Despite solid clinical data, CBD is showing a great deal of promise for combating the immediate as well as long-term consequences associated with menopause.
By Dr. Adam Abodeely MD, MBA, FACS, FASCRS

Natural menopause is defined by the permanent cessation of a women’s natural menstrual cycle for 12 consecutive months. Following menopause, women enter post-menopause. 95% of women develop menopause between the ages of 45-55 years of age and the experience for women is extremely individualized. Although some women may breeze through menopause with very few problems, approximately 80% of women experience significant symptoms which can affect a women’s health and well-being. However, only 20-30% of women seek medical attention for their symptoms. Some women simply accept this as a natural part of aging while others struggle to deal with the physical and emotional changes which occur during menopause.

Menopause occurs as a result of ovarian follicular depletion which results in decreased levels of estrogen. These decreased levels of estrogen can have significant immediate, as well as the long-term, consequences [1-2].

Immediate signs & symptoms of menopause:

Hot Flashes are the most common symptoms of menopause occurring in 80% of menopausal women. Hot flashes typically begin as flushing of the face and chest and can last for several minutes and can be associated with excessive perspiration and anxiety.

Sleep disturbances and insomnia during menopause are multifactorial and can occur as a result of hot flashes, depression and anxiety. This condition occurs in approximately 30-40% of women during menopause but can increase and affect as many as 50% of women towards the end of menopause [3].

New onset depression and anxiety is significantly increased during menopause and is believed to be a result of both decreased estrogen coupled with the emotional experience that can occur during this transitional time in life [4].

Cognitive changes including memory loss and difficulty concentrating are frequently reported symptoms occurring during menopause. These changes may occur as a result of a decline in estrogen in conjunction with the increased rates of depression and anxiety which may occur during menopause.

Pain syndromes including ligament and joint pain, breast pain, or menstrual migraines are well-documented and frequent problems for menopausal women [5-6].

Genitourinary changes including urinary incontinence, vaginal dryness, and vaginal atrophy occur as a result of diminished estrogen. At the same time, the decreased estrogen levels also result in decreased vaginal lubrication, diminished sexual drive/function, as well as painful intercourse.

Long-term consequences of estrogen deficiency (post-menopause):

The risk of cardiovascular disease increases after menopause as a result of decreased estrogen as well as changes in cholesterol and lipid profiles.

Bone loss for women begins during menopause and the rate of bone density loss has been correlated with estrogen deficiency. This can also lead to increased rates of osteoarthritis [7].

Skin changes occur during and after menopause as a result of decreased production of collagen which is essential for skin integrity and is heavily influenced by estrogen.

Towards the end of menopause and during the postmenopausal period, women frequently experience weight gain and an increase in central fat distribution. This also is a result of diminished estrogen which tends to shunt excessive energy into fat storage as opposed to the creation of lean muscle mass [8].

Traditional pharmacologic treatments for combating menopausal and postmenopausal symptoms have included hormone replacement therapy utilizing either unopposed estrogen therapy versus combined estrogen–progestin therapy. Although there appears to be some benefit from utilizing hormone replacement therapy, as women age the risks associated with hormone replacement therapy have been shown to outweigh the benefits associated with their use particularly in women over the age of 50-60. Studies from the Women’s Health Initiative (WHI) have shown that there are increased risks associated with hormone replacement therapy. These risks include blood clots, pulmonary embolism, stroke, coronary heart disease, and particular cancers including breast cancer and endometrial cancer. As a result of these risks, women continue to look for alternatives to conventional pharmaceuticals and hormone replacement therapy.

There is a tremendous opportunity to utilize CBD and cannabinoid-based products for women, particularly those who are menopausal or postmenopausal. Although there is very little data specifically looking at CBD and cannabinoid therapy for menopausal and postmenopausal woman, evidence continues to grow for the use of CBD products for several of the conditions associated with menopause and postmenopausal women. For example, CBD and cannabinoid therapy has shown promise for both depression and anxiety [9]. Treating menopausal women for depression anxiety can have significant positive effects including an improvement in overall quality of life. Additionally, treating depression anxiety with cannabinoid-based therapies may also improve cognitive function as well as sleep disturbances which are often linked to depression and anxiety during menopause.

CBD as well as other cannabinoids have been shown to have significant effects on pain and inflammation. The joint pain, breast pain, and menstrual migraines experienced during menopause are frequently treated with several medications including anti-inflammatories, opioids, and hormone replacement therapy. Given the anti-inflammatory, antioxidant and pain relieving properties of CBD, this plant-based compound offers an excellent alternative to conventional pharmaceutical agents and treating some of the pain syndromes associated with menopause [10-11].

Cannabinoid-based products with CBD are showing a great deal of promise not only to treat the symptoms of menopause but may also potentially protect women against future health problems including cardiovascular disease, stroke, declining cognition, cancer, and osteoporosis. Several of these ailments are associated with increased inflammation, unhealthy lipid profiles, and oxidative damage to healthy cells. For example, osteoporosis continues to be a challenging condition to treat and can lead to decreased strength, fractures, and imposes a significant burden on our health care system. Activation of particular cannabinoid receptors have been shown to increase the activity of bone cells called osteoblasts. These cells are responsible for bone formation and cannabinoids have been shown to increase the activity of osteoblasts thereby increasing bone production to combat osteoporosis [12]. Additionally the anti-inflammatory and antioxidant effects of the cannabinoids may help prevent several age-related illnesses and improve quality of life.

The skin is the largest organ of the human body and is dense with endocannabinoid receptors making the skin an excellent target for cannabinoid therapy and some of our best data we have is on the use of cannabinoids for particular skin conditions. Several cannabinoids have been shown to have skin healing properties due to their anti-inflammatory, antioxidant effects as well as their interaction with the endocannabinoids system [13]. There is also evidence that certain cannabinoids are effective at protecting her skin from ultraviolet radiation exposure and may decrease rates of some associated skin conditions including skin cancers and aging skin. Healthy skin is not only a sign of wellness but also can be an important part of a women’s self-esteem and quality of life.

Combining cannabinoid-based therapies with other plant-based and natural compounds offer a unique opportunity to provide a safe and natural alternative to conventional hormone replacement therapy, antidepressants, and other pharmaceutical agents for the treatment of menopause. There are several ways to formulate and optimize a CBD based product not only through the cannabis plant but also by utilizing several other potential and natural alternatives. Women over the age of 50 who are menopausal require increased consumption of particular vitamins and nutrients including calcium, vitamin D, and vitamin E. Additionally there are several other natural alternatives which show promise to combat menopausal symptoms and aging including resveratrol, flaxseed, rhubarb extract, and black cohosh (just to name a few). Formulating products utilizing cannabinoid therapy, terpene therapy, and several other alternative and natural nutrients will continue to provide women with an excellent alternative to conventional pharmaceutical agents and hormone replacement therapy.

1. Taffe JR, Dennerstein L. Menstrual patterns leading to the final menstrual period. Menopause 2002; 9:32.

2. Harlow SD, Gass M, Hall JE, et al. Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. J Clin Endocrinol Metab 2012; 97:1159.

3. Hollander LE, Freeman EW, Sammel MD, et al. Sleep quality, estradiol levels, and behavioral factors in late reproductive age women. Obstet Gynecol 2001; 98:391.

4. Maki PM, Freeman EW, Greendale GA, et al. Summary of the National Institute on Aging-sponsored conference on depressive symptoms and cognitive complaints in the menopausal transition. Menopause 2010; 17:815.

5. Szoeke CE, Cicuttini FM, Guthrie JR, Dennerstein L. The relationship of reports of aches and joint pains to the menopausal transition: a longitudinal study. Climacteric 2008; 11:55.

6. Dugan SA, Powell LH, Kravitz HM, et al. Musculoskeletal pain and menopausal status. Clin J Pain 2006; 22:325.

7. Neer RM, SWAN Investigators. Bone loss across the menopausal transition. Ann N Y Acad Sci 2010; 1192:66.

8. Lee CG, Carr MC, Murdoch SJ, et al. Adipokines, inflammation, and visceral adiposity across the menopausal transition: a prospective study. J Clin Endocrinol Metab 2009; 94:1104.

9. De Mello Schier AR, de Oliveira Ribeiro NP, Coutinho DS. Antidepressant-like and anxiolytic-like effects of cannabidiol: a chemical compound of Cannabis sativa. CNS Neurol Disord Drug Targets. 2014;13(6):953-60

10. Costa B, Trovato AE, Comelli F The non-psychoactive cannabis constituent cannabidiol is an orally effective therapeutic agent in rat chronic inflammatory and neuropathic pain. Eur J Pharmacol. 2007 Feb 5;556(1-3):75-83.

11. Booz GW Cannabidiol as an emergent therapeutic strategy for lessening the impact of inflammation on oxidative stress. Free Radic Biol Med. 2011 Sep 1;51(5):1054-61

12. Idris AI, Sophocleous A, Landao-Bassonga E. Cannabinoid receptor type 1 protects against age-related osteoporosis by regulating osteoblast and adipocyte differentiation in marrow stromal cells. Cell Metab. 2009 Aug;10(2):139-47.

13. Bíró T, Tóth BI, Haskó G,The endocannabinoid system of the skin in health and disease: novel perspectives and therapeutic opportunities. Trends Pharmacol Sci. 2009 Aug;30(8):411-20