Cannabis is female.

If there's one thing that's clear, it's that there is a beautiful and profound relationship between the cannabis plant and the biologically female. Where conventional (pharmaceutical) medicine has failed, women all over the world have found relief from myriad conditions, from endometriosis to vulvodynia.

Quite a few conditions can affect women’s health, but what if there was a mysterious disorder that effected 8–20% of females of reproductive age that could lead to many different health complications, even causing infertility, and no one was talking about it? Unfortunately, unless you have polycystic ovarian syndrome (PCOS), you’ve probably never heard about it.

PCOS is a group of symptoms related to high levels of hormones known as androgens. In many women with the condition, the ovaries contain numerous small, cyst-like sacs. Women with PCOS may have irregular, missing, or prolonged menstrual periods, excessive facial and body hair, insulin resistance, and problems with fertility. Treatment may include drugs that block androgens, and oral contraceptives, which contain the hormones estrogen and progesterone.

Online PCOS forums are abundant with anecdotes that swear by cannabis' efficacy in managing PCOS's debilitating physical and emotional symptoms, from pain and inflammation to anxiety and depression.

For example, there is increasing evidence that PCOS may in fact be an autoimmune disease. Many women with PCOS have low levels of the hormone progesterone. A drop in this hormone can stimulate the immune system to make autoantibodies—proteins that damage the body's tissues. Because CBD is a potent anti-inflammatory agent and is studied to quell the body's autoimmune response, it should be helpful in relieving many PCOS patients's pain and inflammation.

However, recent research suggests that the pathology of PCOS in a subset of patients is correlated with increased endocannabinoid levels, namely Anandamide (AEA), the bliss molecule. In other subsets, the HPA Axis is responsible for up to half of the androgen production in PCOS patients. In the former subset, there is a chance that CBD may potentiate the progression of PCOS, even if the physical and emotional symptoms are measurably more tolerable. In the latter, CBD regulates imbalances in the HPA Axis to relieve PCOS.

What is the ECS' relationship with female sexual and reproductive health? Is CBD a double edged sword? How can it be used to help manage PCOS? And is THC any better?

Let's dive in.

But first: What is PCOS?

Signs and symptoms of PCOS often develop around the time of the first menstrual period during puberty. Sometimes PCOS develops later, for example, in response to substantial weight gain.

Signs and symptoms of PCOS vary. A diagnosis of PCOS is made when you experience at least two of these signs:

  • Irregular periods. Abnormal, infrequent, irregular, or prolonged menstrual cycles are the most common sign of PCOS. For example, you might have fewer than nine periods a year, more than 35 days between periods, and abnormally heavy periods.
  • Excess androgen. Elevated levels of male hormones may result in physical signs, such as excess facial and body hair (hirsutism), and occasionally severe acne and male-pattern baldness.
  • Polycystic ovaries. Your ovaries might be enlarged and contain follicles that surround the eggs. As a result, the ovaries might fail to function regularly.

The most common symptoms include:

  • Abnormal hair growth: Excess facial hair and heavy hair growth on the arms, chest and abdomen (hirsutism). This affects up to 70% of women with PCOS.
  • Acne: PCOS can cause acne, especially on the back, chest and face. This acne may continue past the teenage years and may be difficult to treat.
  • Obesity: About 80% of women with PCOS are overweight or have obesity, and have trouble losing weight.
  • Darkening of the skin: Patches of dark skin, especially in the folds of your neck, armpits, groin (between the legs) and under the breasts. This is known as acanthosis nigricans.
  • Cysts: Many women with PCOS have small pockets of fluid in their ovaries.
  • Skin tags: Skin tags are little flaps of extra skin. They're often found in the armpits or on the neck in women with PCOS.
  • Thinning hair: People with PCOS may lose patches of hair on their heads or start to go bald.
  • Infertility: PCOS is the most common cause of female infertility. Decreased frequency or lack of ovulation can result in not being able to conceive.

PCOS signs and symptoms are typically more severe if you're obese.

PCOS Causes

The exact cause of PCOS is unknown. There is evidence that genetics play a role. Several other factors also play a role in causing PCOS:

  • Higher levels of male hormones called androgens: High androgen levels prevent the ovaries from releasing eggs (ovulation), which causes irregular menstrual cycles. Irregular ovulation can also cause small, fluid-filled sacs to develop in the ovaries. High androgen also causes acne and excess hair growth in women. Increasing evidence suggests that there is a large subset of patients with PCOS whose increased androgen levels can be attributed to adrenal fatigue resulting from an overactive HPA Axis.
  • Insulin resistance: Increased insulin levels cause the ovaries to make and release male hormone (androgens). Increased male hormone, in turn, suppress ovulation and contribute to other symptoms of PCOS. Insulin controls the way your body processes glucose (sugar) and uses it for energy. Insulin resistance means your body doesn't process insulin correctly, leading to high glucose levels in your blood. Not all individuals with insulin resistance have an elevated glucose or diabetes, but insulin resistance can lead to diabetes. Being overweight or having obesity can also contribute to insulin resistance. An elevated insulin level, even if your blood glucose is normal, can indicate insulin resistance.
  • Low-grade inflammation: People with PCOS tend to have chronic low-grade inflammation. Your healthcare provider can perform blood tests that measure levels of C-reactive protein (CRP) and white blood cells, which can indicate the level of inflammation in your body.

The ECS and female reproduction.

There has been increasing interest in the role of endocannabinoids as critical modulators of female reproductive processes. Studies have unearthed a complex interplay between the endocannabinoid system (ECS) and the hypothalamic-pituitary-ovarian (HPO) axis, and intricate crosstalk between the ECS and steroid hormone production and secretion.

The ECS and the endocannabinoids that modulate it regulate a range of female reproductive events. The ECS has also been localized to areas of the hypothalamus responsible for producing hormones such as GnRH, which controls a number of aspects of female reproductive processes through the hypothalamic-pituitary-ovarian (HPO) axis. It's more than safe to say that the ECS exerts a strong impact on fertility, reproduction, and endocrine function, as demonstrated by rodent, primate, and human studies.

This may account for the effects of CBD and THC on several aspects of reproductive physiology, including the release of hormones along the HPO axis. Chronic exposure to THC, which mimics Anandamide's CB activation, in females has been shown to delay sexual maturation, cause menstrual cycle disruption, depress ovarian follicular maturation, and reduce serum concentrations of LH and sex hormones. Endocannabinoids, their metabolic enzymes, and target receptors have been shown to respond to endocrine signals. Likewise, they have been shown to interfere with reproductive signals in both male and female reproductive processes. It is worth noting that in vivo levels of endocannabinoids, including that within reproductive organs, are tightly regulated by the enzymes that control their metabolism, and when perturbed by exogenous cannabinoids, may lead to reproductive failure.

In simpler terms, chronic (daily, frequent, high volume) use of THC may disrupt reproductive processes, so it is important to consume in moderation, or completely stop when trying to conceive. And while CBD supports homeostasis, it depends entirely on the pathology of every individual's imbalance.

Can CBD help with PCOS?

Although cannabis is not a cure for PCOS, it could be a potential treatment option for many with this condition. Unfortunately, there haven’t been any research studies to examine the effects of cannabis for PCOS specifically. However, rising evidence suggests this disorder may be tied to a dysfunction in the endocannabinoid system. And endocannabinoid therapy, like cannabis, could be used to supplement what the body needs.

A 2013 scientific review in the Journal of Molecular Endocrinology suggests the mysterious cause of polycystic ovarian syndrome may actually be caused by dysfunction in the endocannabinoid system. The ECS may also have a hand in the condition’s other underlying features, such as:

  • Androgen hypersecretion
  • Insulin resistance
  • Inflammation

Evidence suggests the cannabinoids in cannabis could present viable treatment options for PCOS. Cannabinoids like CBD and THC can bind to endocannabinoid receptors to assist the ECS in regaining balance. With further development, cannabinoid technologies could help treat insulin resistance, fight obesity and bring balance to reproductive functions in women with PCOS. Additional research may discover cannabis and PCOS could be the most effective treatment available. Until then, cannabis has other benefits for patients with this condition in its treatment of symptoms.

Cannabis for Treating Polycystic Ovarian Syndrome (PCOS) Symptoms

Not only could cannabis be an effective treatment for the underlying causes of PCOS, but it also helps a few of the associated symptoms. One of the most recognized uses for CBD and THC is the treatment of pain. PCOS can cause severe abdominal pain if cysts develop. These major cannabinoids work with the ECS to provide an analgesic for all kinds of different pain.

There is also evidence women with PCOS are more susceptible to depression. Patients globally use cannabis to help treat depressive symptoms. Not only does it provide them with a boost in energy, as the ECS is critically implicated in energy metabolism, but it also can alleviate persistent negative thoughts, giving patients a brighter outlook.

As PCOS is inflammatory and likely an autoimmune disease, we'd recommend Full Spec. CBD to manage the pain symptoms and confer CBD's immunomodulating properties that can suppress autoimmune activity. CBD also increases serotonin levels and resets the complex brain regions that are critically implicated in feelings of panic and anxiety, so you can reverse the effects of PCOS.

Should I use CBD to treat my PCOS?

It depends. It's not a satisfying answer, but PCOS's pathology is yet to be understood, and recent discoveries indicate that there are multiple subsets with key notable differences. However, CBD has been well-studied to support hormonal balance, reduce insulin resistance, and relieve inflammation and autoimmune disease.

Androgen Hypersecretion

CBD has been studied to reduce androgen hypersecretion. In some, the ovaries are the culprit. In others, it's the adrenal glands. Regardless of the source, studies indicate that CBD assists in regulating hormonal production to establish homeostasis.

Insulin Resistance

Diabetes is an inflammatory condition, and CBD has anti-inflammatory properties. In research, CBD has shown promise in reducing insulin resistance and moderating blood sugars for people with type 2 not taking insulin.

Unfortunately, clinical studies in humans on the direct effect of CBD oil on blood sugar is lacking.

What we do know is that the body’s endocannabinoid system plays an integral part in the regulation of energy metabolism, which is important to know for those who are living with diabetes. Emerging data suggests that “the endocannabinoid system sets the sensitivity of the insulin response in adipocytes.” This means that the endocannabinoid system plays an important role in how the body responds to insulin, increasing or decreasing insulin sensitivity. This is critically important for those who are taking insulin because it could mean that their blood sugars could rise or fall unexpectedly, making tight control more difficult to achieve.

Anecdotally, there are clients who exhibit completely different response reactions to CBD oil use. One client experienced dramatically decreased blood sugar levels within a matter of minutes, which is potentially very dangerous. Other clients notice no effect on blood sugar at all. This is attributed to the uniqueness of each person’s endocannabinoid system and their personal endocannabinoid tone.

Low-grade Inflammation

CBD exerts a number of beneficial pharmacological effects, including anti-inflammatory and antioxidant properties. According to a study published in Future Medicinal Chemistry, cannabinoids reduce symptoms of diseases related to inflammation by suppressing inflammatory responses. These immunomodulatory properties include the role of cannabinoids in the induction of apoptosis (cell death) in activated immune cells and the cannabinoids’ ability to suppress cytokines and chemokines in inflammatory sites.

Cytokines refer to signaling molecules. Chemokines are cytokines that attract cells to inflammatory sites.

Apoptosis is essential in the regulation of inflammation. To maintain balance in the body, invading microbial pathogens (viruses) and dying cells should be cleared. Failure to remove apoptotic neutrophils may result in a prolonged inflammatory response.

Neutrophils are white blood cells that heal damaged tissues and fix infections.

CBD has also been suggested to enhance adenosine signaling, resulting in reduced inflammation. Adenosine receptors suppress overactive immune cells, leading to the protection of several tissues from inflammatory damage.

How much CBD should I take for PCOS?

CBD is biphasic by nature—that means that different doses have distinct benefits. For CBD to confer its anti-inflammatory beenfits, high doses are recommended. What constitutes a high dose depends on your unique biology and the strength of your existing endocannabinoid tone, but we'd typically recommend starting with ~50mg CBD per dose in and up-titrating until you find the dose that works for you.

After vaping and smoking high-CBD flower, tinctures are the most bioactive and provide the most rapid onset (~20–30 minutes to take effect). They also provide the most predictable dosing. We'd recommend our Full Spec. CBD., a potent organic hemp-extracted oil. Drop 50mg under your tongue and wait at least 90 seconds before swallowing.

While full-spectrum CBD is more effective, you might be looking for something without THC. For a THC-free alternative, try our CBD Isolate. It is just as potent, but is formulated without the polyphenols, sterols, terpenoids, and trace amounts of major and minor cannabinoids found in Full Spec. CBD.

Should I avoid using CBD for PCOS?

There is no definitive answer. Research indicates that, for a subset of PCOS patients, high Anandamide levels may be one of the primary culprits behind the pathology of PCOS. As CBD prevents the breakdown of Anandamide and increases endocannabinoid signalling, we'd highly recommend speaking to a specialist about getting your Anandamide levels tested.

What about THC?

Studies suggest that chronic use of THC in general dysrupts female reproductive processes. While low amounts of THC can help activate and tone the ECS, chronic, daily, frequent, high-volume use can actually disrupt not only your reproductive processes, but have an impact on your dopamine production. This can have a major depressive effect on our mood and well-being.

THC also mimics the effects of Anandamide, activating CB receptors in a similar way. Since high Anandamide levels are evident in a subset of PCOS patients, we'd recommend avoiding THC for daily use and use low amounts for relief infrequently—when and as needed.

Conclusion.

There is growing evidence that CBD may be useful in treating PCOS as an inflammatory autoimmune disease, among other underlying causes. There are also subsets of patients that may benefit from its ability to balance hormones and reduce insulin resistance.

However, there are also subsets whose PCOS pathogenesis appears to be tied to high Anandamide levels. Since CBD increases endocannabinoid tone, including Anandamide, there are potential subsets that may not benefit. These health issues require future human studies to be confirmed. 

Compared to conventional hormonal therapies and anti-inflammatory medications like NSAIDs, CBD’s safety profile is more favorable. 

Before using CBD for PCOS, we'd recommend that individuals seek professional medical advice from a qualified healthcare provider.

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