Survey Looks at Cannabis Use in Perimenopausal and Menopausal Women, Calls More Research "Critically Needed"

A new survey conducted by researchers at Boston's Mass General Brigham (MGB) healthcare system found that perimenopausal and postmenopausal women had similar patterns of use for cannabis to treat their menopausal symptoms.

The paper, published in published in Menopause, the journal of the The North American Menopause Society (NAMS), had this to say (with full citations) about the potential for cannabinoid treatments for menopause symptoms: 

The endocannabinoid system is involved in a variety of physiological and psychological processes (e.g., regulating body temperature, mood, anxiety, sleep), and evidence suggests that this system significantly impacts fertility and reproduction. Specifically, the human ovary produces the endogenous cannabinoid anandamide with peak plasma levels occurring at ovulation and correlating with estrogen levels, suggesting that anandamide production may be controlled by this hormone.

In addition, cannabinoid treatments, including administration of anandamide, as well as antagonists of cannabinoid degradative enzymes, improve postovariectomy complications and reduce anxiety. Further, administration of cannabinoids typically results in vasorelaxation [reduction in tension of the blood vessel walls], suggesting that cannabinoid-based therapies may be particularly salient for treating vasomotor symptoms of menopause [hot flashes and night sweats].

In particular, estrogen deficiency results in downregulation of systems involved in hemodynamic regulation and is associated with vasomotor symptoms; 2 weeks of treatment with anandamide has been shown to reverse this downregulation in ovariectomized rats. Taken together, research indicates that medical cannabis (MC) may be a nonhormone treatment option with the potential to alleviate menopause-related symptoms with greater efficacy and possibly fewer side effects relative to existing treatments. 

STUDY METHODS AND RESULTS
Perimenopausal and postmenopausal participants were recruited through online postings on social media platforms (e.g., Facebook, Twitter, Reddit) and Rally, the MGB online recruitment platform. Targeted advertising was used to direct recruitment efforts toward individuals interested in women's health, as well as cannabis and cannabinoids. 

A total of 258 participants (perimenopausal, n = 131; postmenopausal, n = 127) were included in the analyses, mostly white middle-class women. Most participants reported current cannabis use (86.1%), with approximately half of the current cannabis users (51.5%) reporting mixed medical/recreational use; recreational only (30.8%) and medical only (17.7%) use were less frequent. The three most common current modes of using cannabis were smoking (e.g., joint, bowl, bong; 84.3%), edibles (78.3%), and vaping oil (52.6%); a significantly larger percentage of perimenopausal participants reported using edibles.

For participants who reported at least one lifetime use of cannabis, most reported using cannabis at some point to treat menopause-related symptoms (78.7%; Table 4). 

The top two menopause-related symptoms participants reported using cannabis to treat were sleep disturbance (67.4%), and mood/anxiety (46.1%), with perimenopausal women reporting more anxiety and more use of cannabis to deal with it. Libido (30.4%) and sexual pleasure (18.7%) came in 3rd and 4th.

CONCLUSIONS
Somewhat surprisingly, only 13% of participants used cannabis to treat hot flashes and only 12.6% used it for night sweats, despite scientific evidence (cited above) that cannabis could be helpful with those. The authors write: "Although the use of MC to address these symptoms was not commonly reported in the current study, the most prevalent and burdensome symptoms reported in this study (i.e., sleep disturbance, anxiety, and mood) may be mediated by vasomotor symptoms. Given that relatively few participants endorsed MC use to directly alleviate vasomotor symptoms of menopause, clinical trials may be better options for examining the efficacy of MC to treat vasomotor symptoms beyond preclinical research."

The authors also suggested more research into different modes of cannabis use for menopausal women, writing, "Interestingly, although smoking and edibles were the most commonly endorsed modes of use, six different current modes of use were endorsed by at least a quarter of participants; this finding dovetails with previous research indicating that MC patients frequently seek a broad variety of products with diverse cannabinoid profiles."

"Cannabinoid profiles and dosage can significantly impact the efficacy and safety of MC products," the authors write. "Although the current study assessed modes of use, future research should query additional cannabis use characteristics, including cannabinoid profiles of individual products used as well as frequency and magnitude of use."

As with almost every study, the authors call for more research, including into possible harmful effects. They conclude: 

Although this study provides valuable insight regarding the impact of treatment expectancy effects, more research is critically needed....Overall, to ensure generalizability of results, replication of assessments should be considered in a more diverse sample with greater representation of racial and ethnic groups as well more diverse cannabis use history.

RESPONSE

Stephanie Faubion, M.D., M.B.A.

“This study suggests that medical cannabis use may be common in midlife women experiencing menopause-related symptoms," says Dr. Stephanie Faubion, NAMS medical director in a press release the organization felt compelled to issue upon publication of the study in its journal. "Given the lack of clinical trial data on the efficacy and safety of medical cannabis for management of menopause symptoms, more research is needed before this treatment can be recommended in clinical practice. Healthcare professionals should query their patients about the use of medical cannabis for menopause symptoms and provide evidence-based recommendations for symptom management." 

In other words, find out what your patient is using cannabis for and prescribe a pill instead. NAMS accepts corporate donations to the tune of about $500,000 yearly; one of its endowments is funded by "a generous grant from Pfizer." Sponsoring their upcoming conference in Atlanta as "Premier Partners" are the Japanese pharmaceutical company Astellas, which has a new drug they're studying to address vasomotor symptoms associated with menopause, and Therapeutics MD, which markets hormone replacement products.

The #1 reason given by study participants not using or interested in using cannabis for their menopausal symptoms was Lack of knowledge (39.1%). Only seven participants (15.2%) reported their concerns were Access to products, Fear of intoxication, or Cost.  When asked, "What would make you more comfortable using a medical cannabis or hemp-based product for menopause-related symptoms?" the #1 answer was Data to support its use (54.7%), followed by: Able to order online (54.2%) and Education about the risks/benefits (35.5%). 

As we slowly move towards more scientific data, accessibility, and education around cannabis, women who could benefit from its use are being prescribed arguably more dangerous hormones, antidepressants, antiseizure medications (including Pfizer's Gabapentin), and sometimes even nerve blocks to treat hot flashes, according to a page from the Mayo Clinic,  a huge nonprofit medical center and research institute where Dr. Faubion works as the Penny and Bill George Director for Mayo Clinic's Center for Women's Health. Faubion was in the press in 2019 touting the new female libido aid Addyi, before its controversial FDA approval was re-evaluated in 2021.

Bill and Penny George

The medical products company where Bill George made his millions, Medtronic, successfully completed a tax inversion by acquiring an Irish company in 2014 (after George left the helm). Medtronic's is the largest tax inversion in history, and given the changes in the U.S. tax code in 2016 to block the Pfizer-Allergan Irish tax inversion, is likely to remain the largest. (Source.)  An article in this month's In These Times addresses the "nonprofit industrial complex" which began when "status-seeing rich people wanted to fund their own projects rather than pay their fair share of taxes." In recent decades, "as income inequality has increased and the public service sector has shrunk, the number of nonprofits has grown exponentially—from about 99,000 groups in 1946 to 1.5 million today. Meanwhile, key human services, such as healthcare and education, continue to transition from the public sector to various nonprofits." So the wealthy, instead of paying their fair share of taxes which could fund government research into the benefits of cannabis, instead funds nonprofits whose research benefits the companies that made them rich.

The Georges' $5 million gift to Mayo is meant to fund the "George family’s interest in holistic and alternative therapies, an interest borne of Penny George’s experience as a breast cancer survivor. Her name is now synonymous with Allina Health’s Penny George Institute, based in Minneapolis, which promotes the use and research on techniques such as acupuncture, nutrition counseling and spiritual healing." Oh, I know an herb that's a spiritual healer. But Allina's director Dr. Stephen Bergeson said when Minnesota made medical marijuana legal for chronic pain in 2016 that not enough research has been done into its potential harms. He noted that studies didn't look at the kinds of products that Minnesotans have access to; however the federal government allows studies only using their crappy government-grown cannabis (although a pending bill could change that).