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Can Cannabis Help Menstrual Pain?
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10 min
Gleb Oleinik by Gleb Oleinik

Overview

Cannabis has a long history of use for female-specific medical conditions, including menstrual pain. Although studies in this area remain scarce, research suggests that the endocannabinoid system regulates many processes related to menstrual cramps, such as pain and gastrointestinal function.

Furthermore, there’s plenty of evidence that cannabis can relieve pain, nausea, loss of appetite, bloating, and other issues that happen to be symptoms of menstrual pain.

There’s no direct clinical evidence supporting cannabis use in menstrual pain and its associated symptoms. However, accumulating research findings suggest that the endocannabinoid system is a prime target for relieving abdominal pain, nausea, appetite loss, bloating, and other symptoms of menstrual cramps.

As such, it’s not surprising that cannabis has been used to relieve menstrual issues for thousands of years and that dozens of studies back the pain-relieving, anti-nausea, appetite-stimulating, and other effects of cannabis-based medicines.

Although more research is needed before cannabis is accepted as a treatment for menstrual cramps, there’s enough data to warrant trying it out, especially considering that it seems to address not only pain but many other symptoms.

The Endocannabinoid System

The endocannabinoid system (ECS) consists of cannabinoid receptors, endocannabinoids, and enzymes that synthesize and break them down. The major role of this system is to maintain a state of balance in the human body called homeostasis. To achieve this, the ECS regulates key processes such as pain, sleep, appetite, and cognitive, gastrointestinal, and immune function.

So far, scientists have identified two types of cannabinoid receptors: CB1 and CB2. They are found everywhere in the body, with CB1 being particularly abundant in the central nervous system and CB2 in cells of the immune system. These receptors are activated by anandamide and 2-AG, the two main endocannabinoids produced by our bodies. 

Furthermore, plant-derived cannabinoids (phytocannabinoids) such as THC and CBD can also interact with cannabinoid receptors and enzymes. This explains how cannabis-based medicines can produce beneficial therapeutic effects.

There isn’t any specific research looking at the involvement of the ECS in menstrual pain and related symptoms. Having said that, ECS receptors, endocannabinoids, and enzymes are present in the female reproductive system and play an important role in its healthy function.

More importantly, the ECS regulates processes related to the symptoms of menstrual pain, such as gastrointestinal function and pain, which means targeting it with cannabis-based medicine can potentially offer relief. 

To begin with, the endocannabinoid system plays a major role in regulating pain. This is demonstrated by the presence and involvement of CB1 and CB2 receptors and endocannabinoids in every part of the so-called pain pathway: the processes that result in the sensation of pain. For example, the CB1 receptor is abundant in parts of the peripheral and central nervous systems related to sensing, sending, and processing pain signals. Meanwhile, the CB2 receptor plays a bigger role in inflammatory pain through its involvement in immune function. Also, both 2-AG and anandamide are known to have pain-relieving effects. These findings suggest that targeting the ECS is a promising option for relieving the abdominal pain and discomfort seen in menstrual cramps.

Furthermore, the endocannabinoid system is known to regulate appetite and food intake. This is best demonstrated by the fact that CB1 receptor activation increases appetite, and is the reason synthetic THC drugs are used to counter illness-related weight loss. As such, the ECS can also be utilized to counteract the appetite loss associated with menstrual pain.

Moreover, the endocannabinoid system plays an important role in regulating gastrointestinal function, which means it can help with nausea, bloating, and related digestive symptoms of menstrual pain. Most notably, activation of the CB1 receptor seems to reduce gastrointestinal motility, which plays a key role in symptoms such as nausea, bloating, diarrhea, and abdominal pain. 

Meanwhile, research suggests CB1 activation in the central nervous system can also reduce the urge to vomit, another possible symptom of menstruation. The role of the ECS in regulating digestive function is highlighted by the effectiveness of THC drugs such as dronabinol in reducing nausea and vomiting.

Taken together, all of these research findings highlight how we can utilize the ECS to relieve menstrual pain and related symptoms.

Cannabis & Menstrual Pain

Despite the long history of cannabis use for menstrual discomfort, there are currently no studies looking at the effects of cannabis on relieving menstrual pain and related symptoms. Having said that, there’s a good deal of evidence that cannabis can improve nausea, bloating, appetite loss, various types of pain, and other issues that happen to be symptoms of menstruation. 

To start off, pain relief is arguably the most research-backed benefit of cannabis, with a 2015 review of 28 clinical trials concluding that there was “moderate-quality evidence “to support its use in chronic pain. More importantly, the National Academies of Sciences, Engineering, and Medicine stated in 2017 that “There is conclusive or substantial evidence that cannabis or cannabinoids are effective for the treatment of chronic pain in adults.” 

Furthermore, there’s evidence that cannabinoids such as THC and CBD can reduce nausea and vomiting. For example, a 2007 study found that the THC-based drug dronabinol was as effective as prescription medication at reducing nausea and vomiting in people undergoing chemotherapy, with 71% of patients completely resolving their nausea. More importantly, a 2015 systematic review of 23 clinical studies concluded that “Cannabis‐based medications may be useful for treating refractory chemotherapy‐induced nausea and vomiting.”

Similarly, it’s a well-established fact that cannabis use stimulates appetite. This was demonstrated by a 1995 study where 139 people suffering from AIDS-related weight loss successfully used dronabinol to maintain and even regain weight. These effects are so well-documented that cannabis in general and THC specifically are now widely used to help patients suffering from weight loss associated with chronic disorders.

In addition, cannabis may help relieve anxiety and other mental issues associated with menstrual pain. For example, a 2011 study found that CBD, a non-psychoactive cannabinoid, improved anxiety induced by public speaking in people with social anxiety disorder (SAD).

Furthermore, two studies of people with inflammatory bowel disease (IBD) reported that cannabis use was common for relieving abdominal pain, diarrhea, bloating, and reduced appetite. As it happens, these symptoms also occur in menstrual cramps.

Moreover, a 2002 review by leading medical cannabis expert Dr. Ethan Russo highlighted records going back thousands of years of cannabis use for relieving conditions that affect women, including menstrual pain. This review noted that even Queen Victoria was prescribed monthly doses of cannabis by her physician to reduce menstrual discomfort. Dr. Russo concluded his review by stating that cannabis can offer a safe, effective alternative treatment for dysmenorrhea (menstrual cramps) and other symptoms related to menstruation. 

Similarly, a 2018 review noted that cannabis is commonly used to relieve menstrual pain and that cannabinoids such as THC and CBD have muscle-relaxing effects that can relieve the muscle spasms involved in menstrual cramps.

Also, several studies discuss anecdotal reports of cannabis relieving menstrual cramps and list the condition as one of the reasons people turn to medical cannabis. Lastly, research on adenomyosis and endometriosis, two painful disorders affecting the tissue lining the uterus, suggests that cannabis may be a therapeutic option for pain relief.

In summary, although clinical studies looking directly at the use of cannabis for relieving menstrual pain are lacking, there’s plenty of evidence that cannabis can help with abdominal pain, nausea, bloating, appetite loss, and other menstruation symptoms.

Side Effects

One of the main barriers to the medical use of cannabis is its psychoactive side effects. These include memory impairment, euphoria, anxiety, paranoia, and decreased reaction time. 

Also, cannabis can cause other side effects, such as fatigue and dry mouth. Generally speaking, however, cannabis is a safe substance with minor and passing side effects. Furthermore, using CBD-heavy preparations such as CBD oil is an effective way to avoid the psychoactive effects of cannabis.

By comparison, standard medications used to relieve menstrual pain, such as NSAIDs, are associated with side effects such as stomach ulcers, GI bleeds, and its overuse associated with harm to the kidney, liver and heart.

Legal Use

Despite historical, anecdotal, and emerging research evidence, the use of cannabis for menstrual cramps and related symptoms is not currently recognized by clinicians. As such, menstrual pain is not on the list of qualifying conditions for medical cannabis.

However, most places with medical cannabis programs consider chronic pain a qualifying condition. Therefore, if a person’s menstrual pain is significant enough to be considered chronic and severe, it may be possible to get a cannabis prescription. 

Chronic pain is a qualifying condition in Canada, Germany, the Netherlands, Italy, and many other countries with legalized medical cannabis. The only exception to this are countries with restrictive programs, such as the UK.

Also, medical cannabis use for chronic or severe pain is allowed in 29 states: Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Louisiana, Maine, Maryland, Michigan, Minnesota, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, Washington, West Virginia, Utah, and Vermont.

Furthermore, some American states, such as New York, are considering adding dysmenorrhea (menstrual cramps) to the list of qualifying conditions.

About Menstrual Pain

Overview

Menstrual pain, menstrual cramps, or dysmenorrhea are different names for the pain and discomfort that many women experience just before or during periods of menstrual bleeding. For some women, it’s nothing more than an annoying discomfort, but for others menstrual pain can interfere with their daily activities, relationships with others, negatively impact other conditions they have, and leave them disabled for several days each month.  

Women with conditions like endometriosis or uterine fibroids often experience much more painful menstrual cramps. Menstrual pain tends to begin a year or two after you get your first period, but it can grow less severe over time. Some women find that their menstrual cramps improve a lot, or even go away entirely, after they give birth for the first time. 

Around 85% of women and girls experience painful cramps and discomfort before or during their periods, but few of them talk about it with their doctor, so the number could be higher. The percentage of women and girls who have menstrual pain that’s significant enough to stop them from going to school or work could be as high as 40%. 

Symptoms

The symptoms of menstrual pain are generally a cramping, throbbing pain in the lower abdomen, although you might feel it in your lower back, hips, or inner thighs as well as or instead of your abdomen. It usually begins a day or two before your period is due, or together with the start of your period, and lasts for two to three days. Most women find that menstrual pain is worst within the first 24 hours of menstruation.

In some women, this pain is so intense that they can’t make it out to work or to school. For others, it’s a milder pain that can be controlled with over the counter painkillers. 

Women who have very severe menstrual cramps can also experience nausea, diarrhea, irritability, fatigue, dizziness, changes in appetite, and/or a headache at the same time.

When to see a doctor

Far too many women consider menstrual pain an inevitable occurrence and do not seek treatment including consulting their doctor about it, but there are ways to manage the symptoms. If you have menstrual cramps or menstrual pain that interferes with your daily life, discuss it with your doctor. 

You should also see a doctor if your symptoms get worse or change suddenly for no obvious reason, if the cramping lasts for more than three days, or if you suddenly began experiencing menstrual cramps for the first time over the age of 25.

Causes

Menstrual pain is essentially caused by the uterus contracting to expel the unneeded uterine lining. Your body produces prostaglandin to provoke these contractions, which are also associated with pain and inflammation. 

Your menstrual pain could be caused simply by the uterus contracting, but there are also some disorders which lead to severe menstrual pain and cramps. These include:

  • Uterine fibroids—non-cancerous growths along the lining of your uterus
  • Endometriosis—when uterine tissue ends up in parts of your body outside of your uterus, generally the fallopian tubes, ovaries, or pelvic tissue
  • Pelvic inflammatory disease—a sexually transmitted  infection of your reproductive organs
  • Cervical stenosis—when the opening of your cervix is so small that it slows down the flow of menstrual blood from the uterus, increasing pressure inside the uterus
  • Adenomyosis—when the uterine tissue grows into the muscle of the uterus

Menstrual cramps can affect any woman, but you’re more likely to have them if:

  • Your mother or other close family members have menstrual pain
  • Your periods began early, before the age of 12
  • You have heavy and/or irregular periods
  • You’re a regular smoker

Treatment

There are a number of ways to treat menstrual pain. The best treatment can depend on how severe your menstrual pain is, and it can always take a little trial and error to find the treatment that works best for you. If you have endometriosis, uterine fibroids, or other disorder that’s contributing to your menstrual pain, it’s important to consult with your doctor about specific treatment. Treating the underlying condition usually improve or removes your menstrual pain. 

Medication for menstrual pain

Painkillers
Over the counter analgesics can be very effective for menstrual pain. Ibuprofen like Advil and Motrin, and naproxen sodium like Aleve can be bought off the shelf or over the counter. You might find that you need a stronger pain reliever like prescription nonsteroidal anti-inflammatories. 

Whatever painkiller you take, you should begin taking it the day before your period is due, and continue taking regular doses, according to the drug dosage advice. You should keep on taking it as directed for two to three days, or until your symptoms have entirely gone. Beware, however, of potential adverse effects, even if it is not a prescription medication.

Hormonal contraceptives
Forms of birth control that use hormones to control ovulation and menstruation can also potentially reduce your menstrual pain. They can be:

  • Oral contraceptives that you take every day
  • A contraceptive injection that you get every few months
  • A contraceptive implant under your skin
  • An intrauterine device (IUD) that’s placed inside your uterus
  • A flexible ring that you insert into your vagina

Lifestyle changes

There are many different home remedies and lifestyle changes that can make a difference to your menstrual cramps. These include:

  • Regular exercise has been found to ease menstrual cramps for many women. Build it into your daily routine—don’t wait until the day before your period. 
  • Apply a warming pad, hot water bottle, or heat patch to your lower abdomen. Heat often eases the cramps. Lying in a hot bath can help, too. 
  • Massage to your lower back and lower abdomen can help relieve the pain from menstrual cramps.
  • Some women find that certain foods, like caffeine and foods that are high in salt, sugar, and fat, make their cramps worse. So try to avoid them around your period. Alcohol and tobacco can also make cramps worse. 
  • Nutritional supplements like omega-3 fatty acids, vitamins E, B-1, and B-6, and magnesium can reduce menstrual cramps. 
  • Do your best to reduce stress, which can make your menstrual cramps worse.

Alternative therapies

There are many alternative therapies that can help relieve menstrual pain, but not all of them have been studied enough to prove that they work. Some of the most popular alternative treatments include:

  • Using a TENS machine. TENS machines are small devices that connect to your skin with electrodes in adhesive patches. The electrodes deliver a small amount of electric current that stimulates your nerve endings, encouraging your body to release endorphins, which are natural painkillers.
  • Acupuncture and acupressure use either sharp, very thin needles or gentle pressure to stimulate specific points on the body that relieve pain. 
  • Herbal remedies can sometimes work to reduce menstrual cramps. Fennel seeds or extract, pycnogenol, cinnamon, and curcumin (turmeric) are all popular herbal supplements for menstrual pain. Before you take herbal remedies, it’s important to check with your doctor that they won’t interact badly with any other medication you might be taking.

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