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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.”

Jessica* 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.”

Jessica 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.

Harriet, 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.”

Harriet 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 Harriet.

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

Harriet 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’.”

Harriet 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

*Some names have been changed

Women's health

Cannabis legalisation not linked to adverse birth outcomes – study

Researchers studied the relationship between the liberalisation of cannabis laws and key indicators of child health

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Cannabis legalisation not linked to adverse birth outcomes - study
Studies assessing the potential impacts of cannabis exposure during pregnancy are mixed.

Legalisation of cannabis in the US is not linked to any significant adverse outcomes for  child health, according to a recent study.

New data shows that changes in legal status of cannabis in US states is not associated with increases in adverse clinical birth outcomes.

Researchers at Purdue University studied the relationship between the liberalisation of state-level cannabis laws and two key indicators of child health – birthweight and gestational age.

Their findings were published in the journal Population Research and Policy Review.

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While the authors reported a trend which indicated a reduction in average birthweight and gestational age for some groups of women following the relaxation of cannabis penalties, they acknowledged that these changes were not linked to any “increases in clinically meaningful birth indicators associated with adverse child health.”

The findings are similar to those reported in a 2021 study which found “no statistically significant effect of medical cannabis laws on the proportion of newborn hospitalisations”. 

The authors concluded: “Our findings indicate that cannabis policy liberalisation may be contributing to lower average birth weights and reduced average gestational age, but not in a manner that has increased low birthweight (<2500 g) infants or preterm (<37 weeks) births. 

“These results indicate that while cannabis policies have not led to increases in adverse clinical birth outcomes overall, these trends are worth monitoring to ensure that increases in clinically relevant child health outcomes do not emerge as the nationwide trend toward liberalised cannabis policy persists. “

They added: “Although our study does not show substantial changes in adverse birth outcomes, policymakers should be attentive to opportunities to strengthen child health by considering policies that minimise consumption, particularly heavier forms of consumption, by prospective parents.

While the evidence base around the effects of cannabis use during pregnancy on perinatal is growing, studies assessing the potential impacts of cannabis exposure are mixed.

Some observational data has identified a link between exposure and low birth weight and/or an increased risk of preterm birth. However others have failed to substantiate these claims once adjusting for other factors, such as tobacco smoking.

The majority of the existing studies have been done on recreational cannabis, accessed through the illicit market, which tends to contain higher levels of THC than that in medicinal cannabis.

There have been very limited, if any, studies exploring the effect of prescribed cannabis on perinatal health, as advice from clinicians is that women should refrain from using cannabis medicinally or otherwise whilst pregnant or breastfeeding.  

 

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Can cannabis help with menopause?

Juicy Fields explores how cannabis could help women with some of the symptoms brought on by menopause. 

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Juicy Fields explores how cannabis could help women with some of the mental and physical symptoms brought on by menopause.

Menopause is one of the most challenging transitions women face as they go through dramatic physical, psychological, and vaginal/uterine changes.

The stage is characterised by symptoms such as insomnia, night sweats, hot flashes, pain, inflammation, and mood swings.

Although there are various medical alternatives to deal with the unwanted and uncomfortable symptoms, a study conducted in 2021 by the Canadian Institutes of Health Research showed that women experiencing menopause (perimenopause, menopause, and postmenopause) in Alberta were significantly using cannabis to relieve symptoms. Sixty five per cent of the participants had ever used cannabis to relieve menopausal symptoms, while 35 per cent of the group were using marijuana during the period the study was conducted. 

Another study presented to the  North American Menopause Society (NAMS) in 2020 had similar conclusions. In a sample of 232 women from Northern California, 27 per cent indicated using cannabis to manage hot flashes, night sweats, and insomnia.

Ten per cent of the participants expressed interest in using cannabis, while only 19 per cent utilised hormone therapy to combat menopause symptoms. From the studies, one can conclude that women are shifting from hormonal medication and switching to organic, natural alternatives, specifically cannabis. This piece explores everything about menopause and its symptoms and how cannabis can help alleviate these conditions. 

What is menopause?

Menopause is a period in a woman’s life that can stretch 10 or more years. During this period, their reproductive hormones go through a natural decline. This marks the end of the menstrual cycle and, consequently, their fertility. It is divided into three stages;

Perimenopause: this includes the years leading to menopause. Most women experience this during their early to mid-40s, although others can begin early during their 30s or late 40s. The woman will experience biological disturbances characterized by irregular menstrual cycles and varying hormone levels during this time. 

Menopause: this is when a woman stops having her menstrual period for 12 consecutive months. One will not know when they are experiencing menopause until the 12 months have gone by. Common symptoms during this stage include vaginal dryness, night sweats, hot flashes, and sleep issues. 

Postmenopause: this refers to the period after a woman has stayed 12 consecutive months or more without menstruating – after menopause. Symptoms like hot flashes and night sweats begin to fade or disappear entirely. 

Physical, psychological, and vaginal symptoms of menopause

As mentioned earlier, menopause is a life-changing transition with its fair share of problems. It is attached to a host of symptoms, which can be classified as either physical, psychological, or vaginal.

Physical: symptoms include fatigue, pain and inflammation, heart palpitations, headaches, dizziness, stiffness, insomnia, and chest discomfort.

Psychological: symptoms include anxiety, depression, lowered sex drive, lack of concentration, memory loss, and mood changes.

Vaginal/uterine: symptoms include dryness and pain during sexual intercourse.

The relationship between cannabis, the endocannabinoid system, and cannabis

Does cannabis help with menopause? To answer this question, we must first look into the endocannabinoid system. This is a system comprising endocannabinoids, receptors, and neurotransmitters. This cell-signaling system utilizes these components to support normal body functioning, aka homeostasis. It regulates and controls various immune system, cardiovascular, nervous, and reproduction (including fertility and menopause) functions. 

During menopause, the ECS is disrupted, which causes changes in various related biological systems. Cannabis interacts with the ECS on different molecular levels to support its function of maintaining homeostasis, thus relieving the menopause symptoms.

The research into how cannabis directly relieves menopausal symptoms is currently unavailable. However, cannabis is known to have potent analgesic, anxiolytic, antidepressant, appetite-stimulating, sleep-inducing, antiemetic, and muscle-relaxing properties that can play a significant role in managing symptoms like pain, inflammation, mood swings, depression, anxiety, and sleep issues. Below is a highlight of top menopause symptoms and how cannabis can help combat them. 

Hot flashes and night sweats

These symptoms are the primary reasons why women turn to cannabis. THC, the most abundant cannabinoid in cannabis, is associated with lowered body temperatures. The cannabinoid supports thermoregulation, which is handy for women experiencing hot flashes and night sweats. Ever heard of THC-induced hypothermia? This may happen when THC is taken in high doses. Identifying the right amount of cannabis to consume may help mitigate the disturbing hot flashes and night sweats. 

Mood swings, anxiety, depression, and concentration

Anecdotal and scientific evidence point out the effectiveness of cannabis’ mood-boosting and regulating, antidepressant, and focus-boosting properties. Its anxiolytic capability is dependent on various factors, such as the dose taken and the consumer’s tolerance level. These psychological issues affect most women undergoing menopause due to the numerous changes, discomforts, and uncertainties they go through.

Vaginal dryness and low sex drive

Cannabis can help with vaginal dryness and low sex drive in either of two ways; first, its calming, relaxing, and mood-boosting properties coupled with clear-headedness may support a return of the sex drive. Secondly, CBD lubricants have been known to decrease inflammation in the vaginal area, increase blood flow in the area, and support muscle relaxation. 

Pain and inflammation 

Cannabis is a powerful analgesic and anti-inflammation agent. It is utilised by numerous cannabis consumers to treat pain resulting from conditions such as arthritis, fibromyalgia, MS, sciatica, and headaches. Athletes have been known to incorporate cannabis in their pre- and post-workout regimes to combat muscle aches, pains, and injuries.  

Fatigue and insomnia 

Cannabis is a powerful muscle relaxant that, when consumed, melts all the tightness and tension away. It also promotes full-body relaxation and sleep. It helps restore one’s sleep pattern and promotes a regular sleep cycle. 

Take away

Although not directly, cannabis has been proven to help relieve menopausal symptoms such as hot flashes, pain, anxiety, inflammation, depression, sex drive, and insomnia. There is a need for more research to link the two together. This will facilitate the identification of proper cannabis strain genetics and dosage for managing perimenopause, menopause, and postmenopause symptoms. 

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Medical cannabis and endometriosis – “I can live a normal life”

Thirty-two-year-old Megan has lived with the symptoms of endometriosis since her teens.

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Medical cannabis and endometriosis - "With cannabis I can live a normal life"
Megan was diagnosed with endometriosis in February this year.

Megan, an Australian medical cannabis patient living with endometriosis, shares how the plant has helped in managing her symptoms.

Thirty-two-year-old Megan has lived with the symptoms of endometriosis since her teens. At times she’s experienced such intense pain that she struggled to leave her house.

“I honestly believe I would have ended up suicidal within the next few months if I didn’t pursue and get approved for medicinal cannabis when I did,” she said.

During Endometriosis Awareness Month in March, Cannabis Health interviewed several patients across the globe who  live with the often-debilitating symptoms of the inflammatory condition.

US research programme studies cannabinoids in ovarian cancer

Endometriosis is present in about one in 10 women and non-binary people aged between 25 to 40 in the United Kingdom – but can affect people at any age.

Cells similar to those lining the womb grow elsewhere in the body, such as the bladder, ovaries, colon and rectum, and react to changing hormones in the menstrual cycle.

They grow thicker in the middle of the cycle and then break away and start to bleed before being slowly reabsorbed by the body. This process can cause inflammation, pain and new scar tissue.

Megan, who lives in Australia, explained that she was only officially diagnosed with endometriosis in February this year.

Lengthy diagnosis is common as the condition can mirror others and is widely misunderstood among many doctors – the average time from onset of symptoms is seven and a half years.

“I’ve always had painful periods – I just always thought they were meant to be painful,” Megan told Cannabis Health.

“I didn’t question it until early 2018 my periods stopped for about three months and when they returned it was like everything was turned up and the pain was excruciating.”

In early 2019 Megan was told she had adenomyosis, a condition in which the inner lining of the uterus breaks through the muscle wall of the uterus.

Symptoms can include lower abdominal pressure, menstrual cramps, bloating and heavy periods.

Her GP at the time suggested that she may have endometriosis as well, but it was not confirmed until surgeons performed a laparoscopy – keyhole surgery of the abdomen or pelvis.

Managing pain

People who have endometriosis often suffer from painful periods, painful sex, pain in the lower abdomen, pain on passing a stool and urinating, or lower back pain.

This can then lead to difficulty sleeping, an inability to focus on daily tasks, and in some cases a mental health decline.

Over the years Megan has tried NSAIDs, codeine and oxycodone in an attempt to manage the pain.

“I’m somewhat unlucky that I don’t respond to a lot of painkillers… so I was always ‘pushing through’ the pain and essentially burning myself with heat packs,” she said.

Meanwhile, she was using cannabis recreationally, but it took a comment from her partner to realise that it was also helping to dull the symptoms of her two conditions.

I was mid-flare about 12 months ago and we’d run out of cannabis. It was a long weekend in my city so all the dealers we knew were sold out,” she recalled.

“I was curled up in bed with my heat packs and my partner said then I should see if I can get into trials for medicinal cannabis or a prescription for it.

“He’d picked up that it was the only thing that would help my pain and being reliant on black market wasn’t ideal long term.”

She was initially nervous to make an appointment at a clinic, because she did not think she would get approved.

“Everyone downplays endo so much, I was worried I’d get the same kind of dismissal about my symptoms and pain that so many doctors had done in the past,” she said.

She finally applied for a prescription last summer, and because she was able to show all the painkillers she had tried that had not worked, the process to approval was fairly quick.

Among the methods she uses to take cannabis are ingesting CBD and THC oils, and cannabis flower to vape.

The CBD oil helps with overall symptoms – definitely reduces anxiety and nausea and has a huge impact on reducing pain,”  said Megan.

“THC oil I’ll use more on days when the pain is worse than my normal levels, or when I get a random flare up some days, it helps to take THC oil and flower together to get through it.”

Stigma

Despite how much it helps her, Megan has experienced some negative comments due to her use of cannabis, particularly before she was given a prescription.

I think a lot of people still just view it as this evil illegal drug and don’t understand that it’s such a powerful and useful plant and tool in treating people’s illnesses,” she explained.

However, after getting a prescription she said her friends and family had been “surprisingly supportive”.

She continued: “I’m not sure if it’s because it’s issued via a prescription that makes people more approving of it, or if it’s just because they can see the effect it’s had on me since starting it. Maybe a combination of both.”

Getting a prescription for cannabis made a huge difference to her wellbeing. 

“With cannabis I can live a pretty normal life,” she added.

But in the long term, Megan is worried for women who have endometriosis, and the dismissive nature of some doctors when it comes to the benefits of cannabis for pain.

“I’m scared for the next generation of endo warriors who are going to be pushed onto these incredibly strong medications,” she said.

I really struggle to comprehend how some doctors will be happy for their patients to be on really strong pharmaceuticals every day to manage their pain, but can still be so anti-cannabis.”

Alongside the cannabis, the laparoscopy – during which surgeons removed some of the offending cells – also helped to significantly ease the pain of the endometriosis.

She stressed that it is vital that more surgeons are trained in expert excision surgery as a more permanent solution for patients.

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