest during ovulation and lower during the luteal phase.”

Mirroring these anandamide fluctuations, estrogen is also highest up to and during ovulation, tailing off over the rest of the month.

We’re used to thinking of the ECS as the master regulator, but when it comes to the female reproductive system, it appears that estrogen calls the shots.

“Estrogen regulates the fatty acid amide hydrolase (FAAH), the enzyme that breaks down anandamide,” says Wilson-King, “So when anandamide levels need to be high, estrogen will keep FAAH levels low [which] keeps the anandamide up.”

What remains unclear is why anandamide levels need to be high until after ovulation, but as someone who’s struggled with premenstrual syndrome for most of my menstruating life, it is interesting to note that the red mist I often experience coincides with waning levels of the feel-good endocannabinoid, anandamide.

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