Pelvic pain can present itself in very different ways for women, and the cause can be difficult to trace. Traditionally, women have been treated based on data that was originally used to treat men. But women have different needs, hormones and life experiences. And there is a big opportunity for more research in helping women have better health outcomes, according to Marissa Fratoni, a holistic RN, yoga teacher and wellness coach.
Practitioners like Fratoni want researchers to look into how cannabis can help ease pelvic pain, which can be symptomatic of various conditions, including uterine fibroids, ovarian cysts, endometriosis and vulvodynia.
Endometriosis and Cannabis
Endometriosis is a painful condition where cells similar to those that cover the inside of the uterus (known as the endometrium) grow outside of the uterus. The main symptoms are pelvic pain, particularly during menstruation and intercourse. This condition can also impact fertility. There's no cure for endometriosis, but there is evidence that cannabis can help ease the pain it causes.
“I’ve seen and heard of people who have successfully improved pain related to endometriosis, particularly when using cannabis-soaked tampons or infused suppositories, versus ingesting or inhaling cannabis,” Fratoni shared. “In some cases, it is very strain-dependent when treating pelvic pain and sometimes we see what CBD concentration is working, then see what a little bit of added THC can do to ease the pain.”
Fratoni added that there's no shortage of anecdotal evidence suggesting that cannabis can help women with endometriosis enjoy sex.
“One person that I worked with had written off intercourse. Regardless of whether the initial experience was enjoyable, the pain she experienced afterwards was not worth it,” said Fratoni. “Cannabis, used as a suppository and topically over her abdomen, really helped her manage the pain and it helped her get her sex life back.”
Another woman she met had endometriosis and fibroid cysts, so sex was very challenging. But using cannabis reduced her pre-menstrual pain, and helped her and her partner engage in sexual contact.
However, there is no standard dose of CBD or THC for improving sex and reduce pelvic pain. Fratoni stressed that women who are interested in trying cannabis have to take the time to try different products and find out what works best for them.
It could take some trial and error to get it right.
Postpartum Pelvic Health
Many women experience pelvic pain following childbirth, which can cause all sorts of physical problems.
“Issues such as lower back pain, disharmonies in the hips, pushing [during childbirth] for a long time—these can all contribute to pelvic health issues coming to the forefront,” said Fratoni, who specializes in pre-natal yoga to help women prepare for these health problems. She works with a lot of women that experience post-natal problems because birth can create a lot of disharmony in the pelvic region.
“Women have tearing and then restorative procedures, but they go home and are now mothers who are sitting for extensive periods of time, trying to get comfortable holding the baby. In some cases they may have deep pubic pain, they may have had third or fourth-degree tearing or episiotomies and this can all result in an unstable pelvic structure.”
Worse yet, some new mothers don't address those problems right away because they're focused on taking care of their children. As a result, many need surgery to correct those pelvic issues as they approach menopause.
“If women don’t get the opportunity to mitigate this early, it doesn’t tend to get better,” Fratoni said.
But cannabis can help reduce that residual pain—if women are open to trying it. Eloise Theisen, a nurse practitioner who regularly treats patients in their 70s, says patients are often reluctant to use cannabis for managing their pain.
Theisen points out that cannabis is not necessarily a quick fix. In her practice, she says that about 80 percent of the patients who come to her seeking relief (and who are willing to try cannabis) are able to manage their pain, and many of them are able to replace pharmaceuticals with cannabis.
"I try to be gentle with these patients as they have a lot of shame and guilt about using cannabis. Additionally, it can take months to find the right dose for them to get relief," Theisen said.
Fratoni expresses the same sentiment. She has seen a lot of success for women in using cannabis, but you need to take the time with the cannabinoid blend to explore and find out what works for each woman. In Fratoni’s case, she has success in using a good quality CBD topical on her hip and back, then she feels well enough to get into a yoga practice and stretch it out.
“It really can be successful as a multi-modal treatment, where the THC-CBD tincture takes the edge off of the pain, and then doing yoga or going for a walk can help improve the pain. What women need to know is that in order to improve, they need to do some of the work and cannabis can help you but it’s not a cure-all.”
Other Postpartum Considerations
According to Fratoni, while cannabis can be helpful in alleviating pelvic pain, new moms should give their bodies time to heal before looking at cannabis as an alternative.
“In some cases, cannabis can be considered a blood thinner, and you’re healing a giant space where your placenta was. I always recommend waiting six to eight weeks before doing anything as it could increase your risk of bleeding,” shared Fratoni.
She also points out that 1 in 7 women are on at least one prescribed medication and CBD can change the metabolization of other medications, so women need to be clear with their medical practitioners if they choose to use CBD.
Breastfeeding moms should also be cautious, and research their options before using cannabis.
“While most studies focus on smoking cannabis, there is evidence that THC can be transferred to the baby via breast milk, and while it is small amounts, we don’t fully know the developmental impact to the child. It’s challenging because we don’t have a lot of information that we would have if women were being treated conventionally [medically],” said Fratoni.
In Fratoni’s practice, when dealing with moms who are experiencing pain that isn’t being managed, she tries to provide research and current data. She also helps women find midwives and practitioners who can bridge the gap so that the women have enough information to understand the risk.
“In one study from 2018 by Dr. Thomas Hale and Dr. [Teresa] Baker they examined cannabis transfer in real time. The results showed that THC peaked within 30 minutes to an hour after smoking, and at four hours there was a negligible amount of THC in the breast milk. So, the concept is that you could pump fresh breast milk, then consume cannabis and then wait four to six hours to breastfeed again.”
Fratoni was clear that this is just a concept and not a recommended practice.
Fratoni does want women who are dealing with these issues to know that there are resources— and that they are not stuck with these issues for life.
“There is an evolution in women’s health and there are a lot of tools that can be used to heal these disharmonies. Using cannabis in conjunction with mindfulness, awareness and physical interventions can be helpful,” she shared. “There are physicians and health providers to help navigate the resources available and if you haven’t found one yet, please keep looking.”
Fratoni is optimistic that as more research comes out about cannabis, it will become one of the tools that can help women manage pelvic health issues.
Meanwhile, Theisen points out that she has concerns about younger women dealing with pain and being offered opioids.
“While cannabis might not help you, it won’t harm you, and it’s a safer alternative to pain management than opioids which have addiction potential. Cannabis is so much safer,” she said.