What is Menopause?
Menopause begins 12 months after a woman’s last menstrual cycle and signals the end of fertility, or the ability to reproduce. Symptoms of menopause include irregular periods, mood swings, hot flashes during the day, night sweats that keep you from staying asleep, trouble concentrating, vaginal dryness and discomfort during sex, decreased sex drive, metabolism slow down, muscle loss, and weight gain, and urinary incontinence (also known as peeing a little when you laugh or sneeze).
Menopause typically occurs in your 40s or 50s, with 51 being the average age of menopause in the United States. By 2020, there will be more than 50 million American women in menopause, and most women are living a third or more of their lifespan after menopause. As life expectancy increases around the globe, so does the amount of postmenopausal women. In 1998 there were 477 million postmenopausal women globally; in 2025 there will be 1.1 billion.
Approximately 1% of women develop premature menopause. Women can go through premature menopause before entering their 40s, due to genetics, illness, or medical procedures. Age at menopause is mostly inherited and due to your genes. Genetic diseases like Turner syndrome can cause ovaries to not function, resulting in very premature menopause. You may experience natural premature menopause if your mother or sister have also experienced premature menopause, or you have unsuccessfully tried to become pregnant for over a year. Premature menopause may also occur if you or a family member has an autoimmune disorder such as lupus, hypothyroidism, or Grave’s disease because inflammation caused by these diseases can harm the ovaries. Women with epilepsy, a seizure disorder, are more likely to have premature ovarian failure (POF), which leads to menopause. In fact, 14% of women with epilepsy will have premature menopause.
Chemotherapy and radiotherapy to treat cancer can cause premature menopause, making cannabis a brighter alternative for young women with cancer that want to have a child one day. Chemotherapy can first cause irregular menstrual cycles or disappearance of menstrual periods, due to damage to the ovaries or physiological stress. Menopause can come immediately after chemotherapy or be delayed by several months or years. It can also be permanent or temporary, lasting several years, and there is no way to predict how chemotherapy will impact you. However, the older you are when you begin chemotherapy, the more likely it is you will experience menopause and that it will be permanent.
Medical treatments, such as Lupron shots to shut down estrogen production in women with endometriosis, can cause temporary and reversible menopause. Pelvic surgery, in the form of ovary or uterus removal, results in surgical menopause. In 2006 almost 200,000 American women were put into surgical menopause.
Lifestyle factors can bring on menopause up to 5 years earlier than your genes have programed. Exposure to environmental toxins such as dioxin or cigarrette smoke may cause early menopause. Regular smokers or those who have a history of smoking for a long time may experience menopause 1-2 years earlier than non-smoking women. This is because smoking reduces estrogen. Having a low body mass index (BMI) can also result in early menopause because women with low amounts of fat tissue have less estrogen in their bodies. If you have never been pregnant you may also have menopause at a slightly earlier age.
Where you live can change when menopause happens. Living at a high altitude, such as Denver, Colorado, Salt Lake City, Utah, Mexico City, Mexico, or Bogota, Columbia can cause menopause to come 1-1.5 years earlier than normal. Living in a rural country such as Pakistan, Indonesia, Chile, and Peru can cause menopause to come several years earlier than it does in developed countries.
Later menopause does not mean your body is healthier than it is if you have menopause earlier. Late menopause may be in fact caused by high BMI. Using hormonal birth control is also associated with late menopause. Women who enter menopause after the age of 55 are at greater risk for breast cancer because they have been exposed to more estrogen during their lifetime.
Testing for Menopause
FSH is a hormone that stimulates your ovaries to produce estrogen, and when your ovaries stop producing estrogen, your levels of follicle stimulating hormone (FSH) increase. Premature menopause is diagnosed when blood levels of FSH are above 40 µL/mL. Estrogen levels below 30 can also signal menopause.
Consequences of Menopause Timing
Early menopause can have additional negative effects besides loss of fertility. Reduced estrogen levels for longer time than most women put you at greater risk for osteoporosis, heart disease, and even premature death. Late menopause is associated with greater life expectancy, and reduced risk of cardiovascular disease, stroke and osteoporosis.
How is the Endocannabinoid System (ECS) Disrupted in Menopause?
Reduction in endocannbinoids signaling may be responsible for some of the negative symptoms we associate with menopause. This is not surprising as estrogen levels are linked to endocannabinoid levels, and both peak at ovulation, something that does not occur in menopausal and postmenopausal women. Fatty acid amide hydrolase (FAAH), the enzyme that breaks down the endocannabinoid anandamide and controls it levels, is regulated by estrogen. In fact, activation of estrogen receptors and cannabinoid receptors on the same cells often synergize to produce greater effects than the combination of both by themselves.
All parts of the endocannabinoid system are present in the human ovary, including the endocannabinoid anandamide, and its receptors, CB1 and CB2. Anandamide has role in egg maturity and release during the menstrual cycle. Endocannabinoid deficiency, a state in which levels of anandamide are too low, may spur early menopause. Interestingly underweight women or women with anorexia, who enter menopause early, also have low endocannabinoid levels. Boosting levels of endocannabinoids or stimulating cannabinoid receptors with cannabis may help delay menopause.
Estrogen recruits the endocannabinoid system to regulate emotional response and relieves anxiety and depression through its actions on the brain. Lowered levels of estrogen during and after menopause means less activation of the endocannabinoid system, and poor ability to respond to stress and elevate mood accordingly.
The endocannabinoid system regulates the bone loss seen after menopause. Cannabinoid receptor type 2 (CB2) are found on bone cells, called osteoblasts. A common mutation in the gene that codes CB2 in humans, resulting in fewer CB2 receptors, is associated with osteoperosis after menopause.
Women are more responsive to the pain relieving effects of cannabis and THC when their estrogen levels are at their highest. Because menopausal and postmenopausal women have low levels of estrogen, this means they will be less responsive to THC and require higher doses than premenopausal women to achieve the same amount of pain relief, and are likely to be closer to men in their response to cannabis. Premenopausal women develop tolerance to THC quickly, and may be more vulnerable to negative side effects of cannabis such as paranoia, anxiety, or dependence. Postmenopausal women may be able to stay on a stable dosage of THC or cannabis for the long-term, and may be less likely to feel anxious or paranoid from cannabis.
The endocannabinoid system’s role in menopause and postmenopausal health is an area of medicine lacking in research. One day genetic studies will see if mutations in endocannabinoid system genes are correlated with early or premature menopause. Because the reproductive system contains cannabinoid receptors that interact with estrogen, endocannabinoids directly influence the menstrual cycle and menopause.
How Does Cannabis Help Menopause?
Estrogen replacement therapy (ERT) is hormone therapy prescribed to millions of menopausal and postmenopausal women to control symptoms of menopause including hot flashes and bone loss. Cannabis is an optimal alternative for women who can not take ERT due to history of breast or ovarian cancer, heart disease, or lack of health insurance. ERT is associated with increased risk for heart attack, blood clots, gallstones, stroke, breast cancer, and even Alzheimer’s disease, which makes the benefits of ERT not worth the risk for most women. Instead of taking ERT, look into taking alternative phytoestrogens, like increasing soy in your diet and taking red clover supplements. As an added bonus, phytoestrogens also boost endocannabinoid levels.
Bone loss is one of the major reasons doctors prescribe ERT, but it is clear cannabis treatment can be an alternative for stopping bone loss and treating menopausal symptoms. Cannabis, specifically the cannabinoids cannabigerol (CBG), cannabidiol (CBD), (CBC) and THCV, stimulate bone growth and may be able to prevent osteoperosis after menopause. A synthetic drug that activates CB2 receptors prevented bone loss after surgical menopause, suggesting women that undergo surgical menopause should use cannabis.
Menopausal women don’t have to choose between ERT and cannabis. If you believe ERT has some value, but are worried about the risk of breast cancer associated with it, you can use cannabis or CBD to reduce your breast cancer risk while you use ERT. THC and most of the major cannabinoids do not interact with the estrogen receptor, but CBD does at high doses. Also apigenin, a flavinoid found in cannabis, binds the estrogen receptor strongly and can inhibit growth of breast cancer cells. CBD has been shown to to kill breast cancer cells independent of its activity on cannabinoid receptors, and avoids killing healthy breast tissue. This means if you take CBD while using ERT, CBD may kill any breast cancer cells that start dividing before they grow into a tumor.
Women that cannot use ERT due to breast cancer risk or other medical problems are often prescribed non-hormonal prescription drugs, including selective serotonin reuptake inhibitors (SSRIs) like Effexor and Prozac or Gabapentin (neurontin), a drug primarily used to treat seizures. Cannabis can be subsituted for any of these drugs to successfully treat symptoms while reducing numerous unwanted side effects of these prescription drugs, including weight gain, gastrointestinal distress and sexual dysfunction. Cannabis can boost serotonin signaling and lower body temperature, which can reduce hot flashes and anxiety found in menopause.
Total cholesterol and “bad” LDL cholesterol levels increase during menopause, which boost risk of heart disease. Cannabis use is associated with higher levels of “good” HDL cholesterol, which can balance out the increase in “bad” cholesterol found in meonpause. Cannabis can also lower insulin levels, which prevents the development of type 2 diabetes.
Menopause can also cause an increase in facial hair. Topical creams containing cannabis or THC have been shown to slow the growth of hair, and may be appropriate to use in conjuction with hair removal techniques such as waxing or depilatories. Cannabis topicals may also reduce skin dryness because they promote oil production in the skin.
One of the most overlooked aspects of female health is healthy and enjoyable sex. Menopause can lower sex drive and cause pain during sex. The doctor’s answer to this is either ERT or a topical estrogen cream (Estrace) to apply to the vagina, which carries the same risks of ERT with the added risk of cancer of the uterus and dementia. Who wants that? Cannabis can help boost sex drive, reduce pain during sex and enhance orgasms, and can be smoked, eaten, or applied topically depending on your needs.
Cannabis use may interfere with ovulation in some women, and long-term use may delay menopause in a similar way to hormone birth control does by preventing depletion of healthy eggs. Genetic studies in the future may reveal what women have their fertility negatively impacted by cannabis use.
How Can I Take Cannabis to Treat Menopause?
There are no clinical studies looking at cannabis use to aid menopausal or postmenopausal women, so dosage guidelines are still being developed. How you will use cannabis depends on what menopausal symptoms you are treating and whether you mind being slightly “stoned” from consuming cannabis or prefer nonpsychoactive doses.
If you live in a state with legal medical or recreational marijuana, edibles containing 10 mg of THC can help you get to sleep and keep night sweats to a minimum, and you won’t wake up feeling high or hungover. If you’d like to control your symptoms during the day, without feeling out of it, try “microdosing.” Microdosing means taking doses of THC that will provide symptom relief without causing dizziness or a “high.” Depending on your tolerance, this can be between 2.5 and 5 mg of THC at a time (try breaking a 10 mg THC candy into 1/2 or 1/4 portions). It’s important to eat cannabis daily if you’ve made the decision to forgo hormonal estrogen therapy (ERT), as you will need to stabilize your hormones. Cannabis will also protect against osteoporosis.
Vaporizing cannabis during the day can also relieve symptoms of menopause. Vaporizing cannabis is better than smoking cannabis in a joint, pipe, or bong because it doesn’t burn the cannabis. Smoking cannabis releases toxins similar to cigarettes, can cause lung irritation and often disintegrates cannabinoids with healing properties. Vaporizing cannabis heats the air around the cannabis, releasing a range of cannabinoids, each with unique health benefit. It is very important women vape cannabis and do not smoke it because smoking can further lower estrogen levels.
A new way to get cannabis into your body is via a transdermal patch, similar to the birth control patch or the nicotine patch. This discrete method provides extended release medication for up to ten hours and is perfect for people who feel uncomfortable with other methods such as vaporizing or eating cannabis.
If you live in a state where cannabis is illegal, you can order CBD products online, which will help boost levels of your natural endocannabinoids and also protect against bone loss and osteoporosis. CBD can be taken in conjunction with ERT to lower your risk of developing breast cancer. There are several ways to take CBD. You can vaporize CBD only oil, or to get the full health benefits, eat CBD oil, edibles, or pills. A great way to relax is with a tea containing CBD at night time. One note is that taking CBD may make other medications you take stay in your body longer than intended, similar to taking grapefruit juice. If you are going to be taking CBD daily and are on other prescriptions, talk to your doctor about the possibility of lowering your prescription dosages to be on the safe side.
Cannabis and Sex Drive
On a final note, let’s get to how cannabis can improve your sex life during and after menopause. Cannabis can increase your sex drive, remove inhibitions, enhance your sensitive to touch, and help you feel closer to your partner. All these things add up to helping you orgasm, and cannabis may even strengthen and lengthen your orgasm. You can vape cannabis before sexual activity, but the effect will not last as long as an edible will. Take an edible 30 minutes to an hour before sexual activity so that it can “kick in.” Since you want to feel the psychoactive effects of THC, you don’t want to microdose, but you also don’t want to eat so much THC you have a bad experience, feel sick, or fall asleep. The perfect dose is different for each person; we suggest you started at 10-20 mg of THC the first time you use cannabis to improve your bedroom activities. If at anytime you don’t feel good, drink water, relax, and know that the THC will wear off eventually, just like the buzz from alcohol does. Remember the dose you gave yourself, and go lower next time. Another option for improving your sexual experience without having any head “buzz” is using a lubricant with cananbis in it, that will only activate your clitoris and the tissue around it. A great brand to try is Foria, but it is currently only available in California and Colorado.
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