More evidence needed to support cannabis use for menopause symptoms

Key takeaways:

• Many women report cannabis use to manage menopause symptoms, despite lack of evidence-based studies.
• Survey results highlighted issues with access to menopause supports and information to alleviate symptoms.

Despite lack of evidence, midlife women report using cannabis to manage symptoms overlapping with menopause including insomnia, anxiety, mood and musculoskeletal pain, according to results of two studies.

Nese Yuksel, BScPharm, PharmD, FCSHP, MSCP, professor and vice dean at the Faculty of Pharmacy and Pharmaceutical sciences at the College of Health Sciences – University of Alberta, Edmonton, Canada, and colleagues conducted a cross-sectional, web-based quantitative survey, published in 2023 in BMJ Open, and a qualitative study, published in 2024 in Menopause. Overall, 33.6% of women reported current cannabis use and 32.3% reported past use. Of current users, more than 75% used cannabis for medical purposes. Most respondents (73.5%) reported that cannabis use was helpful for menopause symptom management. Participants reported similarities in lack of available information, limited role of health care providers, stigmatization and self-education for both menopause and cannabis use.

Healio spoke with Yuksel about these results, benefits and possible adverse outcomes tied to cannabis use and what research is needed for cannabis use to manage menopause symptoms.

Healio: What prompted you and your colleagues to conduct this study?

Yuksel: In my practice in the menopause clinic here in Edmonton, one of the things we started noticing was more and more women using cannabis, or at least indicating they were using cannabis. In the clinic, as we got a summary of what they were using for their symptoms, and capturing the things they were doing after the legalization of recreational cannabis, more women were letting us know that they were using it for different symptoms. There were a lot of symptoms that overlapped with symptoms of menopause. For example, a lot of women have issues with sleep in menopause, but women were starting to use cannabis for sleep. We started seeing more women using it for symptoms, but they didn’t always realize that they were symptoms of menopause.

Healio: What are some of reasons menopausal women reported using cannabis?

Yuksel: We had close to 1,500 women that responded to our survey. Of those, about 60% were either current cannabis users or reported using cannabis at some point. The main reasons reported in the survey were for symptoms such as sleep, anxiety, mood and musculoskeletal pain. Those symptoms are not always related to menopause, but they do overlap with menopause. We went ahead and conducted the qualitative interviews, getting a little deeper into why women were using cannabis. In those interviews, we observed consistent responses of using cannabis for sleep, anxiety, general mood effects and musculoskeletal pain.

As for the reasons they were using cannabis, access to supports for menopause emerged as a big issue. Women didn’t feel like they had good access to health care providers that would be able to assess their menopause symptoms. Some women were perimenopausal and some were postmenopausal, but they were suffering. Some women didn’t even know these symptoms were menopause related. Others did, but they could not get the support they needed. So, they were looking for their own solutions, and that included cannabis. Because recreational cannabis is now legal, they were accessing cannabis and using it for symptom relief.

What we found surprising was about 22% of people using cannabis had a prescription for it. Most were doing it on their own, without support. Their health care provider might not even know that they were using cannabis for these symptoms. In the qualitative interviews, it became clear that these women didn’t know where to turn to get relief for menopause symptoms, so they started looking at cannabis.

Healio: Did some women report feeling stigmatized for their use of cannabis to relieve menopause symptoms despite its legalization?

Yuksel: The stigma was there. Going through menopause, much like using cannabis, also carries stigma. Women are often gaslit about their menopause symptoms, and because of that, they may not feel comfortable discussing cannabis use. A lot of that comes from the time when cannabis was not legalized, especially recreational cannabis. Women expressed not sharing that they’re using cannabis with friends and family or with their health care providers and would self-manage their own cannabis use. There is still a little bit of that leftover stigma about cannabis use, especially as there are different regulations with cannabis legalization around the world.

Healio: Could you summarize the experiences women in your study had with cannabis use?

Yuksel: We did not get into that granularity in the survey. However, we did have a general question asking if it helped their symptoms. About 75% of people who were using cannabis consistently did say that it was helpful. But it’s a very subjective question, right? We don’t know which symptoms it helped with.

For the qualitative interviews, we only interviewed women who were current users, who reported experiencing benefits. However, not many women were using for hot flashes, but more for symptoms such as sleep, mood or musculoskeletal pain. One note I want to make is that there is a large placebo response in research studies seen with improvements in certain menopause symptoms such as hot flashes.

Healio: Are there any detriments to cannabis use in midlife?

Yuksel: We didn’t go into that much detail in our study about side effects. Side effects depend on the type of cannabis formulation and component/amounts of THC or CBD. Most common side effects in general are drowsiness, fatigue, dry mouth, nausea and cognition issues. Someone who may be prone to falling might fall more, especially if they’re older. For some people, cannabis can cause more mood effects, such as increased anxiety. This is especially true with higher THC components, for example if smoking or vaping. People can get paranoid with much higher amounts of THC. Cannabinoid hyperemesis syndrome has also been reported, which is severe vomiting with long-term cannabis use, especially at high doses.

It is important to be cautious when using cannabis and make sure that you’re using it at the doses that are working, and talking with somebody who understands its impacts.

Healio: Is there anything else you would like to add?

Yuksel: The evidence to support cannabis use for menopause symptoms is not there at this time. Unfortunately, there are not many studies for hot flashes and night sweats. Though there may be studies in other populations for the use of cannabis for sleep, anxiety or pain, but these are not specific to menopausal women. We do not have good evidence, so it’s hard to guide women in what to do.

We’re not advocating for or against cannabis. That was not the purpose of the study. The aim of the study was to capture a picture of what’s going on. As health care providers, we need to be aware that women may be using cannabis for menopausal symptoms. Ask questions, find out, see if there is anything that’s going to interfere with their symptoms and make sure they’re using appropriate doses that won’t lead to more side effects.

Women with bothersome menopausal symptoms should talk to their family physician or primary care provider. As health care providers, we should be educating women on evidence-based options to help with menopause symptoms, such as menopausal hormone therapy or other nonhormonal prescription options. Menopausal hormone therapy, for example, is the most effective option in women with bothersome menopause symptoms affecting their daily life. It is an option in women who are less than 60 years of age or less than 10 years since their last menstrual period and have no contraindications. We should really be pointing women to evidence-based treatments for menopause treatment.

For more information:

Nese Yuksel, BScPharm, PharmD, FCSHP, MSCP, can be reached at nese.yuksel@ualberta.ca.

References:

• Babyn K, et al. BMJ Open. 2023;doi:10.1136/bmjopen-2022-069197.
• Babyn K, et al. Menopause. 2024;doi:10.1097/GME.0000000000002388.