Medical Marijuana: A Possible Treatment for Menstrual Cramps?
Andrea Chisolm, MD, is a board-certified OB/GYN who has taught at both Tufts University School of Medicine and Harvard Medical School.
Jessica Shepherd, MD, Verywell Health’s Chief Medical Officer, is a board-certified women’s health expert and nationally-recognized speaker addressing physical, sexual, and emotional health.
Medical marijuana has proven to have some significant medical benefits, most especially pain control. Although it isn’t strong enough to treat severe pain (such as bone fractures or post-surgical pain), it can be effective in relieving different types of chronic pain in many people.
Practitioners of alternative medicine will frequently include menstrual cramps as one of the conditions that medical marijuana can help treat. Insofar as it has been reported to help relieve symptoms of endometriosis and interstitial cystitis, it would seem reasonable to assume that marijuana can help treat the cyclical cramps and pelvic pain that can occur with menstruation.
Mechanism of Action
Marijuana (Cannabis sativa) contains more than 100 different compounds called cannabinoids, some of which have psychoactive properties. These compounds are easily absorbed when inhaled or eaten and can cross the blood-brain barrier to act directly on the brain.
The body is populated with a vast quantity of cannabinoid receptors, called CB1 and CB2, found mainly in the central nervous system but also in the lungs, liver, kidneys, and joints. These are the same receptors that naturally-occurring compounds, called endocannabinoids, attach to.
Endocannabinoids, part of the body’s endocannabinoid system, are believed to play an important role in regulating pain and inflammation. The ability of cannabinoids to attach to these receptors suggests that they may exert similar activity.
The two most recognized cannabinoids in marijuana are:
- Delta-9 tetrahydrocannabinol (THC), which is primarily responsible for marijuana’s psychoactive “high”
- Cannabidiol (CBD), which does not cause a “high”
While THC and CBD are thought to have anti-inflammatory and analgesic (pain-relieving) properties, how they do so differs from other anti-inflammatory or analgesic agents.
What the Evidence Says
Not surprisingly, there is a lack of quality research regarding the benefits of medical marijuana in treating menstrual pain. Even so, cannabis has a long history of use in gynecology. Back in the late-19th century, Sir John Russell Reynolds, Queen Victoria’s personal physician, was said to prescribe hemp tincture to relieve the monarch’s painful menstrual cramps.
How marijuana is meant to achieve the relief remains unclear. At its heart, menstrual cramps are triggered by the release of inflammatory compounds, called prostaglandins, during menstruation. Women who produce are excessive amounts of prostaglandins are more likely to experience severe cramps.
Nonsteroidal anti-inflammatory drugs (NSAIDs) commonly used to treat menstrual cramps—like Advil (ibuprofen) and Celebrex (celecoxib)—block the production of prostaglandins by binding to COX receptors in the brain and other tissues.
By contrast, cannabinoids like THC and CBD exert no activity on COX receptors. and, therefore, have no influence on the production of prostaglandins. Rather, they stimulate the release of the “feel-good” hormone dopamine in the brain (where CB1 resides in high density) while reducing inflammation in the nerves and joints (where CB2 resides in high density).
This suggests that THC and CBD are most beneficial in treating chronic neuropathic pain and inflammatory joint disorders like rheumatoid arthritis. Even so, a 2018 review from the University of Alberta suggests that the benefits may be small.
Because THC and CBD have no effect on prostaglandin production—the compound responsible for menstrual cramps—it is unclear how they are meant to relieve menstrual pain and inflammation.
With that said, it is possible that THC induces euphoria than can reduce the perception of pain. By contrast, CBD’s effect on menstrual cramps remains unknown and largely unsubstantiated.
Safety of Medical Marijuana
At this point, we don’t really know how safe medical marijuana use. Although many people presume it to be safe, the National Institute of Drug Abuse (NIDA) warns that the long-term consequences of marijuana use are still unknown.
Moreover, CBD oils, extracts, and tinctures popularly sold as alternative therapies sometimes contain unknown ingredients, and it is often difficult to know if the doses list on the product label are accurate.
Based on current advisement from the NIDA, medical marijuana in its inhaled form should not be used in people who:
- Are under 25 years of age
- 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
Because there is little evidence about the safety of marijuana in pregnancy, it is best to avoid the drug if you are of reproductive age or use a proven form of birth control.
Though marijuana has not been shown to be cause birth defects, the presence of cannabinoid receptors in the fetal brain suggests that marijuana may impact a child’s cognitive and behavioral development in later years.
There is also evidence that marijuana use during pregnancy may increase the risk of pregnancy loss due to the overstimulation of cannabinoid receptors in the lining of the uterus.
A Word From Verywell
At present, there is no compelling evidence to support the use of medical marijuana in treating menstrual cramps. However robust the testimonials or anecdotal evidence may be, they lack any clear explanation of how the drug is meant to work. Do not be swayed by manufacturer claims that may or may not be true.
If you have severe, recurrent menstrual cramps that do not respond to conservative treatment, talks to your gynecologist about hormonal therapies or surgical options (like endometrial ablation or hysterectomy) that may help.
Heard the buzz about medical marijuana and menstrual cramps? Learn more about what we know and what we don't know about this controversial therapy.
12 Ways to Use Cannabis for a Less Painful Period
In This Article
Here’s the honest to goodness truth of it: I’m not an expert on cannabis for PMS. In fact, I’m not an expert on cannabis in general. And while I could blame this on the fact I grew up in a state where smoking weed was illegal (not that that stopped anyone), my hunch is it has more to do with that one time in Amsterdam when, after consuming an astonishingly potent space cake (note: “Cake” might have actually been plural), I woke up the next morning high as a kite, proceeded to get lost in the cobblestoned streets of Leiden, proceeded to take the wrong train *not* to the airport, and thus, ultimately missed my flight back to Galway, Ireland, where I was living at the time. And as my first time experimenting with the stuff, it wasn’t, shall we say, ideal. So fast-forward four years later and here I am living in Los Angeles (where taking a hit is as normal as bringing your dog into Whole Foods) with a bad taste in my mouth for weed—very un-Angeleno to say the least.
However, that was prior to last month when I had an interesting, out-of-the-box opportunity to take a tour of MedMen—a leading L.A. cannabis management and investment firm with premium retail locations across Los Angeles and Southern California. The goal: to sleuth out the dispensary’s well-fed crop of cannabis-infused wellness products. (If you need a mental visual, it’s basically the Apple store of marijuana and marijuana-infused products.) And, lo and behold, I found the glittering goldmine of cannabis-enriched products to help with PMS, which, while that wasn’t my initial goal, was a standout trend nonetheless. So since no one I know particularly enjoys a painful period, I took some notes and talked to the experts. Can CBD- and THC-rich products lend relief when it comes to PMS symptoms? And perhaps more importantly, do professionals in the health field recommend them? I was curious, and frankly, I thought you would be too. Keep reading to find out what experts think about cannabis for PMS and, if you happen to live in a state where marijuana is legalized, which products we (and the staff at MedMen) think ought to be at the top of your period’s wish list.
CBD + THC Decoded
According to the experts at MedMen, there are more than 100 different chemical compounds in cannabis called cannabinoids—the all-stars being tetrahydrocannabinol (THC) and cannabidiol (CBD). “THC is the psychoactive element that produces feelings of euphoria or the ‘high,'” one of the official spokespeople explains to me, while CBD is associated with some of the more medicinal and reparative effects, such as decreased inflammation, pain management, anxiety reduction, and improved sleep. In fact, Kiana Reeves, a woman’s health advocate, doula, somatic sex educator, and Chief Brand Educator at Foria, laments, “THC also has incredible pain relieving benefits and studies show all of these compounds work best together, otherwise known as the entourage effect. For certain medical conditions, having THC in the formula is essential (for others not as much), but trace amounts are still beneficial. Currently the legal limit for THC in CBD products is less than .3 %.
“CBD has been scientifically shown to increase levels of anandamide, a neurotransmitter and the main cannabinoid that is produced by the human body, which can reduce pain and inflammation and can also boost levels of adenosine, another neurotransmitter which plays a key role in inflammation,” says MedMen.
How Do They Work?
But what exactly happens within the body after both compounds are ingested? And on a more specific note, how does any of this have to do with debilitating PMS symptoms like cramps, sleeplessness, anxiety, and the like? Well, this is where it gets scientific (i.e., complicated and interesting), so I reached out to Adam Friedman, MD, FAAD, at the George Washington School of Medicine and Health Sciences.
After confirming to me that the best-known and most-studied cannabinoids are tetrahydrocannabinol (THC) and cannabidiol (CBD), Friedman dove straight into the science of the compounds—exactly what I was craving amid the world’s murky swirl of stigmas, associations, and opinions on the topic of marijuana (and whether or not it has a legal place in our health system and everyday lifestyle.)
“Interestingly, it was the study of marijuana that initially led to the groundbreaking discovery of the human endocannabinoid system (meaning, we make our very own cannabinoids and receptors for them, which make up an extraordinary biological network that plays a role in everything from sensations of pain and itch to mood, inflammation regulation, and wound healing). Essentially, it’s the gold star of drugs,” Friedman tells us. But wait, there’s more.
THC and CBD have very different properties, as they selectively go after each of the respective endocannabinoid receptors in the body, CB1 and CB2. CB1 is found throughout the central nervous system, which is why THC does its thing when smoked or eaten. “Think of it this way,” Friedman puts it: “Cannabinoid receptors are present in pain circuits from the peripheral sensory nerve endings (fingertips) all the way up to the brain, thereby impacting the transmission and interpretation of sensations like pain and itch. The CB2 receptors, however, are found all throughout the immune system.” Which is precisely why, he says, the substance is widely loved and praised for its ability to manage inflammation and wound healing. And since CBD goes after that one particular receptor, it lacks the psychoactive effects commonly attributed to marijuana.
“We are learning more about these receptors every day, and it’s possible that the activation of either can have a similar effect on pain, just through different mechanisms,” Friedman continues. “Therefore, many of the studies in animals and the few in humans use a combination of both THC and CBD to reach an optimal effect depending on the indication.” (Thus why the majority of the cannabis-infused products on the market contain at least a little bit of both.)
So—Cannabis for PMS
“Cannabis- and CBD-infused products are the next big trend in reproductive health because they are so effective and relatively safe at the concentrations found in many commercial products,” neuroscientist and holistic wellness expert Leigh Winters tells me. The major key: the quality and sourcing of the products play a huge role in its safety and ability to help with PMS symptoms. “The truth is that the relief you can expect really depends on the quality of the product. If you have unbearable cramping, CBD products can alleviate those painful bouts of searing pain that leave you unproductive and unable to focus on anything else. CBD has been demonstrated to promote muscle relaxation while reducing stress and inflammation. Within a few minutes of using a topical product or ingesting, you’ll feel relief.”
And while some Western medical experts are still very much off-board, (one OBGYN explicitly telling me she would never recommend the use of cannabis for period relief, as menstruation is an inflammatory process and therefore anti-inflammatory drugs (NSAIDs: Nonsteroidal anti-inflammatory drug) are the optimal drug of choice ), it’s a viewpoint (while still fair and valid) that seems to represent the minority.
Again, Friedman who is exceptionally well-versed in the *often* gray area lends some expertise: “Interestingly, there is definitely evidence that women with severe cramping associated with endometriosis have an impaired endocannabinoid system. What investigators demonstrated was that those with severe pain actually had lower expression of the endocannabinoid receptors as compared to those with mild pain, and in turn churned out higher levels of endocannabinoids to compensate (too bad it had little impact). This suggests cannabinoids are important in the management of menstrual pain.” Translated: This could explain why some women may have more painful cramping than others. But again, it’s just one piece of the puzzle.
With that in mind, Friedman breaks down CBD’s PMS benefits a bit more explicitly:
1. As an anti-inflammatory, CBD can limit the degree of inflammation and swelling, which can both lead to pain.
2. CBD impacts specific temperature-controlling nerve receptors called vanilloid receptors (TRPV), through which it can then desensitize pain nerve fibers.
Professional Thoughts on Products
As you may know (or as you’re soon to find out), high-quality and reliably sourced cannabis products will cost you a pretty penny. So is it worth it? To get a scientific and medical opinion on the concern, I asked both Winters and Friedman which (if any) kinds of cannabis-infused products they’d recommend for PMS relief. The consensus: Yes, cannabis-enriched products can most certainly be used for PMS. The rub: some might have more efficacy than others.
“I always recommend a period-relief CBD tincture because it’s easy to integrate into an existing routine and effective,” Winters tells us. “While there’s an unfortunate dearth of clinical data studying these new formulations and products, tinctures seem to anecdotally win out among all product offerings. Many tinctures come with specific instructions, but you can either put a few drops under your tongue or add a dropperful (sometimes more) to a glass of water or tea. I’m also a big fan of topical CBD salve that you can massage on the lower abdomen. The relief of a topical cream or salve will likely not be as immediate as that of a tincture, but a gentle massage can greatly ameliorate discomfort. In my opinion, the jury is out on the ‘weed tampon’ until more research is done on the trace amounts of THC it contains and how the body reacts to long-term use.” Though, Reeves says there is a lot of anecdotal evidence suggesting cannabis suppositories are one of the most effective ways to support menstrual pain. “The cannabinoids are absorbed locally into the tissues that are inflamed and cramping thereby providing direct relief. There is a study underway investigating this with a Harvard research physician, hopefully publishing at the end of the year,” she says. Good to know.
Friedman elaborates, “First off, many of the over-the-counter CBD-containing creams have other scientifically proven analgesic compounds like menthol, camphor, and capsaicin, so it’s hard to know what’s doing the heavy lifting. Second, we have a good amount of animal data, but not many human studies, where topically applied cannabinoids are concerned. So to be honest, who is to know without the clinical science,” Friedman tells us. That being said, he reassures us these types of treatments (again, if high-quality and trustworthy) certainly won’t hurt you, and it’s worth experimenting if you’re interested in an alternative way to treat PMS symptoms. (And live in a state or region where these types of products are legalized, of course.)
All in all, and despite the fact that the taboo surrounding marijuana is perhaps still stronger than many would like, the future seems to be rather bright medicinally speaking, and as both experts confirmed, knowledge is power.
“I think the consumer has more power than he or she realizes,” Friedman says. “There is untapped potential that needs to be explored, and the consumer should feel free to encourage local, federal, and industry sources to dive deeper to fully elucidate how best to use these medical agents. Public opinion matters.”
“Everyone has a different opinion about CBD and THC, but the tide is certainly turning as more people and medical establishments have come to accept the medicinal component of the cannabis sativa plant,” Winters corroborates. “CBD is not weed—these products will not get you high. Plants can heal, but they can also harm. Always consult with a doctor or herbalist before trying any cannabis-based product or if you have an adverse reaction, but yes, the health paradigms are definitely shifting on the topic,” she concludes.
So with a better understanding of cannabis and its use for PMS under our belts, we thought it’d be fun to ask the experts at MedMen what their best-selling products are in the name of a less-painful period. And while the majority aren’t available to buy online (unless the product is derived from “agricultural hemp” which isn’t, technically speaking, considered “marijuana” under the Controlled Substances Act ) you can find them at your local MedMen store or countless other dispensaries around the U.S.
PMS Product Picks
Rich in CBD, this convenient dropper provides you with reliable dosage (check out the brand’s helpful guide here) and an easy way to drop a titch of PMS pain relief into your morning smoothie or beverage of choice.
Expertly and scientifically formulated by Ph.D. chemists and featuring only the best (read: premium) quality hemp, Sagely’s Relief & Recovery capsules are water-soluble, offering highly bioavailable forms of both organic turmeric and CBD for fast and furious absorption. Each capsule features 10mg of CBD and, if taken daily, can help curb tension, inflammation, and pain. So when your period reaches its pinnacle of pain, it might feel more manageable and you might just be able to go on with your day to day life feeling like a normal human being.
Boasting a sweet and soothing cooling sensation, this extra-strength body spray offers fast-as-lightning pain relief perfect for those who suffer from PMS-induced cramps. It’s handily optimal for all skin types, conveniently sized, and expertly balances a small percentage of cannabis with other natural botanical pain relievers like arnica, juniper, peppermint, and clove. Simply spray one to two pumps of mist on your targeted area and wait a few seconds for it to dry.
Another MedMen top seller, this whimsical bath bomb features an addictive citrusy scent, and thanks to an expert infusion of CBD extract (and other skin enhancers like coconut and essential oils), it can lend a helping hand for soothing anxiety and pain (which seem to conveniently peak once Aunt Flo comes to town).
Decadent dark chocolate (lots of it) and our period go together like peanut butter and jelly—it’s a winning, no-brainer combination. Then, go ahead and add 90mg of THC and you’ve reached another level of bliss entirely. Enter Défoncé (translated to “stoned” in French), a bougie and irresistibly cannabis-infused chocolatier lessening period qualms for women everywhere (or at least for those who get major cravings.) MedMen recommends its “Dark+” iteration, which boasts 90mg of THC and 81% pure cacao. Just try to limit your consumption—with 18 pieces per bar, you’ll get roughly 5mg of THC per bite. (A true test of self-control, we know.)
Just when you never thought you’d never see the likes of a vaping pen on Byrdie, well, here we are. (All in the name of preventing period pain, of course.) But despite their perhaps eyebrow-raising reputation, these CBD and THC pens from Dosist can work well for pain management and are infused with custom blends of all-natural terpenes. You’ll need to locate them at participating retailers, though (and prices may vary).
Anti-inflammatory, calmative, and highly effective in pain relief (thus great for pesky PMS symptoms), Kikoko’s Sympa-tea is high in CBD and basically feels like a massage in a cup. Simply brew as you would with any other tea and after 60 seconds the cannabis will have fully dissolved. Also cool: Unlike other plenty of other cannabis-infused drinks, no additional ingredients are needed to activate the tea. Other flavor notes include ginger, turmeric, orange peel, black pepper, star anise, cinnamon, and licorice root for further anti-inflammatory benefits. And if you have questions, the brand has a great FAQ section.
Thanks to pharmacological-grade Epsom salt, apricot kernel oil, avocado seed oil, jojoba oil, vitamin E, aloe vera, essential oils, and oh yeah, sun-grown cannabis, this isn’t your average bath soak. We highly recommend it come that time of the month when you’re feeling especially crampy and achy, as its medical cannabis promotes relaxation and yes, epic pain relief. (Plus, it has a luscious, warm, and woodsy scent.)
If you’re in the market for a hard-hitting topical that has the potential to offer hours of pain relief, this all-natural botanical balm might be a good option. It’s enriched with hydrating coconut oil and the award-winning 3:1 ratio formulation has more than 400 mg of cannabinoids per jar.
Yes, this might be pricey, but if you’re one who suffers from PMS-induced cramps and body aches, this extra-strength, gluten-free elixir feels heavenly for sore muscles and those times for when it feels like there’s an alien inside you. It’s expertly formulated with 100mg of CBD, and each measured pump will dispense 1ml of lotion containing 2mg of CBD for perfect dosing. Oh, and it also smells like sage, mint, and green citrus. Which is very, very nice.
A mixture of California wildflower honey and cannabis-infused cold-pressed virgin coconut oil, these ingredients offer plenty of benefits where pain relief is concerned. Plus, thanks to the Indica strain of cannabis this sweet honey bear features, MedMen tells us it will have an ever-so-slight sedative effect.
According to a MedMen spokesperson, Foria’s beloved suppositories have been carefully crafted to maximize the muscle-relaxing and pain-relieving benefits of cannabis without a psychotropic effect. Boasting antispasmodic and pain-relieving properties, you’ll apply the suppositories directly to the area in need of relief —yes, they go directly into your vagina. Not all that surprisingly, they’re one of MedMen’s best-selling products.
Ed note: Everyone is different and certain products may have subtle intoxication effects and become habit forming. Marijuana can impair concentration, coordination, and judgment. Do not operate motor vehicles or machinery under the influence and products are for use by adults 21 years of age and older. Effects of marijuana and marijuana products may be delayed up to two hours. Use of marijuana while pregnant or breastfeeding may be harmful. Keep out of reach of children.
We explore the best ways to use cannabis for PMS symptoms. Click here for the products we (and the experts) think you will love.