At a recent visit, a longtime patient noted that she was sleeping much better. I had slept terribly the night before and was curious to know her secret. She admitted somewhat hesitantly that she had started taking pot gummies at bedtime.
Just a few days later, another patient told me she was using a cannabis cream from her local dispensary to manage her achiness. She had started using cannabis while she was undergoing treatment for breast cancer. Now the estrogen-blocking medications she takes to prevent the recurrence of her cancer make her feel achy. She feels the cannabis cream is helping her.
Both women were reluctant to share their cannabis use with me despite the fact that in my state, New York, cannabis is legal for recreational use, and both women were buying their cannabis products from state-licensed dispensaries.
Many of you have also asked about cannabis and what we know about its utility in treating perimenopausal symptoms. The answer is not very much, but I think it is helpful to understand why the data on cannabis use is so limited and consider what we do know.
Why don’t we know more about cannabis?
In the past, research was largely focused on whether or not cannabis is addictive and what harms it might cause. This is because it can be quite difficult to obtain funding and approval from research ethics review boards to study illegal substances. Even though cannabis is legal in many states, it is still illegal to use cannabis for all but a few indications under federal law. Researchers must obtain special approval from the federal government to conduct research on cannabis and cannabis-derived drugs.
Furthermore, there is no large pharmaceutical company throwing its financial resources behind cannabis research. Clinical trials are expensive and labor intensive. Most clinical trials of potential medications are largely funded by pharmaceutical companies. Even for generic medications, it’s a struggle to find funding to study new uses. Without government or industry funding, high-quality clinical trials can be impossible to execute.
Until very recently, there were few clinical trials exploring medical uses for cannabis. Even so, there are a few indications for which cannabis-derived drugs are approved by the FDA, including chemotherapy- and AIDS-induced nausea and vomiting, treatment-resistant epilepsy, and a handful of rare childhood diseases.
What do we know about cannabis and perimenopause?
Given the limits on research into cannabis, and the fact that perimenopause has been ignored both in the medical community and in the public until very recently, it is not surprising that data on cannabis use in perimenopause is nearly nonexistent. That is why I was thrilled to see a study on this topic in the September issue of Menopause.
The paper describes qualitative data from interviews of peri- and postmenopausal women using cannabis in Alberta, Canada — cannabis has been legal for recreational use in Canada since 2018. While the number of women included in the study is tiny (just 12), the participants have all used cannabis with the goal of managing perimenopausal symptoms.
During the structured interviews, the women described improvements in sleep disruption, joint and muscle aches, mood swings, depression, and low libido. Some found that cannabis managed symptoms that other treatments such as hormone replacement therapy did not. While none of the women used cannabis for the express purpose of treating hot flushes and night sweats, one participant noted that her severe night sweats improved in frequency with cannabis use from 10 to 12 per night to just 2 to 3 per night.
Interestingly, most women started using cannabis for recreation and then noted it improved their symptoms and transitioned to using it medicinally. Among the participants, there was wide variation in how the women were using cannabis — inhaled, topically in oils and creams, edibles, even bath salts. There was also variability in how often the women were using cannabis, from multiple times per day to just as needed. They typically relied on trial and error in how much and how often they used cannabis.
The participants noted that they perceive cannabis as being more natural than other treatments for perimenopausal symptoms, but they also expressed concern about the lack of information available about using cannabis in perimenopause. Yet, despite the fact that cannabis is available by prescription for medical use in Canada, only four of the women had obtained a prescription.
Women were reluctant to discuss their cannabis use with their doctor, even though they expressed concerns about the lack of information regarding its medical uses. Some of this reluctance likely stems from the women’s experiences with their doctors. Many of them recounted experiences of having their perimenopause symptoms dismissed by their doctors.
What can we learn from this study?
Here at Hot Flash, we talk often about the quality of the available data. Given that, why am I so excited about a study that ultimately amounts to a handful of interviews? What can we take away from studies like this one?
It is true that this study doesn’t tell us whether cannabis effectively treats perimenopausal symptoms. Nor does it tell us which of the many chemicals in cannabis are effective in doing so.
Rather, this study raises the idea of cannabis use for perimenopause to the attention of medical researchers. Women are using cannabis already. We should seek to understand more about it as a treatment for perimenopausal symptoms. This study tells pharmaceutical companies that there could be a market for cannabis-derived treatments for perimenopause. Perhaps it is worth investing time and money in its development.
To my mind, most importantly, it generates questions to be answered by further research. When I finished reading the study, I had ideas for a dozen or more future clinical trials that could be done. We may not know if cannabis is an effective treatment for perimenopausal symptoms, but at least we have started the conversation. It’s the first step on the path to answers.
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