I have seen a recurring scene in movies and TV shows where a group of girls hides in a bathroom stall exchanging secret pills to alleviate menstrual cramps. There are many myths and stigmas against menstruation and the “addictive” use of menstrual pain relief. How much do you know about menstrual cramps? Are you aware of the ways to relieve menstrual cramps? Are menstrual pain relief actually addictive? Can marijuana be used as a remedy for menstrual cramps? I hope this post can advance your understanding of menstrual pain and pain relief.

Dysmenorrhoea is the medical name for menstruation pain. The primary symptoms of dysmenorrhoea can range from mild discomfort to severe cramping that could interfere with daily functioning. Other symptoms include diarrhea, nausea, vomiting, headache, and dizziness. Dysmenorrhoea is the result of natural menstrual cycles, in which increased prostaglandin release causes hyper-contractions of the uterus that eventually stimulate pain receptors. Although dysmenorrhoea is not classified as chronic pain based on the standard definitions, it is not “curable” as a natural process and is impacting at least 80% of women monthly for about 40 years of their life ( Grandi et al., 2012; NCCIH). To date, the most effective and common treatment of dysmenorrhoea is non-steroidal anti-inflammatory drugs (NSAIDs). These are often over-the-counter pain relievers such as ibuprofen and naproxen that suppress the production of prostaglandin, thus reducing the level of dysmenorrhoea from its root (Marjoribanks et al., 2015). Other treatment examples are hormonal contraceptives (e.g., birth control pills) and exercise (Seifalian et al., 2022). To break the myth – – – NSAIDs do not pose any risk of addiction, but there are potential side effects such as blood clotting, kidney issues, nausea, and vomiting due to long-term usage (Marjoribanks et al., 2015).

In recent years, the use of cannabis to relieve menstrual cramps has become a hot topic. Surveys in several countries found that a great proportion of women in their samples self-reported the illicit use of cannabis to treat dysmenorrhoea​​ or expressed the willingness to use cannabis as a self-management tool for dysmenorrhoea​​n (Armour et al., 2021; Han et al., 2021; Sinclair et al., 2020). However, there is very limited research on the use of cannabis for menstrual pain relief. A recent study investigated the effect of paeonol, the main component isolated from the root bark of Paeonia suffruticosa, in treating dysmenorrhoea using rats (Peng et al., 2020). The study found that paeonol alleviated dysmenorrhoea by activating the endocannabinoid CB2 receptors and inhibiting the intracellular calcium influx in uterine smooth muscle cells, thus reducing uterine contraction. Although paeonol is not a cannabis extract, its engagement with CB2 receptors suggests the potential of targeting cannabis and the endocannabinoid system in alleviating dysmenorrhoea. It is worth noticing that the study did not find that activating CB1 receptors by paeonol was effective in dysmenorrhoea relief. Existing literature tends to agree with the CB1 receptor being responsible for the psychoactive effect of cannabis, whereas the CB2 receptor is primarily responsible for anti-inflammatory and immunosuppressive actions (Ashton & Glass, 2007). The result of this study might be exciting for many women that want the analgesic effect but worry about the psychoactive effect of cannabis. In fact, many cannabis-related treatments for dysmenorrhoea available in the market advertise their CBD-only and zero-THC ingredients (e.g., tampon containing CBD oil) because THC is classically considered as the psychoactive ingredient of cannabis. However, these CBD treatments for dysmenorrhoea have not undergone clinical examination, and there is no existing research that directly investigates the analgesic effect of cannabinoid ingredients for dysmenorrhoea.

Among surveys and media discussions of using cannabis for menstrual pain relief, the most reported benefits of cannabis are its analgesic effect and the reduction in nausea and vomiting. Indeed, existing literature has shown the potential of cannabis and the endocannabinoid system in reducing general pain, nausea, and vomiting (Parker, 2018). However, more research on the relationship between cannabis and dysmenorrhoea is crucial because of the side effects, stigma, and legalization status of cannabis consumption.

References

Armour, M., Sinclair, J., Noller, G., Girling, J., Larcombe, M., Al-Dabbas, M. A., Hollow, E., Bush, D., & Johnson, N. (2021). Illicit Cannabis Usage as a Management Strategy in New Zealand Women with Endometriosis: An Online Survey. Journal of Women’s Health, 30(10), 1485–1492. https://doi.org/10.1089/jwh.2020.8668

Ashton, J. C., & Glass, M. (2007). The Cannabinoid CB2 Receptor as a Target for Inflammation-Dependent Neurodegeneration. Current Neuropharmacology, 5(2), 73–80.

Chronic Pain: What You Need To Know. NCCIH. from https://www.nccih.nih.gov/health/chronic-pain-what-you-need-to-know

Grandi, G., Ferrari, S., Xholli, A., Cannoletta, M., Palma, F., Romani, C., Volpe, A., & Cagnacci, A. (2012). Prevalence of menstrual pain in young women: What is dysmenorrhea? Journal of Pain Research, 5, 169–174. https://doi.org/10.2147/JPR.S30602

Han, L., Alton, K., Colwill, A. C., Jensen, J. T., McCrimmon, S., & Darney, B. G. (2021). Willingness to Use Cannabis for Gynecological Conditions: A National Survey. Journal of Women’s Health, 30(3), 438–444. https://doi.org/10.1089/jwh.2020.8491

Marjoribanks, J., Ayeleke, R. O., Farquhar, C., & Proctor, M. (2015). Nonsteroidal anti‐inflammatory drugs for dysmenorrhoea. The Cochrane Database of Systematic Reviews, 2015(7), CD001751. https://doi.org/10.1002/14651858.CD001751.pub3

Parker, L. A. (2018). Cannabinoids and the Brain. MIT Press.

Peng, Y., Zheng, X., Fan, Z., Zhou, H., Zhu, X., Wang, G., & Liu, Z. (2020). Paeonol alleviates primary dysmenorrhea in mice via activating CB2R in the uterus. Phytomedicine, 68, 153151. https://doi.org/10.1016/j.phymed.2019.153151

Seifalian, A., Kenyon, J., & Khullar, V. (2022). Dysmenorrhoea: Can Medicinal Cannabis Bring New Hope for a Collective Group of Women Suffering in Pain, Globally? International Journal of Molecular Sciences, 23(24), Article 24. https://doi.org/10.3390/ijms232416201

Sinclair, J., Smith, C. A., Abbott, J., Chalmers, K. J., Pate, D. W., & Armour, M. (2020). Cannabis Use, a Self-Management Strategy Among Australian Women With Endometriosis: Results From a National Online Survey. Journal of Obstetrics and Gynaecology Canada, 42(3), 256–261. https://doi.org/10.1016/j.jogc.2019.08.033