Medical Marijuana: A Possible Treatment For Menstrual Cramps?

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I have to admit my first reaction to the use of marijuana for menstrual cramps was something along the lines of:

“ Yeah, no kidding if you get high you won’t care about your menstrual cramps. Of course, marijuana use makes your cramps go away!”

Arguably, not the most enlightened response.

 So, since I aspire to be a well-informed and open-minded allopathic physician I felt compelled to learn more about (and share with you) the use of medical marijuana to treat this very common women’s health condition.

 

What The Evidence Says Or Doesn’t Say

No surprise, there is a lack of good quality scientific evidence regarding medical marijuana use in general. This is not surprising since the legalization of medical marijuana is relatively recent and limited. We have, however, started to see some research looking at how marijuana and its components might be helpful in treating certain medical conditions including chronic pain.

Evidence supporting its use specifically in women’s health is essentially nonexistent. In fact, the only article in the medical literature discussing marijuana use for menstrual problems is from the late 1800’s.

 So,  what we are left with is anecdotal evidence and testimonials, both present day (Whoopi Goldberg) and historical (Queen Victoria), supporting the use of marijuana to treat menstrual cramps.

What Makes Marijuana a Pain Reliever?

Marijuana or Cannabis Sativa contains more than 100 different types of cannabinoids.

These compounds have certain properties that in your body make them

  • easily absorbed and stored in body fat
  • move easily into your cells
  • cross the blood brain barrier especially when ingested or inhaled

Maybe even more importantly, your body already has an abundance of its own cannabinoid receptors especially in the tissues of the nervous system and the immune system.

(No, that doesn’t mean you are hard wired to get high.)

Your body produces its own type of cannabinoids called endocannabinoids. These compounds and their receptors make up your body’s endocannabinoid system that is believed to play an important role in regulating body functions including pain and inflammation.

The most recognized of the cannabinoids in marijuana are:

  • THC (tetrahydrocannabinol)
  • CBD (Cannabidiol).

Both of these compounds are thought to have analgesic (pain relieving) and anti-inflammatory properties. These cannabinoids interact differently with your bodies cannabinoid receptors. This is thought to result in an important difference between these two cannabinoids:

  • THC is thought to be primarily responsible for the psychoactive property or the “high” associated with marijuana use.
  • Whereas, CBD is not psychoactive and may even block the high associated with THC.

What We Know About How Marijuana Might Help Menstrual Pain

Researchers are still trying to figure out exactly how cannabinoids work to reduce pain.

Medical marijuana is administered in three ways:

  • Inhalation
  • Ingestion
  • Topical

One thought is that the euphoria achieved with inhalation or ingestion creates an emotional response causing an altered perception of pain.

Another is that pain centers in your brain are blocked by exogenous cannabinoids binding to specific receptors.

Topically administered cannabinoids especially CBD seem to not be psychoactive and do not produce a euphoria or “high”.

It is thought that they bind to the cannabinoid receptors in the peripheral nervous system and interrupt pain signals to your brain. 

Research on the function of your body’s cannabinoid receptors appears to support the possibility that exogenous cannabinoids, especially CBD, may also decrease inflammation and reduce muscle spasm.  

Since menstrual cramps are caused by inflammatory factors and contractions of the muscular wall of the uterus it is thought that local topical administration of CBD may be useful in treating this pain.

Is Medical Marijuana a Safe Option For Treating Menstrual Cramps?

At this point the best answer to this question is we don’t really know if medical marijuana use is safe.

There is currently no really solid evidence to support any claims about the safety of marijuana.

There is some guidance in the medical literature suggesting that inhaled medical marijuana use be limited to patients who have severe pain that has not responded to standard treatments.

This guidance although based on limited evidence states that inhaled medical marijuana should not be used in patients who:

  •  Are under 25 years old
  • Have a personal or strong family history of psychosis
  • Have a current or past cannabis use disorder
  • Have a current substance abuse disorder
  • Have heart or lung disease
  • Are pregnant or planning a pregnancy

Of particular concern, is that the majority of women seeking treatment for severe menstrual cramps are of reproductive age and there is a lack of strong evidence for the safety of marijuana use in pregnancy.   The small amount of current evidence suggests that:

  • Marijuana use in pregnancy has not been shown to be a teratogen or a cause of birth defects. However, because of the presence of cannabinoid receptors in the fetal brain, there is concern that cannabis exposure can have significant negative consequences for fetal neurodevelopment that could lead to long-term behavioral or cognitive problems.
  • There is also some evidence suggesting an increased risk of pregnancy loss in women who are using cannabis around the time of getting pregnant. A possible explanation for this is that the endometrium contains endocannabinoids and receptors and that the function of this system may be interrupted by exogenous cannabinoids.

What Medical Marijuana Products Are Currently Available to Treat Menstrual Cramps?

As far as I know there are only two sources of medical marijuana products specifically designed for the treatment of menstrual cramps:

As of now, these products have limited availability and only in California. 

As with all medical marijuana use, you need to have a medical marijuana card in order to even consider purchasing any marijuana based therapies.

Bottom Line

 There is no strong evidence to support the benefits or the risks of medical marijuana use for the treatment of menstrual cramps. 

There are testimonials from women reporting relief from menstrual pain with the use of medical marijuana but that doesn't replace scientific evidence. 

Studies are needed to determine how effective and how safe medical marijuana is for the treatment of menstrual cramps.

More research into the therapeutic action of the nonpsychoactive cannabinoid CBD may be promising, although it is unclear as to what role cannabinoid-based therapies will play in the management of dysmenorrhea.

It is unlikely that medical marijuana based products will be indicated as first or even second line therapy for menstrual cramps.

Perhaps medical marijuana will eventually be accepted as a third line treatment for women with severe and debilitating dysmenorrhea. In other words, medical marijuana may be an option for those women who would otherwise have to go under the knife and lose their uterus in order to get relief.

 

Kahan,M.et al.(2014) Prescribing Smoked Cannabis for Chronic NonCancer Pain. Canadian Family Physician,(60) 1083-1090

Pacher,P.et al. (2006) The Endocannabinoid System as an Emerging Target of Pharmacotherapy. Pharmacology Review 58(3)389-462 doi:10.1124/pr.58.3.2

American College of Obstetricians & Gynecologists(2015).ACOG Committee Opinion no 637: Marijuana Use During Pregnancy and Lactation. Obstetrics Gynecology. 126(1):234-238

Hutton,H.(2014) Topical Uses for Cannabis sativa. East West School of Planetary Herbology. Retrieved 4/2/2016 from https://www.planetherbs.com/specific-herbs/topical-uses-for-cannabis-sativa-l.html

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