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World Menopause Day: How medical cannabis is helping women manage symptoms

A third of the UK female population are experiencing menopausal symptoms – can medical cannabis help?

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Around 13 million women are going through the menopause in the UK

Around a third of the UK female population are thought to be going through the menopause, but many report feeling isolated and unsupported by their doctors. Can medical cannabis help manage symptoms?

“Hot sweats? It was more like a nuclear reaction,” says Lauren, a 48-year-old former mental health nurse.

“It’s awful when you’re thrown into that, you feel low and weak, it’s as though your life force is ebbing away.”

Lauren was plunged into the menopause suddenly after a hysterectomy at the age of 38. 

“I literally came out of surgery, they took me up to the ward and 10 minutes later I felt as if I had an infection in my body, I was burning up,” she says.

“A doctor came over and said ‘you can’t be experiencing any symptoms yet, you’ve only just had the operation’. He just disregarded how I was feeling.”

Lauren

Working on a mental health ward for three decades, Lauren saw first hand how women were dismissed as having mental health issues, despite presenting with clear menopausal symptoms. 

“We had patients on the ward aged 50 and above, experiencing suicidal thoughts, having made suicide attempts, all which [can be] linked to a chronic lack of oestrogen in the body,” she explains.

“But that was seen as a mental disorder rather than considering that it could be because they’re going into the menopause or perimenopause.”

In her own health journey, she continued to feel unsupported by clinicians and stigmatised by others who failed to understand the extent of her symptoms. 

“There was a lack of understanding of not just the physical but the psychological and the emotional aspect of it. Your hormones are depleting, it’s going to affect the way you think and feel about yourself and the world,” says Lauren. 

“Even at work, in the NHS, the menopause procedure from HR was to give me a fan to put on my desk. How patronising and condescending is that?”

The impact of menopause

According to the British Menopause Society (BMS), menopausal symptoms affect more than 75 per cent of women and over 25 per cent describe severe symptoms. These last an average of seven years, with one in three women experiencing symptoms beyond this. 

While hot sweats are commonly linked to the menopause, many people are unaware of other symptoms, which include low mood, anxiety, depression, insomnia, low libido, poor memory and brain fog. These, amongst others, can be debilitating and have a huge impact on a woman’s daily life. And the lack of awareness and understanding mean sometimes women themselves may not realise why they are experiencing them.

Perimenopause or ‘menopause transition’ can begin years before the final menstrual period and may last for four to eight years.

Women experiencing perimenopause in particular, are less likely to be aware of what’s happening to them as the emotional symptoms can begin before any physical changes to the body, according to Dr Dani Gordon, a medical cannabis prescriber who specialises in women’s health. 

“Women will come to me saying, ‘I feel like an alien is taking over my brain. I don’t know what’s wrong with me. I’m tearful all the time, or on edge and I just can’t seem to get my emotions under control’,” she says.

“These emotional dysregulation symptoms can come before the night sweats and before the periods start to get irregular, so you could still have a pretty regular cycle and still be entering into the beginnings of that transition.”

Symptoms can be so debilitating that a survey of almost 4,000 women, published in October by not-for-profit Newson Health Research and Education, highlighted that 99 per cent felt their perimenopausal or menopausal symptoms led to a negative impact on their careers. 

In a BMS National Survey in 2016, 47 per cent of those who needed to take a day off indicated that they would not tell their employer the real reason behind their absence.

Despite this, menopause and perimenopause symptoms are poorly understood in the modern healthcare system. A documentary hosted by Davina McCall earlier this year started a viral conversation, the fact that it hit a nerve highlighting just how many women feel unsupported by their GPs who are often a first port-of-call for those experiencing symptoms.

Lack of understanding

According to Dr Gordon – who has heard first hand from patients and her own peers – women are frequently told to “manage their stress better”, “lose some weight” or “do more exercise” when seeking medical treatment for menopause symptoms.

There’s so many reasons why [symptoms] may be poorly treated,” she explains. 

“One of them is cultural and the fact that we don’t talk about menopause. Our culture is based on this obsession with youth and women after a certain age don’t want to talk about the transitions that they are experiencing, even though they’re completely natural and normal and everyone goes through them.” 

The other factor is the medical system itself. Earlier this year it was revealed that 41 per cent of UK universities do not have mandatory menopause education on the curriculum at their medical schools. The BMS does offer additional training courses for GPs on the menopause, but these cost time and money which many simply don’t have considering the increasing pressure they are already facing. 

Rachel Mason had a hysterectomy at the age of 30 after being diagnosed with ovarian cancer. She describes trying to access support with perimenopause as “horrendous” despite receiving excellent care during her cancer treatment. 

“With everything else I can’t fault the care, it has been amazing but when it comes to the menopause there’s no support there,” she says.

“I tried to move my menopause clinic appointment forward as I was in a really bad place but was told they only run it once a month – can you imagine how many women need to go to that?”

As GPs have no formal training in this area, women can wait up to a year for a diagnosis, according to Dr Louise Newson, ​​a GP and renowned menopause specialist, with only around 37 percent being offered hormone replacement therapy (HRT). 

Dr Gordon believes this may be down to GPs not feeling confident in the prescribing of this treatment. 

Dr Dani Gordon is a world-leading expert in medical cannabis and women’s health

She explains: “Many GPs, it seems, are not confident in the differences between body identical HRT and more traditional progestin containing HRT.

“After speaking with patients who had tried to have these conversations with their GP about wanting to try body identicals or about the specific non-drug approaches they can take for different symptoms, or about the latest research into what supplements may or may not be helpful.” 

The role of cannabinoids

Dr Gordon has successfully treated many women experiencing menopausal symptoms with cannabinoids and is in the process of opening her own private integrative medicine clinic, Resilience Medicine in the UK.

“When women are going into the perimenopause phase, their ability to regulate stress usually gets worse, because the hormones are more difficult to balance, and when you throw extra stress hormones into the mix it makes the imbalances worse in the female hormones as well,” she says.

“Women are told, ‘oh just learn how to manage your stress better’, but if your hormones are raging all over the place and you have high cortisol, the stress hormone, it’s really hard to manage your stress because physiologically you’re going to be on edge, irritable, anxious, tired but wired. What cannabinoids can do is give people a tool to help get those symptoms under control.”

While menopause isn’t currently a primary indication for the prescription of cannabis-based medicines in the UK, the symptoms such as anxiety and sleep components can respond well to the treatment. 

“Even if someone can’t take HRT they can still usually take cannabinoids to help with symptoms,” continues Dr Gordon. 

“We have cannabinoid receptors in our womb, in our uterus, throughout our female reproductive tract, and also in the brain area, the hypothalamus that deals with the stress response. This is called the HPA axis and it also controls what’s called the HPO axis which is how the brain talks to the ovaries.

“When we introduce a high-CBD during the day and then a little bit of THC to help people sleep at night, the perimenopausal symptom clusters respond well to this in the majority of cases, because CBD can help reduce the stress response.”

Several overseas studies suggest increasing numbers of women are turning to cannabis to help manage their symptoms. A study from the University of Alberta in Canada found that one in every three women near the menopause transition uses cannabis for symptom management. Likewise, the North American Menopause Society reported earlier this year that out of over 200 women in California, who participated in the Midlife Women Veterans Health Survey, around 27 per cent reported having used or were currently using cannabis.

Lauren had been taking a high dose of HRT for around a decade when she became unwell and doctors halted the medication, fearing she was having a stroke. After being prescribed medical cannabis for primary progressive multiple sclerosis (MS) – which she was diagnosed with last year – she found it was actually helping her menopause symptoms too. 

“MS is bad but some of the symptoms from the menopause were actually 20 times worse,” she says.

“Medical cannabis has given me a new lease of life. I take it in the morning and it gives me the energy to get out of the house and go to the gym. 

“In the evening, if I’m having problems sleeping or with hot sweats, I take an indica strain and that just relaxes my body so I don’t feel stressed and anxious about the symptoms I am having.”

Rachel Mason, Menopause

Rachel Mason is founder of Our Remedy CBD

Experiencing the benefits of cannabis also gave her the confidence to speak more openly with her GP about what she was going through. She now volunteers with PLEA (Patient-Led Engagement for Access) to help improve awareness so others can access cannabis-based medicines. 

“I know how good it’s made me feel, so I’m more able to put my foot down and say ‘this is helping me, I know what I need’. Life is too short to feel unwell when there are things that you can do, you’ve got to take back the power for yourself,” she says.

“I would like to see GPs point women in a direction where they can have a discussion about medical cannabis. It might be something that they’ve never tried or they’ve been against, but it’s just about having that advocacy and giving the information to the healthcare professionals so that when they are offering choices to women they’ve got this in their toolbox.”

Tackling the stigma

Despite the fact that there are around 13 million menopausal women in the UK, it can be an isolating experience, particularly for someone going through perimenopause in their 30s as Rachel was. 

“I was really scared to go through the menopause, I didn’t tell anyone because there’s such a stigma attached to it, regardless of your age, I was worried how people would react,” she admits.

“I think if I had a group of friends who were all going through it at the same time, we would talk about it and you wouldn’t feel so alone, but none of them have the same experience.

“My biggest concern was if I would still enjoy going out and socialising. I was so confused about the person I would be, but I can honestly say I don’t feel like I’ve actually changed at all.”

Rachel went on to set up her own CBD brand, focusing on women’s health. Speaking about her situation has encouraged other women in her life to open up.

“My dad’s partner was having horrendous hot flushes, she suffered for two years and didn’t know who to talk to. She was embarrassed. When I started opening up about my situation she did too and I got her started on CBD, she said they virtually stopped,” Rachel says.“Once you break through that stigma it is beneficial for everyone.”

Lauren agrees, she adds: “For me the biggest thing is the mental and emotional feelings that come with menopause, you can feel isolated, but we are 50 percent of this country, we shouldn’t feel ashamed or embarrassed. Our voices need to be heard.”

 

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Lauren, Rachel and a panel of clinical experts will join us to discuss the experiences of women who find medical cannabis helpful in managing symptoms of menopause on Tuesday 30 November at 7pm.

Register for FREE here 

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How cannabis can offer an alternative for menopause symptoms

Experts at Integro Clinics explore how cannabis medicines can offer an effective alternative to HRT

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Experts at Integro Clinics explore how cannabis medicines can offer an effective alternative to HRT treatment for menopause symptom control.

It is now widely accepted that Hormone Replacement Therapy (HRT) can be very useful in treating menopause symptoms. However, it is not suitable for all women – some who may not feel comfortable using it or have a medical contraindication such as a family history of cancer.

There is an alternative out there that can be used in conjunction with HRT treatment, to complement it, or used entirely on its own – cannabis medicines.

At Integro Clinics our female pain expert, Dr Sally Ghazaleh and Neuropsychiatrist, Dr Mayur Bodani have seen encouraging results from patients using medical cannabis in the form of an ingestible oil (CBD mixed with THC) and by vaping prescribed cannabis flower.

The specific symptom cannabis-based medicines (CBM’s) can address in menopause include insomnia, anxiety, depression, headaches, low libido, and brain fog. If you have profoundly disturbed sleep, it can have a massive impact on your quality of life, mental well-being & ability to cope.

At Integro Clinics we have witnessed that once the patient achieves a better and more consistent regular quality of sleep, with the help of CBM’s, everything starts to pick up. Anxiety can decrease, the desire to take physical exercise and mental clarity are increased, which can lead to a lift in depression and a more positive mindset.

If you are interested in finding out in more detail how CBM’s can help you with your menopause symptoms, do not miss the opportunity to register for free for a webinar on Tuesday 30 November.  Hosted by Integro Clinics, Cannabis Health and Cannabis Patient Advocacy and Support Services (CPASS), it will look to break down the stigma that women face when it comes to menopause and medical cannabis.

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Menopause: An event image advertising a panel discussion around women's cannabis and menopause

To register for a free ticket for the webinar, please click here

On the panel

Integro Clinics Dr Sally Ghazaleh and Dr Mayur Bodani will join other experts in the field including specialist sexual health nurse Sarah Higgins. There will also be an opportunity to take questions from the audience.

Menopause: Dr Sally Ghazaleh

Dr Sally Ghazaleh

Dr Sally Ghazaleh is a pain management consultant and prescriber of cannabis-based medicines at Integro Clinics, where she is the resident female pain expert. Dr Ghazaleh specialises in managing patients with lower back pain, neck pain, neuropathic pain, abdominal pain, cancer pain, complex regional pain syndrome, post-stroke pain and fibromyalgia. She has a particular interest in bladder and abdominal pain in women, and women’s health in general & menopause. She is fluent in Arabic, English and Hungarian.

Menopause: Dr Mayur Bodan

Dr Mayur Bodani

Dr Mayur Bodani, a neuropsychiatrist at Integro Clinics qualified in both General Medicine (to hospital medicine standard) and neuropsychiatry. He has over 25 years of experience in the field and prescribes cannabis medicines at Integro Clinics for mental health-related conditions.

Gone are the days where women are just supposed to put up and get on with it – there are new medicines out there such as medical cannabis, that can address and help menopause symptoms.

If you would like further information or to speak to Dr Sally Ghazaleh or Dr Mayur Bodani or any of the team at Integro please contact us at:

Website: www.integroclinics.com
Email: Contact@integroclinics.com
Twitter: @clinicsintegro

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Women's health

The gender gap in medical cannabis – why are less women accessing treatment?

Women reveal how workplace stigma and healthcare inequality have affected their decision to access cannabis.

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With two thirds of medical cannabis patients in Project Twenty21 identifying as male, what is holding younger women back from accessing what could be a life-changing treatment?

There’s a whole year of Claire’s life which she can’t remember. 

Diagnosed with fibromyalgia while sitting her exams in high school, she was prescribed a dose of 1,800mg of gabapentin a day. 

“I took my tablets in the morning and by 12 o’clock that afternoon I couldn’t tell you what I had for breakfast, that’s how strong they were,” says the 28-year-old.

“I don’t remember any of it. I failed all my exams. I even had a boyfriend that I don’t really know anything about.”

Claire’s battle with chronic pain began at the age of 13, when she fell off of a horse and broke her hip. The break wasn’t picked up until she underwent an operation three years later and the pain never fully subsided.  

Claire has been experiencing chronic pain since the age of 13.

At the same time she was struggling with excruciatingly painful cramping – not just during her period – but was frequently dismissed by male doctors as having anxiety, or blamed for “eating too much dairy” or “just trying to get out of school”. 

“I told my GP that I was struggling and asked if he could write me a note so I could get some support at school. When I got the letter from him he had written that I should try going to bed a bit earlier,” Claire adds.

“That’s just one of the stories I can tell you about being a young woman experiencing chronic pain.” 

In 2015, after finally being listened to by a female GP, Claire underwent a laparoscopy [a surgical procedure required to diagnose the condition] and was told she had endometriosis. 

By this point she had scarring all over her bladder, kidneys and bowel and the disease had progressed to such a point that she was told she may not be able to have children. 

Claire says: “It makes you think, had they listened to me sooner could they have prevented that? I think the fact that I was also suffering from chronic pain and a hip injury, made them less likely to believe me, they felt that there was too much going on.”

The medical gender gap

According to a 2017 government survey, women reported a higher prevalence of chronic pain than men and studies have also shown that women supposedly experience more severe and frequent levels of pain, for a longer duration than men and are more likely to report migraines, musculoskeletal pain, and pain from osteoarthritis, rheumatoid arthritis and fibromyalgia. 

Despite this, many like Claire do not feel they are taken seriously by doctors and research now shows that women are more likely to have their pain discounted as “emotional” or “psychogenic”.

“I remember how suicidal I felt, how pointless everything seemed,” she says of that period of her life.

“After I failed my exams I thought I’m never going to get a degree, I’ll never get a job. What is the point?

“I never experienced anxiety or depression until the chronic pain got out of control, but [doctors] were always trying to conflate that relationship.”

Claire did manage to go to university, but struggled to manage the workload and social life with her condition, eventually having to resit a year.

“I couldn’t go out so my social life was affected,” she says. 

“It was really difficult just to be normal, I had to choose between uni work, sleep or friends, and sometimes I never had the option to do any of it.”

In her third year, with a prescription amounting to 480 tablets a month, a friend encouraged her to look into medical cannabis. 

“At this point I was still very anti-drugs,” Claire admits.

“I’m a prim, piano-playing nerd and always have been, but I was struggling, I was in a lot of pain and I didn’t really want to be around anymore.”

Claire was able to climb the hill behind her house for the first time thanks to her prescription

With the help of cannabis Claire was able to come off all of her other painkillers. She completed a masters in psychology, set up her own business and now works supporting young people struggling with mental health issues. 

Since January, Claire has had a legal prescription through Project Twenty21, which helps to subsidise the cost of prescriptions while aiming to build the UK’s largest evidence base for the safety and efficacy of medical cannabis.

Despite the fact it is this which has made all of her achievements possible, she is still wary of stigma when it comes to her professional career.

“I was really lucky [my manager] was open minded, but I am also very reserved about who I tell,” Claire says.

“If I was going for a new job I wouldn’t feel comfortable telling them straight away, because you don’t know what people’s perceptions of it are.”

This stigma could be holding other women back from accessing cannabis treatment.

According to data from Drug Science’s Project Twenty21, two thirds of patients enrolled in the programme identify as male, with only 29.3 per cent of those in the younger patient group (aged 18-25) women. But the number of female patients steadily increases with age and in the over 75s group, 63 per cent of patients identify as women.

This is at odds with the fact that women are thought to make up the majority of CBD consumers, with more than one study reporting that they are more likely to use the supplement than men and a survey from the Brightfield Group of 2,400 participants found that 58 per cent of CBD users were women.

So, why doesn’t this translate to those accessing a medical cannabis prescription?

Stigma in the workplace

Claire believes that it could be the fact that women are statistically more likely to hold jobs in health, social care and education where the risks of being associated with cannabis may be greater, even to the point it could cost them their job. 

According to Government figures published in March 2021, 78 per cent of jobs in the health and social work sector and 71 per cent of jobs in education were held by women. Women are also more likely than men to work as employees and less likely to be self-employed.

“I work with vulnerable young people every day,” says Claire.

“My biggest fear was one of my students finding out and damaging my reputation and I think that’s a big barrier for a lot of young women.”

Laura works in education and runs the blog and Instagram account The Endo Monologues, where she documents her journey with endometriosis and adenomyosis. But even though she is a legal medical cannabis patient, only a select number of colleagues know about  her prescription.

“My employer is not aware of my prescription and as it stands and I don’t think that I will be able to disclose this until the understanding and viewpoint on using medical cannabis changes,” she told Cannabis Health. 

“Working in an environment that tout’s cannabis as being a negative thing plays a huge part of this as I feel it would be seen as contradictory on their part to be accepting of someone who uses it even if that is for legal medical reasons.

“I think it would trigger lots of discussions where I would have to defend myself, which is ridiculous as it’s my body, it’s having a significant impact on my health and wellbeing and it’s allowing me to work. I would love to be able to have conversations to educate people on it at my work but until the overall public opinion of cannabis changes, that won’t happen.”

She continues: “Using medical cannabis turns me into a pain-free functioning human being, so on my employer’s part I think they’re happy in the fact that I can work and not be restricted by my conditions. As far as they’re concerned, they think I’m using conventional medication to allow that and I’m happy to let them think that.”

Laura admits that she had reservations about accessing a prescription due to what she describes as the “prejudice in her profession” and feels other women may be in the same position.

“Ultimately, I had to do what’s right for my health,” she says.

“From my standpoint my work doesn’t need to know, as it’s no different to taking any other legal long-term medication and it doesn’t impact my work performance. My only concern was and still is, that I could be penalised for not declaring it and potentially lose my job due to the attached prejudice.”

She adds: “Women have so much to fight against in the workplace already that adding cannabis to the equation is another battle to fight. It might be that you don’t need to declare it to your employer like me but for individuals who do, the ongoing prejudice is another barrier to overcome. We already have it ingrained by society that we must choose between a career and a family and can’t have both, cannabis adds another bias against us which is so incredibly wrong.”

Seeking validation

It could be that after years of being misdiagnosed and generally feeling unsupported by the medical system, women are less likely to seek out other healthcare professionals and may even experience trauma in medical settings.

Katie* 25, who suffered severe endometriosis symptoms from the age of 11 until her diagnosis two years ago, was consistently told “this is just what periods are like”. 

She now experiences severe anxiety in medical situations after more than a decade of not being believed. 

“I have had both incredible experiences with health professionals and experiences that I could call traumatising,” she says.

“I’m usually quite a confident person but in medical situations I am so terrified I can’t speak. I believed them after years of being told that I had a psychosomatic disorder, when actually I had endometriosis and a spinal condition.”

Katie has also now been able to access a medical cannabis prescription, through Project Twenty21. She says she finally felt validated after her initial appointment with the prescribing pain consultant.

“I can understand why people with chronic conditions may feel defeated and may not want to seek out another health professional,” she says.

“I was so scared my mum had to sit with me in case I froze. But it was one of the most pleasant experiences I’ve ever had with a medical professional. I felt listened to and validated.”

With millions of patients facing even longer delays to their diagnosis journey, as waiting lists swell in the wake of Covid-19, many who are suffering could be benefiting from medical cannabis.

“There is an endometriosis crisis in this country at the moment, particularly as a result of Covid-19 – I know people who are on waiting lists of up to five years for surgery,” says Katie.

“I think medical cannabis could be the answer to that, but there is so much stigma to overcome.”

Katie sees the gender gap which we know is present in the medical system, reflected in the emerging medical cannabis space, where she says support groups feel “male dominated”.

“There is a gender gap in medicine, but you can also see it in the medical cannabis space,” she says.

“We need to hear from more women, particularly those with endometriosis and reproductive conditions. People who were assigned female at birth are facing double the stigma, as a woman who uses cannabis but also a woman in pain, we have to battle with that old trope of the ‘hysterical woman’.”

Katie adds: “Cannabis is not a magic wand, it hasn’t cured everything but it has given me a quality of life and allowed me to function as a human being. I want to see women talking about how it helps them.”

A sentiment which Claire echoes.

“I want to advocate for this medication, it really has changed my life and that’s why I don’t mind talking about it,” she says.

“The more people who say ‘I can do this and still do my job and so do millions of other people around the world’, that’s what’s going to change things.”

Find out more about Project Twenty21 here

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*Some names have been changed

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