Cannabis & menstrual cycle

TL;DR

• Follicular phase (days 1–14): high estrogen → stronger THC effects, more euphoria.
• Ovulation: peak CB1 sensitivity.
• Luteal phase: progesterone dominates → stronger sedation, often used for PMS relief.
• Menstruation: many use CBD oil (25 mg oral) for cramps.

Adjusting dose by phase

• Follicular phase: reduce THC dose by 20–30 %.
• Ovulation: caution — anxiety reactions possible.
• Luteal phase: standard dose; CBD:THC 2:1 can soften PMS.
• Cycle tracking (Clue, Flow) helps understand individual patterns.

Endocrinological interactions of cannabinoids

The endocrine system and the endocannabinoid system are closely linked through complex biological feedback loops. CB1 and CB2 receptors are located not only in the central nervous system, but also in the hypothalamus, the pituitary gland, and directly in the ovarian tissue. Exogenous cannabinoids such as THC can influence the activity of the hypothalamic-pituitary-gonadal axis. This occurs primarily through the modulation of the gonadotropin-releasing hormone, which in turn regulates the release of luteinising hormone and follicle-stimulating hormone, and can thus directly influence the entire course of the menstrual cycle.

In addition, the body's own endocannabinoid anandamide plays an essential role in controlling female reproductive functions. The concentration of this neurotransmitter fluctuates during the menstrual cycle and typically reaches its peak shortly before ovulation. If this sensitive balance is disrupted by the regular consumption of exogenous THC, it can lead to impaired follicle maturation. Scientific data indicate that the body's response is highly dose-dependent, with high doses disrupting the hormonal balance more severely than moderate amounts.

• Localisation of cannabinoid receptors in the hypothalamus and ovaries
• Modulation of the hormones GnRH, LH, and FSH by exogenous cannabinoids
• Natural fluctuations of the endocannabinoid anandamide during the menstrual cycle
• Risk of impaired follicle maturation with uncontrolled consumption

Swiss legal framework and medical practice for menstrual discomfort

In Switzerland, the legal situation for patients with severe menstrual discomfort has improved significantly. Since August 2022, doctors have been able to prescribe medical cannabis directly and without a time-consuming exceptional authorisation from the Federal Office of Public Health (FOPH). This particularly affects women suffering from chronic pelvic pain or severe endometriosis. However, since compulsory health insurance does not automatically cover the costs of such therapies, a reasoned request for cost assumption must generally be submitted to the respective health insurance provider before the start of treatment and reviewed by them on an individual basis.

For self-medication, many of those affected resort to over-the-counter CBD products. In Switzerland, these do not fall under the Narcotics Act, provided their total THC content is strictly below 1%. Such products, which are often offered as oils or special vaginal suppositories, are subject to the supervision of the Federal Food Safety and Veterinary Office (FSVO) and Swissmedic. They offer a non-psychotropic alternative for relaxing smooth muscle tissue without inducing the psychoactive effects of THC, which significantly facilitates integration into normal daily work life.

• Direct medical prescribability of medical cannabis since August 2022
• Legal classification of CBD products below the limit of 1% total THC
• Competence of the FOPH, FSVO and Swissmedic in product regulation
• Necessity of an individual cost assumption guarantee for health insurance coverage

Dosage forms and risks in everyday life

In the therapeutic use of cannabinoids during the menstrual cycle, the choice of dosage form is crucial for therapeutic success. Inhalation leads to a rapid onset of action, but due to its short duration of action, it is less suitable for long-lasting pain relief. Oral dosage forms such as capsules or oily drops have a delayed onset but offer constant relief over several hours. Local applications such as suppositories aim to act directly in the pelvic area, thereby minimising systemic side effects in the brain, which maximises tolerability in everyday life.

An often underestimated risk in Swiss everyday life is driving under the influence of THC. A strict zero-tolerance policy applies, with a statutory limit of 1.5 micrograms of THC per litre of blood. Since this limit can still be exceeded even after the noticeable effects have subsided, drivers risk having their driving licence withdrawn during checks. In case of uncertainty regarding dosage, undesirable side effects or accidental overdose, those affected in Switzerland can contact the emergency number 145 of Tox Info Suisse for free medical advice around the clock.

• Different kinetics of inhalation, oral ingestion and local application
• Prevention of systemic side effects through targeted vaginal application
• Strict zero-tolerance practice in road traffic with a limit of 1.5 µg/L of blood
• Around-the-clock emergency advice in case of overdose via Tox Info Suisse

FAQ