Dear Cannabis RN
"I’m a medical cannabis patient. I went to see my functional medicine naturopath for hormonal issues and was told that I shouldn’t use THC because it would lead to “increased estrogen uptake”. I’m wondering if your practice is aware of research to support this claim? I understand this question may have a complicated answer.
Thank you, Terry Has Confusion"
First things first, thank you for asking the question and kudos to you for having the courage and common sense to ask your provider for research or evidence to support their point of view!
Many patients feel intimidated asking their physician or healthcare provider for verification of evidence, and while I can understand this hesitation, you also have a right to know the source of their information. This is one of my favorite aspects of working as a nurse: teaching people how to investigate the health claims they hear about cannabis (or anything for that matter) as a first step toward empowering themselves with real information. As nurses we have a responsibility to educate and then to back that up with real data.
To answer your question: Does THC caused increased estrogen uptake? No, this claim is not supported in the research. However, the interaction between the ECS and sex hormones is a fascinating and expanding area of science that has real implications for future advances in medicine. Here’s why: the endocannabinoid system (ECS) is deeply interwoven and interconnected with the hormonal and nervous systems in both males and females. Examining how these three systems interact sheds light on common hormonal and reproductive issues that affect large numbers of women.
There are several major lines of evidence suggesting that the [endocannabinoid system and the hormonal system] interact extensively.” This interaction is called bidirectional, because each system can influence the other.
Alterations in the ECS can affect estrogen levels and vice versa: estrogen levels can affect the structure and function of the endocannabinoid system.
This is meaningful because it partially explains what we see in clinical practice: that we each have highly individualized response to THC. Furthermore, it insinuates an underlying physiological reason why females might experience different responses to THC than males. Additionally, it means that an individual female could experience different responses to THC at different points in her menstrual cycle, and that females at different stages of reproductive maturity could experience different effects from THC. In my personal practice, I have seen this play out as females having an increased sensitivity to THC compared to males, which means that they often do not need to take as much to get the desired effect.
When we start talking about the intricacies of the female hormone system many people’s eyes (including some healthcare providers and females alike) glaze over. They will say things like, “Let’s just leave that part out because it is too complicated.” In fact, leaving out the differences between the male and female reproductive system has been the practice of medical science for a long time, but as simple as it seems to just leave out the physiological differences between males and females when it comes to studying how cannabis consumption and the female hormone system interact, the end result will be inaccurate for half the population. So, buckle your seatbelts, we’re going to talk about how estrogen works.
Estrogen is the sex hormone that causes females to ovulate. When a female begins her menstrual cycle, estrogen is at its lowest level for that cycle. As menstruation ends, her estrogen level gradually climbs until it reaches its highest level for that cycle, and this triggers the egg to be released from the ovary. This is the midpoint of the cycle, and it’s called ovulation. After ovulation, estrogen levels gradually drop until menstruation begins and the whole cycle starts again.
Our bodies (male and female) make our own cannabinoids, and one of these endo-cannabinoids we make is called anandamide. Anandamide fits into the same receptors as THC. In fact, the molecules are so similar that our bodies can’t tell the difference. Additionally, anandamide is manufactured by our body on demand. Compounds called enzymes in our bodies that make anandamide molecules and then break them own when the body is finished with them.
It turns out that estrogen may increase the presence of anandamide.
In other words, the more estrogen in your body the more anandamide you will have, and the better you will feel. Why? Anandamide---like THC confers a sense of well-being and pleasure. This explains why women often feel their best right around the time of ovulation. It also offers one possible physiological explanation for PMS and its more serious cousin PMDD (premenstrual dysphoric disorder). It also can help explain some of the mood issues faced by perimenopausal and menopausal women. Their estrogen levels drop and hence their anandamide levels drop, leading to decreased feelings of well-being and increased feelings of anxiety and depression.
Mind blown? Mine was. I struggled with PMS for years, with many healthcare providers downplaying the symptoms I experienced or trying to tell me that the way to solve my problem was to take synthetic hormones so that I wouldn’t have a menstrual cycle anymore.
When I started using medical cannabis to manage the symptoms, I realized something. I realized there is a very real physiological reason why cannabis works to manage PMS symptoms. And now you know why as well: the endocannabinoid system has a role in regulating the female menstrual cycle, and by working with the ECS some women (myself included) can have less disruptive menstrual cycles.
To summarize: the body produces less estrogen and anandamide (the body’s version of THC) during the premenstrual phase of a cycle, which can contribute to feelings of irritability, depression, anxiety, and tension. These feelings often spontaneously resolve as soon as bleeding stops, and the body begins to produce more estrogen and anandamide. Using THC during the premenstrual phase and through menstruation helps with these difficult feelings because it works exactly like anandamide in the body, increasing feelings of well-being.
This blog is for informational and educational purposes only and is made available for does not constitute health advice. Please contact a healthcare provider for healthcare advice.
-Amy Silverman, RN