Menopause is associated with a number of hormonal fluctuations – including changes in the levels of oestrogen and progesterone – that have been linked to various symptoms. These symptoms include hot flushes, sleep disturbance, depression, and anxiety. The most commonly reported symptoms (hot flushes and night sweats) are related to the dilation of blood vessels and may also mediate other menopause-related symptoms, such as sleep disturbances, alterations in mood, and cognitive function. More severe symptoms of menopause are associated with increased feelings of shame, loss of productivity, and lower quality of life, all of which can represent a significant psychosocial and economic burden.
There are currently a number of effective treatment options available for the management of menopause-related symptoms; however, many of these treatments are consistently associated with unwanted and negative side effects, such as mood swings and fatigue. The development of alternative treatment strategies is, therefore, an important area of research.
Medical Cannabis and Menopause-Related Symptoms
Evidence suggests that the endocannabinoid system is involved in a variety of physiological and psychological processes, including the regulation of body temperature, mood, anxiety, and sleep. Furthermore, evidence suggests this system may also impact fertility and reproduction. Additionally, the human ovary produces the endogenous cannabinoid anandamide with peak levels occurring at ovulation and following a rise in oestrogen levels, suggesting that anandamide may be controlled by this hormone.
Administration of cannabinoids has been suggested to improve post-ovariectomy complications and reduce anxiety, and to induce vasorelaxation. Given the involvement of the endocannabinoid system in these processes, cannabis-based therapies may be a promising area of research for the management of menopause-related symptoms.
Medical cannabis has become increasingly accessible for a number of conditions, including anxiety, sleep disorders, epilepsy, multiple sclerosis, and nausea and vomiting. Some recent work has also focused on the potential of medical cannabis in gynaecological diseases, such as endometriosis; however, few studies have examined the prevalence and efficacy of medical cannabis for menopause-related symptoms. A recent study aimed to assess the effects of cannabis use in perimenopausal and postmenopausal individuals.
Design and Methods of the Study
Participants were recruited through online postings on social media platforms (including Facebook, Twitter, Reddit) and the Massachusetts General and Brigham and Women’s Hospitals’ online recruitment platform. Enrolment was conducted between 3rd March, 2020 and 16th April, 2021. Applicants were considered eligible if: they were aged 18 or older, assigned female at birth, and reported perimenopausal or postmenopausal status.
Eligible participants completed self-report questionnaires featuring questions regarding demographic information, self-reported medical conditions and medications, menopause-related symptoms, cannabis use in general, and medical cannabis use for menopause-related symptoms. Clinical scales used included the Menopause-Specific Quality of Life Questionnaire (MENQOL), Day-to-Day Impact of Vaginal Aging Questionnaire (DIVA), and the Arizona Sexual Experiences Scale (ASEX).
Results of the Study
A total of 258 participants (perimenopausal, n = 131; postmenopausal, n = 127) were included in the analysis. Perimenopausal and postmenopausal participants were well matched on all demographics except for age: perimenopausal participants were significantly younger than postmenopausal participants.
Perimenopausal participants were also more likely to report psychiatric conditions, including anxiety and depression. This group also reported significantly worse vasomotor and psychosocial menopause-related symptoms on the MENQOL scale, relative to postmenopausal participants. Postmenopausal participants reported significantly worse dysfunction measured by ASEX total score; however, both groups reported similar scores on all subscales and total score of the DIVA.
According to the results of the MENQOL scale, the most burdensome menopause-related symptoms were sleep, tiredness, and lack of energy; however, anxiety and hot flushes were both rated as significantly more burdensome by perimenopausal participants.
The majority of participants (92%) reported at least one incidence of lifetime cannabis use, while 83.5% reported a history of cannabis use (a period using cannabis at least once a month), and 86.1% reported current cannabis use. Around half (51.5%) of current cannabis users reported mixed medical and recreational use compared with recreational only (30.8%) and medical only (17.7%). Smoking was the most common mode of use (84.3%), followed by edibles (78.3%) and vaping (52.6%). It is important to remember that smoking a prescribed medical cannabis product is a prohibited in the UK by the Home Office, and is also associated with potential harm from the production of smoke.
Among participants who reported at least one lifetime use of cannabis, the majority (78.7%) reported using cannabis to for menopause-related symptoms. The top three symptoms that participants reported using cannabis for were sleep disturbance (67.4%), mood/anxiety (46.1%), and libido (30.4%). The majority of this group also reported an interest in exploring additional cannabis products (e.g. vaginal suppositories) for these symptoms.
Those who were not interested in exploring medical cannabis for menopause-related symptoms cited a lack of knowledge (39.1%) and no need/symptoms well-managed (32.6%). All participants also indicated what would make them feel more comfortable using cannabis for menopause-related symptoms; the most common responses were scientific data supporting efficacy (54.2%) and the ability to order online (54.5%). Finally, the results demonstrated that a greater number of medical conditions was associated with increased odds of medical cannabis use, whereas postmenopausal status and higher education level were associated with reduced odds of medical cannabis use.
The responses received in this study indicate that many individuals are currently using commercially (or illicitly) available cannabis products as an adjunct for menopause-related symptoms. The most common reasons for medical cannabis use were disturbance of sleep and mood/anxiety – which were also reported to be the most burdensome menopause-related symptoms. Therefore, these symptoms may be salient targets for future clinical trials of cannabinoid-based therapies.
The researchers suggest that future research is needed to comprehensively assess the risks and benefits of medical cannabis for menopause-related symptoms, including assessment of how unique cannabinoid profiles, modes of use, and other use characteristics may impact safety and efficacy.