Most women of child-bearing age experience symptoms of Premenstrual Syndrome (PMS) or the more severe Premenstrual Dysphoric Disorder (PMDD) (1) at some point in their lives. As the campaign for cannabis legalisation gains more support around the world, an increasing number of women are turning to cannabis seeking relief from their symptoms. What many might not know is that cannabis has been used by women throughout history to soothe cramps and mood swings, with the most famous historical example being Queen Victoria. Indeed, as far back as 1564, Leonhart and Lonicer wrote about this use of the plant in the German herbal book, ‘Kratterbuch’:
“Women stooping due to a disease of the uterus were said to stand up straight again after having inhaled the smoke of burning cannabis” (2).
Conventional Treatment for PMS
Premenstrual symptoms include, abdominal pain, cramps and contractions, nausea, vomiting, depression, anxiety, irritability, gastrointestinal issues, insomnia, general aches and pains and breast tenderness.
Typically, if a woman complains of debilitating PMS symptoms to a health worker, anti-inflammatory medication such as ibuprofen will be recommended, or alternatively, hormonal birth control may be suggested. For women with certain health conditions or who suffer adverse reactions to anti-inflammatories, these options are not acceptable. Additionally, some women may be against hormonal birth control for religious, cultural, or personal reasons. For these women, cannabis might be a viable alternative, or it could be used in tandem with other methods of pain relief.
Cannabis is gaining more and more acceptance in the US with 47 states now allowing ‘some form of medicinal use’ (3). It is still illegal, however, in most countries. Due to its illegality, research and studies on how cannabis affects menstrual pain and emotional symptoms of PMS are few and far between. More research is certainly needed.
Cannabis and Abdominal Pain
The cannabinoids CBD and THC are known to cause the smooth muscle of the uterine wall to relax. This leads to increased blood flow providing relief to oxygen-starved tissues, thereby reducing pain. The myometrium is the middle layer of the uterine wall and its main job is to induce contractions during menstruation and child birth. THC and CBD target different cannabinoid receptors embedded within the muscle tissue of the myometrium, consequently relaxing these contractions (4). Prostaglandins are a necessary nuisance, a group of lipids that occur at the site of tissue damage to assist in blood flow, child birth etc. The increase in prostaglandin production contributes to inflammation and that all too familiar abdominal pain (5).
‘Cytokines are the signalling proteins synthesised and secreted by immune cells upon stimulation. They are the modulating factors that balance initiation and resolution of inflammation’ (6). During the luteal phase (between ovulation and menstruation) pro-inflammatory cytokine production increases (7). ‘Cannabinoids are potent anti-inflammatory agents and they exert their effects through induction of apoptosis (that’s cell death to you and me), inhibition of cell proliferation, suppression of cytokine production and induction of T-regulatory cells’ (6). Basically, cannabinoids are attacking inflammation from a number of angles so by medicating in this way you may be able to fit into those jeans on Day 2 after all.
Cannabis for Nausea/ Vomiting
Nausea and vomiting are common among women experiencing severe cramps and contractions and by treating the abdominal pain these symptoms often subside. Cannabis is also popular among pregnant women suffering from morning sickness, many of whom also experience similar abdominal pains. Cannabis for the treatment of nausea in general is not new. In the United States, Dronabinol (a synthetic version of THC) has been prescribed to patients for nausea related to AIDS, chemotherapy and cancer since the 1980s (8). Nausea and vomiting can be debilitating regardless of cause, so why the stigma over those using cannabis for PMS related nausea?
Cannabis for Depression/ Mood Swings
In the days leading up to a period, with serotonin levels plumbing the depths, the relaxing and euphoric effects of cannabis can offer relief for those struggling emotionally with depression, irritability and mood swings. Cannabinoids stimulate and target different receptors in the brain and wider nervous system to help the body recognise and regulate a wide variety of stimuli and changes (9), most notably mood and stress during PMS.
Cannabis for Gastrointestinal Issues
The PMS symptom nobody talks about. PMS related constipation and diarrhoea is
due to an increase in prostaglandin production causing contractions of the uterus, which affect the nearby intestines, causing diarrhoea in many women (10).
According to a 2012 study in Israel, cannabis has been shown to be very effective for patients suffering from Crohn’s Disease. 21 patients were split into two groups. They were asked to report their symptoms during the 8 weeks of treatment and for 2 weeks after. In the first group each participant was given two spliffs daily each containing 11.5mg of THC. The second group was given a placebo containing cannabis flowers devoid of THC. The data showed that the group smoking the THC reported a significant reduction in the severity of their symptoms. 5 out of 11 patients (45%) reached complete remission of their Crohn’s Disease, where steroid and immune system suppressors had been unsuccessful. Only 1 person out of 10 reached remission in the placebo group (11). Although further research is always needed, this suggests that cannabis could also be effective in the similar, temporary PMS related gastrointestinal problems.
Cannabis for PMS-Related Insomnia
Sleep quality alters throughout the menstrual cycle. During the menstrual phase an increase in nocturnal body temperature and painful cramps means that getting enough shut-eye can seem like a mission, ‘the menstrual phase is known to influence stage 2 and REM sleep’ (12). Although there is plenty of anecdotal evidence to suggest cannabis can help with PMS related sleep problems, as of yet there are no serious studies devoted to this. Hopefully with medical cannabis gaining more support, PMS related insomnia will be recognised as a very real condition affecting many women.
PMS can be an endurance test for many women and if a hot water bottle and an ibuprofen just aren’t cutting it, cannabis can be a life-changing and life-affirming option.