Cannabis & women's health — knowledge hub

Endocrinological interactions and cycle phases

The female endocrine system stands in a close, reciprocal relationship with the endocannabinoid system. Oestrogen significantly influences the activity of the enzyme FAAH, which is responsible for the breakdown of the body's own cannabinoid anandamide. Consequently, during high oestrogen levels, such as those occurring shortly before ovulation, the concentration of anandamide in the body also changes. This leads to women reacting with varying sensitivity to externally administered cannabinoids in different phases of their menstrual cycle. The pharmacological effect of THC or CBD is therefore not a static value, but is subject to cyclical fluctuations.

In the subsequent luteal phase, the hormone progesterone dominates, which is often associated with the typical symptoms of premenstrual syndrome. The interaction of cannabinoids with receptors in the central nervous system and the reproductive tract is investigated in this phase regarding its modulating effect on mood and pain perception. At the same time, chronically high consumption of exogenous THC can disrupt the release of luteinising hormone. This shows that cannabinoids are not only influenced by the hormonal balance, but conversely also actively influence it and can potentially make the cycle irregular.

• Oestrogen regulates the breakdown of the body's own cannabinoid anandamide.
• Fluctuating hormone levels influence the density and sensitivity of CB1 receptors.
• Sensitivity to psychoactive THC peaks during certain phases of the menstrual cycle.
• Chronic, high-dose cannabis consumption can impair the hormonal regulation of the menstrual cycle.

Therapeutic potential for gynecological complaints

Chronic pelvic pain, particularly in connection with endometriosis or severe dysmenorrhea, represents a significant reduction in the quality of life for many of those affected. Since the uterus and surrounding tissue exhibit a high density of cannabinoid receptors, the therapeutic potential of cannabis is increasingly coming into focus. Since the amendment to the law in August 2022, Swiss doctors have been able to prescribe medical cannabis directly. Although large-scale clinical trials are still pending, preclinical data and patient reports suggest that cannabinoids can support anti-inflammatory and pain-relieving processes in the pelvic area.

When using gynecological cannabis products, safety is the primary concern. In addition to the oral intake of standardized extracts, vaginal suppositories are also being discussed abroad, although the scientific data regarding their efficacy and absorption remains very sparse. Patients should note that cannabinoids are metabolized by the liver, where they can block key enzymes. This can lead to interactions with other medications, including painkillers or hormonal preparations. Close consultation with the treating gynecologist is therefore essential to avoid adverse effects.

• High density of endocannabinoid receptors in the female genital tract and uterine tissue.
• Medical cannabis has been prescribable by doctors for chronic pain conditions since August 2022.
• CBD products with less than 1 percent THC are freely available for sale in Switzerland.
• Possible interactions with hormonal contraceptives via the cytochrome P450 enzyme system.

Legal classification and gynecological practice in Switzerland

The legal framework in Switzerland strictly separates medically indicated use from recreational consumption. For women suffering from therapy-resistant gynecological complaints, access has been simplified since August 2022, as an exceptional permit from the BAG is no longer required. Anyone who, on the other hand, relies on over-the-counter CBD products must ensure that the total THC content is strictly below 1 percent. Products that exceed this value fall under the Narcotics Act and are illegal. The cantonal authorities consistently enforce these regulations, with fixed penalty fines threatening for minor possession for personal consumption.

Particular caution is advised in Swiss road traffic, as a strict zero-tolerance policy applies here. Even with a detection level of 1.5 micrograms of THC per litre of blood, a person is deemed unfit to drive, which can also have legal consequences for patients with a medical prescription. Furthermore, Swiss professional associations such as the SGGG clearly position themselves against consumption during pregnancy and breastfeeding. Since THC crosses the placental barrier and passes into breast milk, there is a risk of developmental delays in the child. Health education and prevention are the focus of the cantonal health services here.

• Direct medical prescription of medical cannabis is possible without a BAG exceptional permit.
• Limit of under 1 percent total THC for over-the-counter CBD products.
• Strict zero-tolerance policy in Swiss road traffic with a limit of 1.5 micrograms of THC per litre of blood.
• Clear rejection of consumption recommendations during pregnancy and breastfeeding by Swiss professional bodies.

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