Medical cannabis and women’s health have been related for as long as humans have been conscious of the herb. The use of cannabis in ancient obstetrics and gynaecology seems to reveal a connection between a woman’s nature and the peculiarity of the female cannabis flower. Throughout history, cannabinoids have acted as potent allies to several conditions related to our complex reproductive system. And today, the booming cannabis industry offers oils, bath products, capsules, topical creams, and even tampons infused with THC, CBD, or a combination of the two cannabinoids.

CANNABIS AND THE HISTORY OF GYNAECOLOGY

Archaeologists found references to medical cannabis for women’s health in ancient Mesopotamian texts dating back to around 2000 BCE. At this time, the herb was mixed with other botanicals to address menstrual pain, and since then, women from around the world have used the herb for a variety of reasons. The fragrant plant was even included in the Egyptian pharmacopoeia, was widely mentioned in ancient Persian medical texts, and was used by female populations all around the Mediterranean and Europe. The same was happening in India and the Chinese Empire, as reported by a comprehensive historical review by Ethan Russo.

The herb used to be administered via pretty similar methods to the ones used today: orally, rectally, vaginally, topically, and via fumigation (by inhaling the smoke of burning cannabis flowers). We find clear descriptions of these methods in old medical texts, with specific references to symptoms and gynaecological conditions to be treated. Such conditions include painful cramps, bleeding, infections, swelling, menstrual disorders, menopausal symptoms, and more. Cannabis also helped ease contractions and facilitate the birth process, but was also used to provoke abortion. This is an area that is particularly enigmatic.

CANNABIS IN GYNAECOLOGY BEFORE PROHIBITION

During the 1800s, cannabis derivatives were included in official pharmacopoeias for a wide range of conditions, and their use in gynaecology was recommended by major medical luminaries, as well as by Queen Victoria. This smart Queen was also the Empress of India, from which many herbs and natural remedies derived. Centuries after her death, she became famous to the worldwide cannabis community as it was found she used cannabis tincture to relieve her menstrual cramps.

The Irish physician William Brooke O’Shaughnessy was still a subject of Queen Victoria when he validated traditional use of cannabis in India, discovering new applications and recommending cannabis extracts for a variety of therapeutic purposes. Cannabis was mentioned by O’Shaughnessy as efficient at reducing uterine bleeding, and up until the early-mid-1900s, doctors promoted cannabis tinctures for menstrual diseases and other women's conditions. A new branch of clinical research on cannabis that included women’s health was starting up, but then prohibition came, and everything changed.

THE RENAISSANCE OF CANNABIS IN WOMEN’S HEALTH

After the dark age of prohibition, which today is only relatively brighter, a slew of new research started confirming the science behind centuries of anecdotal accounts.

The endocannabinoid system (ECS) is a major regulatory network with functions related to mood, metabolism, appetite, immune system response, memory, and pain perception. Ultimately, one of the main jobs of the ECS is to help the body maintain a state of internal equilibrium known as homeostasis.

The ECS also plays a role in female hormonal balance and reproductive processes. Cannabis-derived cannabinoids are able to interact with our body’s cannabinoid receptors, and this is where all the magic happens.

THE RENAISSANCE OF CANNABIS IN WOMEN’S HEALTH

PERIOD PAIN

Today, we have a solid body of evidence on the pain-relieving properties of cannabis, both from clinical studies and patient experience. Research also confirms the anti-inflammatory effects of cannabis derivatives, which can contribute to lowering pain. A growing number of women today use various forms of cannabis to address painful symptoms like uterine inflammation and other issues related to menstruation.

Despite that, no extensive studies have investigated cannabis’ anti-nausea properties during a woman’s period. With that said, THC has long been known for its antiemetic properties, with the compound playing a role in chemotherapy treatment for years. Research on cannabis’ effects on period pain specifically is also lacking, but it was found that interaction between THC and oestrogen causes an increased level of pain relief. This result leads to the conclusion that cannabis might be more effective for pain relief in women than in men.

PREMENSTRUAL SYNDROME

There is very little research available on cannabis’ effects on PMS, despite well-known benefits for pain, muscular tension, headache, and mood. Women living in regions where cannabis is fully legal can easily experiment with products containing THC and CBD to relieve mood-related symptoms of PMS. Most everywhere else in the world, it is possible to use CBD products as a home-treatment for the aforementioned conditions, including anxiety and mood disorders triggered by PMS.

ENDOMETRIOSIS

Endometriosis is a fairly common and painful health issue causing the inner tissue of the uterus to grow elsewhere, generating severe pelvic pain, scars, and risk of infertility. Endometriosis affects about 1 in 10 women worldwide during their fertile years.

A recent online survey found that Australian women with endometriosis who used cannabis flowers or extracts, CBD oil, heat, and dietary changes were the most successful in terms of pain reduction. Physical interventions such as yoga, stretching, and exercise were rated as less effective. Despite these findings, the most common remedy to self-manage endometriosis pain is still anti-inflammatory medication, although these drugs come with significant side effects.

SEX

A study found that 68.5% of women who used marijuana before sex had a more pleasurable experience. In most cases, women who use small amounts of cannabis experience an increase in sex drive, while higher doses of THC are reported to exert a negative effect. The positive effect of cannabis on anxiety can reflect on one’s sexual life too, as well as potentially increase physical sensitivity. Though using cannabis during sex has always been popular, research has not provided clear evidence on exactly how the sexual experience is enhanced. And it isn’t an easy task.

Anyhow, healthcare start-ups involved in the legal cannabis business have been developing products with cannabinoids aimed at boosting sex-life. These contain THC, CBD, or a combination of both, and they come in the form of lubes, creams, relief oils, suppositories, and, of course, a lot of sweet aphrodisiac edibles. User reports are largely positive, particularly when it comes to reducing pain during or after sex.

CANNABIS MENSTRUAL DISEASES

PREGNANCY

Pre-industrial medicine concluded that “Indian hemp” had a remarkable ability to increase uterine contractions during delivery, while being also beneficial against bleeding. It may take a while before edibles or vapes enter the delivery room, but this is another area worth exploring.

The University of Washington School of Medicine in Seattle recently initiated a study called “The Moms + Marijuana Study”. For the first time, researchers are trying to assess whether using cannabis to alleviate prenatal nausea is safe for a baby’s development. The results, which will comprise images of the developing foetus brain, might change the way cannabis is perceived within the medical community.

MENOPAUSE

Women going through menopause experience several symptoms, many of which are difficult to treat outright. A growing body of clinical and anecdotal evidence suggests that cannabis, and particularly CBD, has the potential to alleviate some symptoms of menopause. Research has shown the endocannabinoid system to regulate mood, sleep, pain perception, and more. There is also scientific evidence on the complex role of the endocannabinoid system (ECS) in female fertility, with researchers establishing a clear relation between the hormone oestrogen, the endocannabinoid anandamide, and functions of the ECS.

Moreover, lab research argues that cannabinoids may help regulate bone development, reducing the common risk of postmenopausal osteoporosis. Research indicates that CBD can bind with bone cell receptors, inhibiting the declining process and slowing down bone density loss. Despite a lack of conclusive evidence, the use of cannabis even during menopause may help the endocannabinoid system maintain homeostasis.

While a proper mix of THC and CBD might be most effective for menopausal issues, CBD alone has been documented as being effective for treating menopausal sleep and mood problems, without exerting the intoxicating effects of THC.

REDISCOVERING CANNABIS USE AMONG WOMEN

Unfortunately, studies show that women develop a tolerance to cannabis faster than men, and are more adversely affected by the eventual symptoms of withdrawal. It also seems that the area of the brain that controls “spatial memory” is more affected by cannabis consumption among women than in men. But beside this fact, just like any substance, cannabis has mild side effects and might not work for everyone.

While most people can safely experiment with CBD, a little more caution should be taken with the intoxicating cannabinoid, THC. In legal markets, it’s possible to source seeds or products that contain around a 1:1 ratio of CBD:THC, or just CBD with barely any THC at all. Those looking to use THC might also try microdosing—that is, taking small doses of THC throughout the day, without ever getting truly “high”. This should still provide the sub-perceptual benefits—such as inflammation and pain relief—but without significant mind-altering qualities. On the other hand, those well-acquainted with THC can select from any number of strains.

On a final note, a survey of US women published in Obstetrics and Gynecology in May 2019 demonstrates significant anecdotal support for cannabis use among women. Out of 1,011 women with a median age of 37, 36% reported using it to treat a specific medical condition such as pain, depression, or anxiety. Of these women, 16% reported cannabis use to treat a gynaecological condition like menstrual cramps. Furthermore, most of the surveyed women considered using cannabis to treat a gynaecological condition.

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