A New Approach to Menopause and Female Sexual Wellness

August is Women's Month in South Africa, a time to celebrate the resilience, strength, and health of women while acknowledging the unique healthcare challenges they face throughout their lives. 

One of the most significant yet often overlooked transitions is menopause. Despite affecting every woman who reaches midlife, many continue to suffer in silence, believing that debilitating symptoms are simply something they must endure.

Hormone replacement therapy (HRT) remains an effective option for many women. However, others either cannot use HRT because of medical contraindications, such as a personal or family history of hormone-sensitive cancers or simply prefer what they perceive to be a more natural therapeutic approach. This has led to increasing interest in medical cannabis for menopausal symptoms.

As research into the endocannabinoid system (ECS) expands, scientists are beginning to understand why cannabinoid-based medicines may offer meaningful benefits for women experiencing menopause.

Understanding Menopause

Menopause is defined as the permanent cessation of menstruation following the loss of ovarian follicular function and is diagnosed after twelve consecutive months without a menstrual period. It typically occurs between ages 45 and 55 and is associated with a progressive decline in oestrogen and progesterone production.

These hormonal changes affect virtually every organ system, producing symptoms that can significantly impair quality of life.

Common symptoms include hot flushes, night sweats, sleep disturbances, anxiety, depression, mood swings, fatigue, brain fog, joint and muscle pain, vaginal dryness, reduced libido, pain during intercourse, and weight gain 

While many women experience only mild symptoms, others report severe physical and psychological distress that affects relationships, careers, and overall well-being.

The Endocannabinoid System and Female Hormones

The endocannabinoid system plays a fundamental role in maintaining physiological balance throughout the body. It regulates numerous processes, including improving mood, stress responses, pain perception, sleep, inflammation, thermoregulation, appetite, sexual function and hormonal signaling 

CB1 receptors are abundant within the hypothalamus, the brain region responsible for regulating body temperature and reproductive hormones. As oestrogen declines during menopause, endocannabinoid signaling also changes, which may contribute to symptoms such as hot flushes, insomnia, anxiety, and reduced sexual desire.

Emerging evidence suggests that cannabinoids may help restore homeostasis within these pathways, potentially reducing symptom burden while improving overall well-being.

Can Medical Cannabis Help Menopausal Symptoms?

Although large-scale clinical trials remain limited, a growing number of observational studies and patient surveys suggest that many menopausal women experience improvements in multiple symptoms following cannabinoid therapy.

Potential benefits include:

Improved Sleep: Sleep disturbance is one of the most common menopausal complaints. Low-dose THC may reduce sleep latency and improve sleep continuity. While CBD appears to reduce anxiety that may contribute to insomnia, this has not been rigorously studied in humans. Improved sleep often leads to better daytime energy, mood, and cognitive performance.

Reduction in Hot Flushes and Night Sweats: Although evidence remains preliminary, cannabinoids may influence thermoregulation through hypothalamic CB1 receptors. Many women report that fewer night sweats, reduced frequency of hot flushes, less severe flushing episodes, and improved sleep often follow these reductions.

Improved Mood and Anxiety: Fluctuating hormones frequently contribute to irritability, anxiety, emotional lability, and depressive symptoms. CBD has suggested anxiolytic properties in both pre-clinical and observational studies, but have not been studied rigorously in high quality randomized controlled trials in humans.  Similarly,  balanced THC: CBD preparations may improve overall emotional well-being when carefully titrated under medical supervision.

Medical Cannabis and Female Sexual Health

One aspect of menopause that remains under-discussed is female sexual health.

Reduced oestrogen levels contribute to vaginal dryness, pain during intercourse, decreased genital blood flow, reduced arousal, diminished orgasm and loss of libido. These changes frequently affect intimate relationships, emotional well-being, and self-confidence.

The endocannabinoid system is increasingly recognised as playing an important role in female sexual function. Cannabinoid receptors have been identified within reproductive tissues, while central ECS signalling influences sexual motivation, pleasure, and reward pathways.

Several observational studies have reported that women using cannabis before sexual activity experienced improved desire, arousal, orgasm, and overall satisfaction, while also reporting less discomfort during intercourse. However, responses vary between individuals, and higher THC doses may impair sexual function in some women. Careful dosing and medical supervision are therefore essential.

For many women, improving intimacy extends beyond physical symptoms; it restores confidence, strengthens relationships, and enhances overall quality of life.

Current Scientific Evidence

Interest in cannabis for menopause has grown rapidly over the past decade.

Interest in the use of medical cannabis for menopausal symptom management has increased substantially over the past decade. A survey by Dahlgren et al. (2022) found that nearly 80% of women reported using medical cannabis specifically to manage menopausal symptoms. The most targeted symptoms were sleep disturbances (67.4%), anxiety and mood changes (46.1%), and reduced libido (30.4%), highlighting the broad impact of menopause on both physical and emotional well-being.

 Similarly, a large cross-sectional survey by Barbosa-Leiker et al. (2023) involving 1,485 women found that sleep disturbances, anxiety, irritability, and muscle or joint pain were among the most common menopausal symptoms experienced by women using cannabis. Importantly, 74% of current cannabis users perceived cannabis to be helpful in managing their menopausal symptoms, suggesting a high level of patient-reported benefit in real-world clinical practice. 

These findings are consistent with earlier observations by Shifren et al. (2014), who reported that many women used cannabis to alleviate menopausal symptoms, particularly sleep disturbances, anxiety, and mood changes, reinforcing the growing interest in cannabinoid-based therapies as a potential option for symptom management during menopause.

Although these observational findings are encouraging, high-quality randomised controlled trials remain necessary before definitive treatment recommendations can be made.

Current evidence supports careful, individualised prescribing under the supervision of clinicians experienced in cannabinoid medicine.

Clinical Case Study

A 51-year-old woman presented with severe menopausal symptoms that had progressively worsened over several months. She had a significant family history of breast cancer, with her mother having been diagnosed with the disease, and therefore wished to avoid hormone replacement therapy. Instead, she sought a more natural, evidence-informed treatment approach and was referred to the Holistic Healing clinic.

Her symptoms included severe hot flushes and drenching night sweats that required her to change her clothes several times each night. She experienced profound mood swings and irritability, which had begun to affect her marriage, along with persistent insomnia, vaginal dryness, loss of libido, and complete avoidance of sexual intercourse because of discomfort.

After a comprehensive assessment, she commenced a personalised cannabinoid treatment regimen consisting of a full-spectrum cannabis extract providing 20 mg CBD and 5 mg CBG twice daily to support anxiety, mood regulation, and inflammation. Because of severe insomnia, 2 mg THC was introduced at night. This was her first experience using medical cannabis.

Following the first day of treatment, she reported feeling noticeably calmer, although her night sweats remained unchanged. By the third day, the sweating had begun to decrease, and she noticed an improvement in vaginal moisture. Over the following two weeks, her mood improved dramatically, with an estimated 80% reduction in irritability and emotional instability.

By the end of the first month, her transformation was remarkable. Her hot flushes had become infrequent and significantly less severe, she was sleeping through the night, and her vaginal dryness had resolved sufficiently to allow comfortable intimacy with her husband. She described herself as feeling "like a completely new person," noting not only the physical improvements but also the restoration of her confidence, emotional well-being, and relationship.

While individual case reports cannot establish efficacy, experiences such as this highlight the potential role of carefully prescribed cannabinoid therapy as part of an integrative, patient-centred approach to menopause. They also reinforce the urgent need for larger prospective clinical trials evaluating medical cannabis in women's health.

Quality of Life

This Women's Month, the conversation around women's health should include not only longevity but also quality of life. Menopause is not simply the end of reproductive years; it is a significant biological transition that deserves compassionate, evidence-based care. While medical cannabis is not a universal solution, emerging research and growing clinical experience suggest it may offer meaningful relief for selected women, particularly those seeking alternatives to hormone replacement therapy or those in whom HRT is not appropriate. As science continues to evolve, empowering women with safe, personalised treatment options will remain at the heart of integrative healthcare.

Selected References

• Baron EP. Comprehensive Review of Medicinal Marijuana, Cannabinoids, and Therapeutic Implications in Medicine and Headache. Headache. 2015;55(6):885-916. 

• Barbosa-Leiker C, Lamont J, VanOlm B, et al. Cannabis use for menopause in women aged 35 and over: a cross-sectional survey on usage patterns and perceptions in Alberta, Canada. BMJ Open. 2023;13:e069197. doi:10.1136/bmjopen-2022-069197. 

• Bhambhvani HP, Kasman AM, Wilson-King G, Eisenberg ML. Cannabis use and its association with female sexual function. Sexual Medicine. 2023. 

• Dahlgren MK, El-Abboud C, Lambros AM, et al. A survey of medical cannabis use during perimenopause and post menopause. Menopause. 2022;29(9):1028–1036. doi:10.1097/GME.0000000000002023.

• Lynn BK, López JD, Miller C, et al. The relationship between cannabis uses and female sexual function. Sexual Medicine. 2019;7(2):121-127. 

• Maccarrone M, Bab I, Bíró T, et al. Endocannabinoid signaling at the periphery: 50 years after THC. Trends in Pharmacological Sciences. 2015;36(5):277-296. 

• Shifren JL, Gass MLS, et al. The North American Menopause Society recommendations on menopausal health and symptom management. Menopause. (Guideline publications). (2014) 

• Stampanoni Bassi M, Sancesario A, Morace R, et al. The endocannabinoid system in female reproductive physiology and menopause. International Journal of Molecular Sciences. 2023.