Everything You’ve Wanted to Ask a Doctor About Weed, but Couldn’t

There are a lot of reasons we don’t know more about women’s health. Most of the clinical research that built the modern medical model is based on men. Ethical concerns about impacting women’s fertility and ability to have children played a major role here. As did the inaccurate belief that women and men were similar enough to generalize results from one sex to another. Alas, this has resulted in a large amount of research on biological and psychological conditions that impact both women and men, and little on those that impact women only.

While cannabis has been used as a medicine across cultures for thousands of years, its status as a modern day illegal drug has contributed to the lack of information on cannabis and women’s health. The same concerns about impacting fertility that has biased modern medical research is pervasive in cannabis research as well. Additionally, the legal status of cannabis encourages silence among women concerning their cannabis use, especially during pregnancy, but also in their role as mothers.

Even with all of those obstacles, there are women in the medical field who are pioneering the study of cannabis medicine and women’s health. I had the chance to talk to one of them, Dr. Michelle Sexton, about cannabis and women’s health across the lifespan and for addressing some of the women-specific issues that never quite get the attention they deserve.

Sex Differences

Ever feel like your tolerance swings back and forth during the month? According to Dr. Sexton, our monthly period cycle and the related cycling of hormones makes our biological relationship with cannabis more complex than a man’s. Some women do report that their THC tolerance varies depending on where they are in their cycles, and estrogen may have a relationship to THC tolerance.

“Endocannabinoid tone (the efficiency and effectiveness of the ECS) across women’s cycles is mediated by changes in cannabinoid receptor density, affinity, and function. These menstrual phase-related changes in endocannabinoid tone likely influence the behavioral effects of cannabis and cannabinoids. As with most issues related to women’s health, these changes are very understudied, and most studies examining effects of cannabinoids in women typically do not control for the menstrual cycle phase.”

There are also differences in how women and men experience and consume cannabis. Dr. Sexton summarizes from a study she co-authored, “Women report greater pain benefit from cannabis than men. Women are more likely than men to report appetite decrease, rather than increase, more dizziness, and more improvement in a memory test than men. Women have reported using cannabis less than men (frequency and quantity) and women are twice as likely as men to initiate use after the age of 30.”

“Women were significantly more likely than men to report using cannabis to treat anxiety, nausea, anorexia, irritable bowel syndrome (IBS), and headaches/migraines.”

Regarding cannabis dependence, Dr. Sexton reports that this is actually the most well documented sex difference in human cannabis consumers. Men are more likely to use and become dependent on cannabis, but women demonstrate a more rapid progression from first use to cannabis use disorder.

Women’s Health Issues

Cannabis holds promise for a wide variety of women’s health issues across the life span. I asked Dr. Sexton to tackle a few of the most reported issues among women at different stages of life.

PMS

The cramps, the headaches, the bloating, the sleep disturbance, the poor concentration. Symptoms of PMS can vary from person to person and change throughout life. When I was growing up, Midol was the drug of choice. Now, there are several cannabis products on the market promising relief from PMS, but what is the science behind it?

According to Dr. Sexton, “Women using cannabis for PMS have reported good effectiveness for menstrual cramps, alleviating some of the mood elements, and helping with sleep. Anxiety can worsen for some people, but this effect is clearly dependent on the dose. A low dose of THC can alleviate anxiety, and increasing doses are more likely to cause or exacerbate anxiety. Similarly, heavy cannabis use can contribute to depression, while a light dose may be more effective at elevating mood (euphoria). In general, medical benefits appear to come from low doses of THC or low potency of cannabis. Vape pens deliver extremely high doses of THC (sometimes up to 90%) and this is the cannabis [format] most likely to be detrimental to health. Sticking with low to moderate potency THC (5-15% THC) is typically sufficient for medical benefit and oral doses from 1-10mg.”

Bottom line, cannabis can help make some of the symptoms of PMS easier to deal with, but start low and go slow because too much of a good thing may make some symptoms worse, and even introduce a new one or two.

“Cannabis can be palliative, meaning that cannabis is not treating the root cause, but is alleviating some symptoms. Uncovering the cause is the best approach and this can be done by accessing healthcare providers that are skilled in interpreting laboratory tests for hormonal fluctuations. There are many botanical medicines that women can turn to help balance the hormones that are causing these symptoms.”

Dr. Sexton notes, “Cannabis use during the childbearing years can be tricky, especially if not using birth control. Cannabis use in pregnancy has not been shown to be 100% safe for the developing embryo or fetus.”

Fertility

The relationship between cannabis and fertility has been one of the most difficult areas to research due to the ethical concerns mentioned before. However, many women who consume cannabis are of child-bearing age, so this is an important topic to address.

Dr. Sexton reports that, “Heavy cannabis use has been shown to affect the ability of a fertilized egg to become implanted in the uterus. This is due to inhibiting the release of luteinizing hormone (LH), which is involved in upregulating progesterone—essential for establishing and maintaining pregnancy. This doesn’t mean that cannabis is a form of birth control, however! It likely means that some people could be sensitive to the impact of cannabis on hormonal signaling and fertility.”

“Endocannabinoids have been measured in ovaries, follicular fluids, amniotic fluid, and human milk! Because all reproductive tissues have all of the machinery for making endocannabinoids and for signaling through this system, cannabis can impact this function.”

Dr. Sexton explains that these effects are likely dose-dependent, meaning that high doses are more likely to have this effect than low doses. One study illustrating this showed that couples undergoing IVF were more likely to fail to get pregnant if they used cannabis. Dr. Sexton concludes, “For those people who may be struggling to achieve pregnancy, foregoing cannabis may improve chances of success.”

Pregnancy and Breastfeeding

There are a lot of opinions out there on this one, but Dr. Sexton says, “Just say no! THC crosses the placenta and also into breast milk. While there is the argument that cannabinoids are in breast milk (yes, this is true), these are the body’s natural cannabinoids which are much less potent than THC and in much lower concentration than THC (when inhaling cannabis, specifically). So, justifying that cannabis is safe because of this is not really a fair argument. Dr. Sexton covers more on this topic in her course (see details at the end of the article!) including: natural remedies for morning sickness, risks vs. benefits of cannabis use in pregnancy, effects of THC on the developing brain, and potential outcomes for children exposed to THC in the womb.

Peri-menopause

​​Now this is the life stage I find myself in, and let me tell you, there are bupkis out there on this topic save for a few “love yourself” themed self-help books. Cannabis to the rescue! According to Dr. Sexton, “There are a variety of plant compounds, including THC, that may act as phytoestrogens by binding to the estrogen receptor, thus activating it similarly to how estrogen does. It’s a great idea to incorporate more and more phytochemicals into daily self-care, when approaching the peri-menopause and Wise Woman years.”

“This time of life, and that after menopause, is a great time for cannabis as a medicine and for health! There are so many benefits, such as for joint pain, sleep problems, mood, stress regulation, anxiety, menstrual pain, and changes in sexual desire.”

Let’s talk about hot flashes! Dr. Sexton explains, “The most likely way that cannabis could help with hot flashes is through reduction of body temperature. This might be particularly useful in the late afternoon and night, when the core body temperature is at its highest and when hot flashes peak.”

As I wrote about in a previous article, at age 46 I am finding that my tolerance to THC has started to decline. Dr. Sexton explains why this is and what to do about it. “It is likely that as we age, and endocannabinoid function overall diminishes, and estrogen levels decline, we become much more sensitive to cannabis than when we were young. So adjusting the dose based on these factors is reasonable. To taper off of a vape pen dose, first move to vaporization of cannabis flower and then slowly start to reduce the flower potency. You can do this by mixing hemp with cannabis. You can also quit cannabis cold-turkey, but there are withdrawal symptoms that can be experienced. It’s a good idea to take a break from cannabis for a couple of weeks every few months, just to make sure your cannabinoid system is in good ‘tone.’ It is a system that can reset easily since it is a homeostatic system.”

Intimacy

Last, but certainly not least, I wanted to learn more about a topic that impacts women throughout their lifespan, intimacy. There are a lot of claims that cannabis can help heat things up in the bedroom (or the bathroom, or the kitchen). Is there any truth to that, or is it a marketing tool?

Research focused on helping women with libido, well, let’s just say has never been a priority, which is shameful for many reasons, especially considering women are reported to experience issues with sexual function about twice as often as men. What role does the endocannabinoid system play? Dr. Sexton reports, “Physiologically, women (similar to other mammals) are more likely to be sexually aroused around the time of ovulation.” Unsurprisingly, there doesn’t seem to be much hurry to develop this research in a meaningful way.

“Effects of cannabis on sexual functioning have been documented literally for centuries, including reports of increased arousal and sexual pleasure. Of course, there is also the need for the natural elements of attraction (including visual and scent or pheromones) and receptivity to engaging in a sexual encounter. Cuddling and getting skin-to-skin contact can lead to desire. Oxytocin is released with skin-to-skin contact and this has been shown to increase the amount of the endocannabinoid Anandamide, which is reinforcing for pleasurable experiences. So cuddling can ‘tone’ your endocannabinoid system (ECS) and help with receptivity for more!”

Like much of the information we have about cannabis in the real world, consumers themselves have spoken out about how cannabis has or has not enhanced their sexual experiences. Dr. Sexton relays one such study. “In a formal survey at a gynecology clinic of 737 women (average age 36) using cannabis prior to sex in the real world (published in 2019) and reporting on their experiences, they reported increases in sex drive, improvement in orgasm and decreased pain with intercourse (for those who had pain). There was no effect on vaginal lubrication (cannabis has been known to dry secretions). In this study there was no information on the exact timing of the cannabis use, but the majority were inhaling cannabis, which has a quick onset of effects. 68.5% reported that their overall sexual experience was more pleasurable, 52.8% reported an increase in in satisfying orgasms, and 60.6% reported an increase in sex drive.”

Empowering women to take charge of their health!

Cannabis and other plant medicines give women a chance to get around the biases and lack of research to teach and learn from each other how to manage the symptoms and stresses of the female sex. Through her course, The Green Woman’s Guide, Dr. Sexton offers knowledge and practical advice to help any woman, regardless of life stage, develop a healthy and beneficial relationship with cannabis. You can learn more about Dr. Sexton’s course here: Greenwomensguide.com. Use code “plants” for a course discount! And follow Dr. Sexton for more science based information on cannabis and women’s health.

Website: msextonnd.com
Instagram: @dr.michellesexton
LinkedIn: https://www.linkedin.com/in/michelle-sexton-a40408b/

About Dr. Sexton: Dr. Sexton is an Assistant Adjunct Professor in the Department of Anesthesiology at the University of California, San Diego. She is a naturopathic doctor/scientist with extensive clinical experience and basic, translational and clinical research. Her clinical research and work focuses on body/mind healing. Dr. Sexton has been helping her patients fine-tune their Endocannabinoid Systems since 2008.