Cannabis and Women’s Health: A History- Part 3

JAKE F. FELICE, ND, LMP 

In parts 1 and 2 of this article, I reviewed historical accounts of the use of cannabis for women’s health in ancient texts from around the globe, up through mid- to late-19^th century European and American accounts. Much of the historical data used in this article is based on the work by Dr Ethan Russo, who wrote an excellent review in his 2008 paper, “Cannabis Treatments in Obstetrics and Gynecology: A Historical Review.”¹ Based on Dr Russo’s work, and my own experience as a clinician and cannabis educator, the best case for the use of cannabis in women’s health can be made for the treatment of dysmenorrhea, endometriosis, and menopausal symptoms. By looking to these historical accounts, it is apparent there is a relative lack of current research into the use of cannabis for women’s health complaints, especially when considering its broad use for common women’s health issues historically, and the relative amount of current research on cannabis for other areas of medicine. It is my hope that by recognizing the potential for cannabis’ use in women’s medicine, researchers and clinicians will take another look at how cannabis can be beneficial in the treatment of common women’s health complaints, and that the relative paucity of studies in this area may eventually be reconciled. 

Late-19^th Century 

Moving forward in time, the late-19^th century literature includes greater reference to menstrual symptoms successfully treated with cannabis. In 1870, Alexander Silver, MD, discussed the treatment of dysmenorrhea and menorrhagia in an article for the Medical Times and Gazette. In the article, he reviewed 5 case studies, all of which had excellent outcomes.² Silver also discussed another colleague that had treated over 100 patients with cannabis; they reported that it had never failed to control pain and discomfort within 3 doses.² This degree of clinical detail suggests a need for modern clinical trials, and is consistent with my observations when using cannabis for pain secondary to muscle spasm. 

In 1883, the British Medical Journal received and published 2 letters espousing the benefits of cannabis in treating pain and menorrhagia; both accounts included mention of its success rate with only a small number of doses.¹ One author specifically noted that, based on their observed success, further clinical investigation was needed, stating: “Indian hemp has such specific use in menorrhagia–there is no medicine which has given such good results … A few doses {commencing with 5 minims of tincture} are sufficient. The failures are so few, that I venture to call it a specific in menorrhagia. The drug deserves a trial.”¹  

Perhaps most telling of how widespread the use of cannabis became in the mid- to late-19^th century is the account that Queen Victoria used cannabis for dysmenorrhea.³ J. Russel Reynolds, a very influential British doctor and Queen Victoria’s personal physician, further reported that “Indian hemp … is of great service in cases of simple spastic dysmenorrhea.”³  

Toward the end of the 19^th century, a huge body of work was produced outlining various uses of Indian Hemp as well as aspects of its production. The extensive report, known as the Indian Hemp Drugs Commission Report, 1893-1894, was set up by the British House of Commons and examined areas use, and potential for abuse, of cannabis.⁴ Gathering data from across the social strata, the authors mentioned cannabis’ efficacy specifically for menorrhagia, dysmenorrhea, and prolonged labor.⁴ The report also dispelled many myths about cannabis use and investigated its safety.⁴ For cannabis scholars, I recommend a review of this document, which is vast in its scope and descriptive elements of the wide-ranging benefits of cannabis as used throughout 19^th century India. This document has taught me as much about how to best use cannabis as an effective botanical treatment than any other single body of work. 

Current Perspective 

The ancient as well as more modern writings of traditional healers, physicians, and scientists suggest that cannabis may be a useful botanical addition for the treatment of common women’s health complaints. Combining this information of the past with current research, it becomes clear that there is a dearth of evidence properly investigating cannabis for conditions that have numerous first-hand accounts of its success. Based on the historical record, the best case can be made for further investigation of the use of cannabis for dysmenorrhea, endometriosis, and menopausal symptoms. Many accounts reviewed discussed the use of cannabis for hemorrhage and menorrhagia; however, other medications exist that are well-validated in cases of hemorrhage, and investigation of the effects of cannabis on vasoconstriction/vasodilation/hormone regulation in dysmenorrhea would likely inform these early accounts of cannabis’ success in treating menorrhagia. 

Dysmenorrhea 

Primary dysmenorrhea pain derives from prostaglandins produced in the lining of the uterus. Prostaglandins cause narrowing of the blood vessels supplying the uterus, as well as abnormal contractile activity of the uterus, leading to ischemia, hypoxia and increased nerve sensitivity.^5,6 Roughly 10% of women do not respond to the conventional treatment of NSAID’s and oral contraceptive medication.^5,6 Furthermore, both of these treatments carry significant side effect profiles. Cannabis may offer women suffering from dysmenorrhea a more viable alternative. 

The prostaglandin pathway shares many similarities with cannabinoid pathways, as both are arachidonic acid derivatives. Several cannabinoids, including CBD and delta-9-THC, have been shown to inhibit cyclooxygenase activity, thus impeding the production of prostaglandins.^7,8 Additionally, cannabis and its constituents (CBD) have known vasodilatory, smooth muscle relaxing, and anti-hypoxic effects.^8–10 

Despite the knowledge of these physiologic mechanisms, extensive study on cannabis and dysmenorrhea has yet to be completed. There seems to be a disconnect here for investigators, especially considering the vast amount of literature available on the effects of cannabis for pain. For example, a search of the National Library of Medicine database yields only 4 results for the search terms “cannabis and dysmenorrhea.” Perhaps more cannabis researchers need to spend some time perusing the work of Dr Russo more closely.² 

Endometriosis 

Targeting the ECS for endometriosis involves more than just treating the pain, as cannabis may impact several levels of the pathogenesis of the disease. The current literature on endometriosis and cannabis is sparse, with many clinical studies focusing on the relationship between the ECS and endometrial pain using palmitoylethanolamide (PEA), a lipid molecule belonging to the endocannabinoid family of fatty acid amides.¹¹ These interactions include the expression of cannabinoid receptors, ligands and enzymes, effects on inflammatory and neuropathic pain, as well as psychological aspects of pain perception.¹¹ 

In a New Zealand cross sectional survey of 213 women with endometriosis, the authors stated:  

The most common outcomes that cannabis was used for were to improve pain relief (95.5%) and to improve sleep (95.5%). Respondents reported that their symptoms were “much better” for pain (81%), sleep (79%), and nausea or vomiting (61%). Over three-quarters (81.4%) indicated cannabis had reduced their normal medication usage. Over half (59%) were able to completely stop a medication, most commonly (66%) an analgesic. Opioids (40%) were the most common class of analgesic stopped.¹² 

In a 3-month study of Australian women with surgically confirmed endometriosis, researchers found that 13% of the women who used self-management for endometriosis used cannabis for symptom relief.¹³ The authors reported: “Women report good efficacy of cannabis in reducing pain and other symptoms, with few adverse effects reported. Further clinical research is warranted to determine the effectiveness of cannabis in managing endometriosis symptoms. In locations where medicinal cannabis is more accessible, there remains a paucity of evidence for its clinical efficacy with endometriosis-associated symptoms.”¹³ In the same study, the women using cannabis for symptom relief further reported that its efficacy was high for pain relief (7.6/10), that they were able to reduce pharmaceutical medications (some by 50% or more), and that the greatest improvements were improved sleep and decreased nausea/vomiting.¹³ 

Menopause 

Studies of cannabis and menopause are extremely limited. In a survey of 115 postmenopausal and menopausal women who had favorable impressions of cannabis, perceived benefits occurred for joint/muscle pain, irritability, sleep problems, depression, and anxiety.¹⁴ Symptoms of vaginal dryness, bladder problems, heart discomfort, and exhaustion were not affected in the study.¹⁴ 

Mejia-Gomez et al published a 2021 systematic review of cannabis use for menopausal symptoms.¹⁵ Similar to the results of the survey, which was also part of the review, the authors established that many women believed that cannabis was effective for symptom management, yet these beliefs were not able to be verified through more objective parameters. The review initially retrieved 564 studies through relevant search terminology, yet they could only find 3 that were of sufficient quality for full-text review. Additionally, the 3 studies reviewed offered little useful clinical information, leading the authors to conclude: “There is limited research on the impact of cannabis use on menopausal symptoms in peri- and/or post-menopausal women. None of [the] studies assessed quality of life as an outcome and no study was performed by a group of menopause specialists.”¹⁵ 

Perhaps the belief that cannabis can be used for treating menopausal symptoms is unfounded. Based on currently available, peer-reviewed literature, the only conclusions that can be drawn about its efficacy are that many have tried or are continuing to use cannabis for menopause, and that more research is needed. When examining the works of the early pioneers in the use of cannabis for women’s health, and in light of what we are learning about the diverse homeostatic nature of the ECS, it becomes clear that we simply do not yet know how and why cannabis can be beneficial during menopause. That it is already helping many women, and that it has been for centuries, however, is certain. What research can potentially reveal is more symptom or condition specific preparation and dosing, along with mechanisms of action and identification of endocannabinoid receptor targets. 

Conclusion 

Throughout history, cannabis has been used to treat gynecologic and obstetric conditions. Despite lacking an understanding of the endocannabinoid system, ancient healers and early Western physicians were able to intuit antispasmodic, anti-inflammatory, and pain-relieving properties of cannabis and apply them to women’s health conditions. With the discovery of the ECS, modern clinicians now have a physiologic basis that adequately interprets, describes, and supports the broad effectiveness of cannabis observed in women’s health. The limited, but growing body of modern clinical research supports the potential for low toxic cannabinoid therapy for analgesic, anti-inflammatory, and antispasmodic purposes with medical benefits often being derived at less than psychoactive doses. The ancient and modern history of cannabis encourages further extensive clinical investigation, especially in women’s medicine, and specifically for dysmenorrhea, endometriosis, and menopausal symptoms. 

References: 

1. Russo E. Cannabis Treatments in Obstetrics and Gynecology: A Historical Review. J Cannabis Ther. 2002;2(3-4):5-35. 

2. Silver A. On the value of Indian hemp in menorrhagia and dysmenorrhoea. Medical Times and Gazette. 1870;2:59-61. 

3. Crocq MA. History of cannabis and the endocannabinoid system. Dialogues Clin Neurosci. 2020;22(3):223-228. 

4. India Hemp Drugs Commission. Report of the India Hemp Drugs Commission, 1893-1894. New York, NY: Johnson Reprint Corp; 1971. 

5. Barcikowska Z, Rajkowska-Labon E, Grzybowska ME, et al. Inflammatory Markers in Dysmenorrhea and Therapeutic Options. Int J Environ Res Public Health. 2020;17(4):1191. 

6. Coco AS. Primary dysmenorrhea. Am Fam Physician. 1999;60(2):489-496. 

7. Ruhaak LR, Felth J, Karlsson PC, et al. Evaluation of the cyclooxygenase inhibiting effects of six major cannabinoids isolated from Cannabis sativa. Biol Pharm Bull. 2011;34(5):774-778. 

8. Corroon J, Felice JF. The Endocannabinoid System and its Modulation by Cannabidiol (CBD). Altern Ther Health Med. 2019;25(S2):6-14. 

9. Di Marzo V, Goparaju SK, Wang L, et al. Leptin-regulated endocannabinoids are involved in maintaining food intake. Nature. 2001;410(6830):822-825. 

10. Pacher P, Bátkai S, Kunos G. Cardiovascular pharmacology of cannabinoids. Handb Exp Pharmacol. 2005;(168):599-625. 

11. Bouaziz J, Bar On A, Seidman DS, Soriano D. The Clinical Significance of Endocannabinoids in Endometriosis Pain Management. Cannabis Cannabinoid Res. 2017;2(1):72-80. 

12. Armour M, Sinclair J, Noller G, et al. Illicit Cannabis Usage as a Management Strategy in New Zealand Women with Endometriosis: An Online Survey. J Womens Health (Larchmt). 2021;30(10):1485-1492. 

13. Sinclair J, Smith CA, Abbott J, et al. Cannabis Use, a Self-Management Strategy Among Australian Women With Endometriosis: Results From a National Online Survey. J Obstet Gynaecol Can. 2020;42(3):256-261. 

14. Slavin MN, Farmer S, Earleywine M. Expectancy mediated effects of marijuana on menopause symptoms. Addict Res Theory. 2016;24(4):322-329. 

15. Mejia-Gomez J, Phung N, Philippopoulos E, et al. Effect of cannabis use in peri- and post-menopausal women: a systematic review. J Obstet Gynaecol Can. 2021;43(5):680-681. 

Jake F. Felice, ND, LMP is a cannabis author, clinician, educator, and consultant whose vision is to advance the science and practical application of cannabis for medical and recreational markets around the world. Dr Felice provides world-class educational experiences by speaking authentically about hemp and cannabis. He consults with healthcare providers, industry, and the general public. His Category 1 CME courses for doctors, nurses, and pharmacists has been translated into 4 languages. Dr Felice is the founder of Cannabis Matrix Consulting, LLC, and he maintains a regular cannabis blog at drjakefelice.com.