CBD and Reproductive Health

Disclaimer: to protect the medical licenses of the doctors who were gracious enough to provide us with these interviews, we must clarify that these physicians do not endorse any CBD products listed on this website, and this is NOT medical advice. The following information is meant to be educational, and should not replace any medical advice from your own physician.

We deal with so much sh*t as women. Hormones and hormonal imbalances, pain and cramping, mood swings, acne, and a bevvy of dysfunction  — it’s almost like our bodies want to wreak havoc on us. WHY HAVE YOU BETRAYED ME, UTERUS?! 

Endometriosis affects upwards of 10% of women of “childbearing age.” So does PCOS. Over 80% of women have period pain at some point in their lives. With so many women struggling with some form of reproductive or endocrinological issue, it’s natural that we’d want to look for any possible relief. So that begs the question: How can CBD help our reproductive and endocrine systems?

What do we know, what’s been studied, what’s anecdotal, and what remains to be seen? Studies have been limited — as many of you know — due to aggressive, erroneous legislation that has blocked researchers from doing their jobs and studying the effects of this plant in a clinical context. That said, we know some things so far — and can make some inferences about what might work, too. Especially knowing that CBD is safe (generally speaking), it might not hurt to use this as a complementary treatment while we await the science and clinical trials to prove what we’re hoping for.

We spoke to three medical doctors: Allen Morgan, MD, a double-board-certified OB/GYN and reproductive endocrinologist, Medical Director for Morgan Fertility and Reproductive Medicine (and one of the co-founders of Maxine + Morgan CBD), Bonni S. Goldstein, MD, Medical Director of Canna-Centers Wellness & Education and author of Cannabis is Medicine, and Zaher Merhi, MD, FACOG, HCLD, a world-renowned Reproductive Endocrinology and Infertility specialist and the founder of Rejuvenating Fertility Center. 

The consensus? CBD can most likely help in these areas of hormones, reproductive health, and reproductive disease and dysfunction. But — always the ‘but’ — we’re waiting on more rounds of specific research to prove these assertions and hypotheses.  

CBD AND PERIOD PAIN, PELVIC PAIN, CRAMPS

The most common, nearly universal experience women experience: PMS pain, or CPPD (cyclic perimenstrual pain and discomfort), according to Dr. Morgan. “Cyclic perimenstrual pain and discomfort (CPPD) is widely experienced by women at some point during their reproductive life,” says Dr. Morgan. “At least 80-97% of women will experience at least one CPPD‐related symptom during this time.” 

There may be a tie to endometriosis, too, he explains. “Endometriosis may be a cause of this pain, but it is only found in seven-percent of females in the reproductive age, so pelvic pain is [also] caused by other factors than endometriosis,” says Dr. Morgan

And while CPPD may come and go for some women, Dr. Goldstien says “Chronic pelvic pain affects up to 15% of women in the US,” and — pointing to four different peer-reviewed sources — says “Numerous surveys of women with this condition report benefits from cannabis use.” 

[sources: 1, 2, 3, 4]

Obviously, treatment is a priority so women can live pain-free lives. “Pain from menstrual cramps can be a burden and even disabling for some women,” says Dr. Morgan, who suggests that CBD may be an alternative for commonly-used NSAIDS such as Midol, Aleve, or Motrin (Ibuprofen). “CBD acts as an anti-inflammatory,” he says (which some of you may already know!), which is why “Women are turning to cannabidiol (CBD), a non-psychoactive byproduct from hemp since many over the counter NSAIDS aren't able to relieve the pelvic pain women suffer from. The option is to either add CBD to NSAIDs or to try CBD alone in its several forms; capsules or in an oil tincture droplet form.”

Dr. Goldstien says that this is where CBD or cannabis could come into play yet again. “Numerous surveys also report benefits from cannabinoids for the symptomatic treatment of PMS, PMDD and menopause,” she says.

“Although not all symptoms require treatment, women with moderately severe to severe symptoms usually seek help,” Dr. Morgan says. But PMS and cannabis are two areas that tend to be kind of murky in the medical world — “A lack of both definitional clarity and understanding of underlying mechanism(s) have resulted in the absence of satisfactory treatment strategies,” he explains. In other words, the medical community hasn’t figured PMS out; neither why it happens nor how to best treat (or cure) it. Why that is — that’s probably up for debate (*cough* patriarchy *cough*) but what is certain is that women are in pain, and the path to relief isn’t clear. 

Dr. Morgan says that in some cultures, women simply don’t seek help for their pain. “It is possible that attitudes to CPPD among different cultures affect not only the tolerance of these symptoms but also the adoption of certain treatment‐seeking behaviors,” he says. “Despite the fact that CPPD and endometriosis symptoms have the potential to greatly interfere and affect a woman’s quality of life, it has been widely reported that many do not seek help. This is true especially in women with less severe symptoms.”

CBD AND ENDOMETRIOSIS

Endo ravages women’s bodies — “Menstrual cramping and pain due to endometriosis is a big problem for some women and can be chronically disabling,” says Dr. Morgan.

What’s promising is that CBD may be a glimmer of hope on the horizon. “There are studies showing that a lot of women are using — on their own — CBD for endometriosis pain,” says Dr. Merhi. “Those women are reporting significant relief in endometriosis pain, and they are reporting significant decrease in need for pain medications — especially narcotics,” (HELL yeah!). 

“At the cellular level, it makes sense because the ovaries and the uterus have receptors for CBD,” Dr. Mehri explains. “One study in mice showed that CBD can significantly decrease the development of endometriotic cysts (called endometriomas). There is clearly a need for randomized trials to assess the topic in humans.” In other words, the science is showing a high likelihood of this working out, but we aren’t mice… so we have to wait for a clinical trial to get some more concrete info. 

Dr. Golstein echoed this. “Many women who suffer with endometriosis report benefits from cannabinoid treatment,” she says, noting that “A survey of Australian women with endometriosis found that cannabis and CBD were included in the group of highly effective self-management strategies (along with heat and dietary changes).”

She also says that — as the other doctors corroborated — that “there are no randomized placebo-controlled clinical trials on the use of cannabinoids for treatment of pain associated with endometriosis. Pain from endometriosis is thought to be both from both inflammatory and neuropathic (derived from damaged nerves) sources.”

“Phytocannabinoids, including THC and CBD, have been proven to provide pain relief from both of these mechanisms,” says Dr. Goldstien. “Additionally, CBD in particular may be beneficial because it activates a type of receptor called the TRPV1 vanilloid receptor, which was found to be overly expressed in patients with endometriosis. When CBD stimulates the TRPV1 receptor, it can desensitize it, leading to decreased pain sensation.”

Dr. Morgan agrees, and says that — in theory — CBD should work for endometriosis treatment. “Since CBD acts on CBD receptors in the body — which are a part of the endocannabinoid system — and this network of receptors is responsible for immune function and pain perception, theoretically it should be effective,” he says. “Unfortunately, there are no clinical studies looking at this question. There is only one study completed recently looking at the effectiveness of CBD for menstrual pain and PMS symptoms (Morgan et al, 2020). It was found to be as effective as ibuprofen for pain, but even more effective for the other symptoms of nausea and moodiness.”

All of that in mind, Dr. Morgan says “I do believe that CBD will be effective [for endometriosis treatment] but this will have to be evaluated in a randomized placebo controlled clinical trial.”

Dr. Goldstien agrees that we need more specific research, but also brings up that there is some scientific research on how the ECS (endocannabinoid system) may be involved in the root cause of endometriosis — which would be good news for CBD being a potential treatment. 

“Although research on cannabis for endometriosis is limited, there is some scientific evidence pointing to an underlying dysfunction in the endocannabinoid system, which regulates cell growth and endometrial cell migration,” she says, citing multiple studies.

“One study found that women with endometriosis had lower levels of cannabinoid receptors in their endometrial tissue, supporting this idea of a dysfunctional endocannabinoid system contributing to this condition,” says Dr. Goldstien. “This study also showed that drugs that triggered the cannabinoid receptors led to decreased growth of endometrial tissue and increased cell death.”

There’s information beyond that, too — all pointing us in the right direction. “Another study took endometrial cells from human patients with deep infiltrating endometriosis, which is characterized by chronic pain, fibrosis (scarring), and extensive proliferation of endometriosis cells, and tested the effects of a synthetic cannabinoid (laboratory-derived, not plant-derived) that binds to the cannabinoid receptor, similarly to THC,” says Dr. Goldstien. “The researchers found the synthetic cannabinoid exerted anti-growth effects both in cells in the test tube and in cells implanted in mice.”

Does it apply to all cannabis — or just CBD? “And another study found that CBD blocks a receptor called GPR18, which when stimulated, promotes cellular migration,” she says, explaining that “Blocking this receptor may result in less abnormal spread of the endometrial cells.” There is a catch, though: “THC was found to stimulate GPR18, which may promote migration of cells. Certainly more research is needed to address how cannabinoids may affect the medical course of endometriosis.” 

So when will we know more? Dr. Goldstien says that currently there are two clinical trials looking at the use of cannabinoids to alleviate pain in endometriosis sufferers: “One comparing placebo with both low dose CBD and high dose CBD in patients on hormonal treatment, and the other using a 1:1 CBD:THC ratio preparation. Hopefully these studies will reveal helpful information.”

CBD AND PCOS

So what about Polycystic Ovary Syndrome (or Polycystic Ovarian Syndrome, depending on who you ask)? This is a whole other ballgame. “The mechanism of action of how women develop PCOS is very intricate,” says Dr. Morgan. “It involves a normal hypothalamic-pituitary-ovarian (HPO) axis of communication via endogenous steroids,” — and if that sounds like too much, just know that it’s a dance between your brain and your sex organs that manages your reproduction.

Dr. Morgan does not believe CBD can affect the HPO axis — but (big but) — CBD may interact with the ECS receptors in those areas. “It is a big guess,” he says, “And there are no studies on how CBD can help the imbalance of steroids. We do know that weight loss can help irregular menses found in PCOS, but can CBD? The studies are needed to answer this question.”

Dr. Merhi agrees, saying that “Data is very limited regarding the relationship between CBD and PCOS.” He brings up that “Studies suggest CBD might enhance insulin resistance (similar to pre-diabetes) in women with PCOS. However, there is a significant lack of studies pertaining to this subject.”

And Dr. Goldstein corroborated all of this as well, echoing that the studies aren’t there, but saying the evidence of relief for PCOS via CBD is largely anecdotal. “There may be some benefits for PCOS patients because these patients struggle with insulin resistance (when the body makes insulin but cannot use it properly) as well as inflammation, obesity and an increased risk of Type 2 diabetes,” she says. “Cannabinoids are well-known to decrease inflammation. Additionally, there are a number of studies that found cannabis users have a lower risk of obesity. Another study found that both CBD and THCV (tetrahydrocannabivarin, another phytocannabinoid) were shown to be beneficial in patients with abnormal glucose metabolism and insulin resistance. 

CBD AND FERTILITY

We can’t do a dive into CBD and our reproductive health without talking about… well, reproduction. This needs a lot more science and data to have insight, but CBD may impact fertility. Dr. Mehri says that while this cannabinoid can help with your chronic pelvic pain and menstrual cramps, “it has been shown to potentially compromise female reproduction and fertility.”

Dr. Goldstien brought this up too, unfortunately — and it applies to THC as well (though you may not be in the category to which this applies). “High levels of cannabinoids can suppress the hormones required for fertility,” she says. “Observational studies reveal that moderate to heavy users of THC may have an increased risk of infertility.”

SO WHAT NOW? 

All in all, there’s a lot more ground that needs to be covered in the medical world. If you’re using CBD as a treatment for pain as it relates to these reproductive disorders, make sure you talk to your doctor (or a doctor in this field who knows a bit about cannabinoids) — especially if you’re concerned about fertility. This could be a wonderfully promising treatment for conditions that plague nearly ALL women… we’re just waiting for confirmation from PubMed.