Many people are exploring alternative ways to manage menstrual discomfort and find relief from related symptoms. To understand the potential benefits of cannabis, it’s helpful to first look at the body’s endocannabinoid system (ECS), which plays a key role in regulating various functions, including pain and mood, both of which can be affected by the ups and downs of our hormones throughout the menstrual cycle.
Ethos pharmacist, Jullien Navizaga, explains how compounds like THC and CBD may help relieve pain, as well as how they stack up against traditional options like NSAIDs and opioids. Let’s take a closer look at the research on how cannabis might provide relief during your menstrual cycle.
What does the research say about cannabis and the menstrual cycle?
To understand how cannabis affects the menstrual cycle, it is essential first to examine the body’s endocannabinoid system (ECS). The ECS is a complex cell-signaling network that involves endocannabinoids (AEA and 2-AG), endocannabinoid receptors (CB1 and CB2), and the enzymes that closely regulate the signaling in the system. The ECS plays a crucial role in maintaining homeostasis in the body’s various physiological functions, including pain perception, mood regulation, immune function, and reproductive function. The endocannabinoid system is significantly influenced by the hormonal fluctuations that we see during the menstrual cycle.
The menstrual cycle is a four-phase cycle that typically lasts 28 days. During this, we see a fluctuation in various hormones, such as estrogen and progesterone, resulting in fluctuations in both physical and emotional symptoms. For example, during the luteal phase, we see higher levels of progesterone, which can lead to premenstrual symptoms — including irritability, fatigue, bloating, and breast tenderness. In general, we typically see a heightened pain response and potential mood changes with the elevation of progesterone levels during this phase. (Maccarrone, 2001)
Cannabis’ importance in use is associated with many premenstrual symptoms, as well as various menstrual disorders such as dysmenorrhea, premenstrual syndrome (PMS), premenstrual dysphoric syndrome (PMDD), and endometriosis. The use of cannabis for menstrual pain relief dates back centuries, and we often see patients today who use cannabis to relieve menstrual cramps, mood changes, and other premenstrual symptoms.
How can cannabis provide relief for menstrual pain?
Cannabis may offer relief for menstrual pain in various ways. To understand how it works, we first need to examine the actions of THC and CBD and their roles in the endocannabinoid system (ECS).
THC is a chemical compound that mimics the endocannabinoid anandamide and is a partial agonist of the CB1 receptor, which binds in the central nervous system, resulting in reduced pain perception and modulation of inflammatory responses.
In contrast, CBD, or cannabidiol, does not directly bind to the endocannabinoid receptors CB1 and CB2. Instead, it influences the ECS in several other ways. One way it relieves pain is by inhibiting the enzyme fatty acid amide hydrolase (FAAH) that breaks down the anandamide cannabinoids, resulting in increased levels of anandamide. An increased anandamide level is associated with modulating pain, sensitivity, and heightened inflammation. (Andrieu, 2022)
Additionally, CBD mediates pain and inflammation during menstruation by interacting with TRPV1 receptors, which leads to analgesic effects and a reduction in the severity of menstrual cramps. CBD also possesses strong anti-inflammatory properties, helping to reduce prostaglandin synthesis, which can relax uterine muscles.
What is the role of cannabis in managing chronic pain, such as menstrual cramps, endometriosis, or fibromyalgia, which disproportionately affect women?
Cannabis interacts with the endocannabinoid system to help regulate pain and inflammation associated with various menstrual disorders, such as dysmenorrhea, PMS, PMDD, and endometriosis. These conditions may be related to a deficiency or dysfunction in the endocannabinoid system.
For instance, dysmenorrhea is characterized by painful uterine contractions due to excessive prostaglandin release, and research shows that CBD can help reduce this pain.
Regarding endometriosis, note that normal endometrial tissues typically have a high density of CB1 and CB2 receptors. However, women with endometriosis often exhibit lower levels of CB1 receptors in their endometrial tissues, and their endocannabinoid levels are significantly altered. Reduced ECS function has been suggested to lead to the growth of endometriosis tissue and a more severe pain experience. (Bouaziz et al., 2017)
THC acts as a partial agonist at CB1 receptors, mimicking anandamide by binding to these receptors in the central nervous system (CNS). This action may lead to a reduction in pain perception and modulation of inflammatory responses. Additionally, CBD possesses strong anti-inflammatory properties, which can help reduce the synthesis of prostaglandins, ultimately aiding in the relaxation of uterine muscles.
How does cannabis compare to other pain management options, such as opioids or NSAIDs, in terms of effectiveness and safety for women?
THC has twenty times the anti-inflammatory potency of aspirin and twice that of hydrocortisone. Unlike NSAIDs, THC does not inhibit the COX enzyme. (Russo, 2008) This lack of COX inhibition means that patients using THC may have a reduced risk of developing stomach ulcers compared to those taking NSAIDs.
Cannabis may offer pain relief and allow for pain management with various disease states, but unlike opioids, it does not have a high potential for misuse and abuse. The treatment of opioid addiction typically requires considerable resources, and patients are often prone to relapses. (Birnbaum et al., 2006)
Some potential side effects of THC include dizziness, cognitive impairment, paranoia, or increased anxiety, but are particularly seen in higher doses. THC may also increase heart rate as well as lower blood pressure, which is notable for patients with cardiovascular conditions.
References
- Andrieu T, et al. Association of endocannabinoids with pain in endometriosis. Pain. 2022 Jan 1;163(1):193-203. doi: 10.1097/j.pain.0000000000002333. PMID: 34001768; PMCID: PMC8675052.
- Birnbaum HG, White AG, Reynolds JL, Greenberg PE, Zhang M, Vallow S, Schein JR, Katz NP. Estimated costs of prescription opioid analgesic abuse in the United States in 2001: a societal perspective. Clin J Pain. 2006 Oct;22(8):667-76.
- Bouaziz J, et al. The Clinical Significance of Endocannabinoids in Endometriosis Pain Management. Cannabis Cannabinoid Res. 2017 Apr 1;2(1):72-80. doi: 10.1089/can.2016.0035. PMID: 28861506; PMCID: PMC5436335.
- Maccarrone M, et al. Progesterone up-regulates anandamide hydrolase in human lymphocytes: role of cytokines and implications for fertility. J Immunol. 2001 Jun 15;166(12):7183-9. doi: 10.4049/jimmunol.166.12.7183. PMID: 11390466.
- Russo EB. Cannabinoids in the management of difficult to treat pain. Ther Clin Risk Manag. 2008 Feb;4(1):245-59. doi: 10.2147/tcrm.s1928. PMID: 18728714; PMCID: PMC2503660.
