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Bridging the Gap: Menopause, Sleep and the Treatment Gap

In this bi-weekly series, Dr Sue Clenton explores the growing interest and potential of cannabis-based therapies to address unmet needs in women’s health conditions.

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Dr Sue Clenton, Consultant Oncologist and Medical Director at Releaf Cannabis Clinic, shares her insight from the front line of an emerging field of medicine, taking readers inside the clinic and offering a doctor’s perspective on what it really means to prescribe cannabis medicines in the UK today. In this bi-weekly series, she explores the growing interest and potential of cannabinoid-based therapies to address unmet needs in women’s health conditions. 

Although it’s a natural transition for every woman at a certain stage of life, there remains a lack of understanding of how menopause can affect their physical health, emotional wellbeing and quality of life.

While public awareness has improved considerably over recent years, there is still a significant gap between the symptoms women experience — and the impact these can have on their lives — and the level of care and support they receive.

As a clinician, one of the most common issues I see women struggling with during the perimenopause and menopause stages is sleep. Hot flashes, night sweats, anxiety, and persistent pain can all make it difficult to get a good night’s rest. 

This, in turn, can exacerbate symptoms, such as pain, anxiety, and brain fog, making it harder to function during the day. Women become trapped in this cycle and find it difficult to break out of it. 

While hormone replacement therapy (HRT) has transformed menopause care for many women, it does not always provide a complete solution for everyone. 

This is one of the reasons we are seeing growing interest in alternative and complementary approaches, including cannabis-based medicines.

Sleep and other symptoms are interconnected

In my experience, insomnia and pain are among the symptoms women are most frequently seeking help for.

Sleep disruption is one of the most commonly reported symptoms during perimenopause and menopause, but it is also one of the most complex to address.

Fluctuating and declining hormone levels can affect sleep directly, while symptoms such as hot flushes and night sweats may repeatedly wake women throughout the night. For others, anxiety, joint pain, and general physical discomfort make it difficult to fall asleep or stay asleep.

These symptoms are interconnected. A woman experiencing chronic pain may struggle to sleep, and the resulting fatigue can lower her tolerance to pain and make everyday challenges feel more difficult.

Similarly, anxiety can further contribute to sleeplessness, creating a cycle that can be difficult to manage without addressing the wider picture.

For some women, persistent sleep problems can affect relationships, work, mental health and overall quality of life. Yet this is not always given the attention it deserves in discussions around menopause treatment. 

When conventional treatment isn’t enough

HRT remains an important and effective treatment for many menopause symptoms, particularly hot flushes and night sweats. 

However, it does not necessarily address every symptom, and some women continue to experience insomnia despite receiving hormonal treatment, which can result in them turning to sleep aids. 

There are also women for whom HRT may not be suitable, including those with a history of breast cancer or blood clots. 

As an oncologist, I am particularly aware of the challenges faced by women who experience menopause following cancer treatment, or who have medical histories that limit their treatment options.

This is where a more individualised approach to treatment becomes essential.

Why women are asking about cannabis 

Recent research reflects a growing interest in medical cannabis among menopausal and mid-life women. 

A 2023 study published in BMJ Open surveyed 1,485 women aged 35 and over in Alberta, Canada, exploring patterns of cannabis use and perceptions of its potential role in managing menopause symptoms.

Of those surveyed, 34% reported currently using cannabis, with more than three-quarters of current users reporting use for medical purposes.

Sleep difficulties were the most commonly reported reason for use, cited by 65% of current users, followed by anxiety (45%) and muscle or joint aches (33%).

Almost three-quarters of current users felt cannabis helped manage their symptoms.

However, the Canadian study was based on self-reported experiences and was not designed to establish the effectiveness of cannabis in improving menopause symptoms.

 The role of cannabis-based medicines 

More research is needed to better understand the role that cannabis-based medicines can play in menopause treatment. 

Studies specifically examining medical cannabis in menopause remain limited, but real-world evidence and some early clinical trials have suggested potential benefits for certain types of chronic pain and sleep-related symptoms.

We also know more now about how cannabinoids interact with the body’s endocannabinoid system and the role of this in regulating functions such as pain perception, mood and sleep.

Some women may consider using CBPMs as an adjunctive treatment to HRT when sleep or pain remains problematic. For others, it may be considered as part of a wider non-hormonal treatment plan.

However, treatment with medical cannabis is not right for everyone, and any decision to prescribe should follow a careful assessment of the patient’s medical history, existing treatments, potential risks and individual needs.

The importance of open conversations 

As a clinician, I feel strongly that patients should feel comfortable discussing all the treatments they are considering, without fear of being judged or dismissed.

Healthcare professionals have a responsibility to listen to our patients and provide balanced, evidence-based information. 

But the Canadian study found that women frequently turned to online sources for information about cannabis, despite expressing a preference for guidance from healthcare professionals.

This is a concerning finding, which suggests we need a more holistic approach to menopause care to allow these conversations to take place openly and with sensitivity.

Closing the menopause treatment gap is about more than new treatment options — as important as this is — it is about listening to women, recognising the complexity of their symptoms and ensuring that care is tailored to their needs.