What do Japan, South Korea, Mexico and Taiwan have in common?
In all these countries women have a right to take a period holiday. Makes sense because who’d want to work when in pain.
Period pain is experienced by nearly 3 out of 4 women at some point in their life. Therefore it’s not surprising, that those clever marketers behind CBD products started targeting us with their products. Which is how I ended up with a marketing e-mail in my inbox telling me that the CBD spray of the highest quality was back in stock which would help me through that time of the month.
Obviously, the huge marijuana and CBD boom haven’t gone unnoticed by me. I even had contacts who started working on and investing in marijuana companies— with mixed results.
So when I got that mail I was intrigued. And as a very fact-oriented person wanted to explore, if there is actually some truth to all the marketing claims.
To really get insights into how CBD might work, let’s begin with what period pain is and how normal painkillers offer relief.
Why does period pain occur?
Medical professionals differentiate between two different types of period pain: primary and secondary dysmenorrhea. Primary dysmenorrhea describes pain caused by the period itself while secondary has other underlying root causes such as endometriosis. For this article, we’ll focus on pain relief for the first.
The sensation of pain before and during a period stems mainly from menstrual cramps. These are triggered by prostaglandins — naturally released by the uterine lining as it prepares to shed. However, an excess of it can cause strong contractions, reduced blood flow and a decrease in oxygen supply to uterus muscle tissue which results in pain (Dawood 2006). While some women experience no pain whatsoever during their periods, others have problems getting out of bed without a pile of pain-killers. It’s not fully understood why some experience worse pain than others, but inflammation may play a role. Individuals with more painful periods show higher inflammatory markers in their blood. (Berthone-Johnson, Ronnenberg et. al 2014).
While some women decide to take the pill to help with pain management, anyone not wanting to use artificial hormones will have to stick to heat, moderate exercise, supplements and pain-killers for relief.
A quick foray into the mechanics behind pain-killers
Pain-killers are omnipresent in our lives. While they are certainly not a fix for bigger underlying issues, using them occasionally doesn’t cause much harm. But have you ever thought about how exactly pain-killers work?
Without diving too deep into the chemistry, 3 different types of pain-killers exist:
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Paracetamol
- Opioids
NSAIDs include ibuprofen, naproxen and diclofenac. They work by blocking the Cyclooxygenase (COX) enzyme which is responsible for the production of — 🥁 prostaglandins. There it is again, the evil causing the pain. By blocking the enzyme, fewer prostaglandins are produced and the pain goes away. Isn’t science fascinating? Aspirin is also included in NSAIDs but mostly prescribed when one goal is to prevent blood clotting. It should be pretty obvious why using a blood-thinning pain-killer might not be the best idea during periods.
Paracetamol is the mysterious one out of the trio. Scientists don’t yet fully understand how exactly it works: it’s thought to also block CXO enzymes in the brain and the spinal cord. Unlike NSAIDs, it doesn’t treat inflammation but it can help lower a high temperature which makes it the first choice for people down with the flu.
While you can buy NSAIDs and Paracetamol over the counter, opioids might awaken a loose association with opium dens and cannot be found in your local drug store. Unlike the former two, opioids work by blocking pain messages in your brain and spinal cord. They can lead to adverse effects as well as addiction and patients being treated with them are often in the hospital.
To sum it up, NSAIDs which are preferred treatment for period pain work by blocking the enzyme which is responsible for the production of prostaglandins aka the culprit behind the pain.
But what about CBD?
While pain-killers are great short-term fixes, using them too frequently over a long timeframe can come with side-effects. So wouldn’t it be great to have a natural alternative? And as such is CBD presented.
CBD is short for Cannabidiol, a chemical compound from the Cannabid Sativa Plant, better known as Marijuana. If you want to get high, sorry, CBD is not the right choice, as it has no psychoactive properties like its cousin THC — except if you’re one of the 5% of people whose bodies react differently to it.
CBD is said to help with anxiety, pain and relaxation. While for the foreseeable future, you might not have many chances to speak publicly, if you’re someone who gets really nervous or anxious before speaking in front of a lot of people — CBD is worth a try. Researchers in 2011 proved that CBD reduced anxiety induced by simulated public speaking (Bergamaschi et.al 2011).
Needless to say, Marketing Claims of CBD products go a lot farther than that. Claims range from more realistic promises such as “easing pain, improving mood” to obviously exaggerated claims such as “reduce the growth of cancer cells” or “a solid alternative for anti-depressants”. While some companies end up being sued and even seize business, the myth persists. So is there actual science behind it and how can CBD aid in dealing with period pain?
Endocannabinoid System
When attempting to understand what CBD does to us, we have to start with the endocannabinoid system. Until late last century scientists had no idea it even existed — and yet we all lived happily until then …(Is ignorance bliss?)
What led to the discovery of the endocannabinoid system was researchers who started investigating the effects of THC on the human body. The individuals in their experiment basically got high for science and the researchers found a new system. If that's not a win-win.
The endocannabinoid system is a complex cell-signalling system and its exact functioning remains a mystery up until today. From what we know so far, it is responsible for homeostasis — keeping our body in balance. As part of that, the endocannabinoid system plays a role in
- memory
- appetite
- mood
- reproduction and fertility
- sleep
Components of the endocannabinoid system
The endocannabinoid system is made up of 3 components: enzymes, endocannabinoids and receptors.
Two different endocannabinoids (2-arachidonoylglyerol (2-AG)) and anandamide (AEA) similar to CBD are produced by our body as needed. Their effect depends on where in the body they bind to the second component of the system: receptors.
As already indicated in the picture above, we differentiate between CB1 and CB2 receptors. CB1 receptors are mostly found in the central nervous system while CB2 receptors are more present in the peripheral nervous system — especially in immune cells.
The third and last components are enzymes which break down and manage the level of endocannabinoids in our blood.
Having covered all that, let’s dive into the topic of how CBD can help in managing pain.
Miracle Cure or science-based?
Plenty of studies have been conducted since the legalisation of medical cannabis on the impact of smoking marijuana in controlled settings on patients with different conditions. However, when looking into just CBD so far the amount of studies is significantly lower.
One doctor has pointed out that “Depending on what type of pain you have, you might be able to do just CBD, but sometimes you need CBD and THC.” (Source).
And just as a quick reminder, what we want from CBD is to reduce the pain and one crucial part of that is managing inflammation.
From what researchers discovered so far, CBD is thought to work by preventing enzymes from breaking down endocannabinoids in our system which can then activate and de-sensitize ion channels involved in sensory transmission — in simple terms: preventing us from feeling the pain. As this review of several studies has found, CBD has not only an effect on endocannabinoids in our system but is also affecting GCPRs (g-protein-coupled receptors) — which play a role in inflammatory processes, Ion channels — which transport sensory impulses e.g. pain and PPARs (Peroxisome proliferator-activated receptor) out of which one subtype is known to play a role in antiinflammatory processes.
Taking all this into account, we can understand how Jesse Lo et. al 2005 and Klein 2005 concluded that cannabinoids could contribute to pain relief by supporting anti-inflammatory action.
While many might think of CBD as something to take orally or inhale, one study focused on the external application of CBD for pain relief for rats with arthritis and found that it helped ease pain and reduce inflammation of the arthritic joints (Hammel, Zhang et.al 2015). The researchers also figured out that a bigger dose did not translate into a better effect of the CBD — 6.2mg were most effective while 62mg didn’t significantly offer more anti-inflammatory and pain-relieving effects.
These are some encouraging results speaking for the use of CBD to fight pain. However, as often in the sciences it’s not hard to find contradicting studies such as the one conducted by Buggy et al. in 2003 who concluded that CBD was not effective against acute pain.
The dose and bioavailability matter
What surprised me was, that I couldn’t really find much of a scientifically-backed recommendation on how much CBD one should daily take for it to be effective. BeYou — the website that advertised their CBD tincture to me — recommends 70mg daily. Keep in mind that the amount you take won’t necessarily make it into your blood (bioavailability).
The most effective way to deliver CBD directly to the blood is obviously injection. However, not very practical and not an option of choice for a majority for obvious reasons.
The next effective way to consume CBD is by inhaling. Consequently, it’s directly delivered to the lungs and medical studies suggest that this method has a bioavailability of 34 -46%.
The products that are advertised for period pain relief are thought for oral consumption, so how does bioavailability look like for tinctures, sprays or edibles?
When simply consuming CBD through the mouth bioavailability is estimated to be between 4% and 20% in this 2009 study. While that is quite a range, the most optimistic 20% is still low considering that you always pay for the 100%.
Making a slight adjustment to oral consumption by leaving drops of CBD under the tongue — also known as sublingual consumption — increases bioavailability to rates between 12–35%.
In a best-case scenario, if I were to take 70mg of CBD as suggested by BeYou daily, 24.5 mg would find their way into my blood. In the worst-case scenario, just 8.4 mg would be absorbed into my bloodstream. Enough to make a difference? It’s hard to say when there is not much research done on it nor official guidance.
Just take note, that you probably get more value for money when opting for a CBD product that is inhaled or consumed under the tongue rather than edibles.
To sum it up
Period pain, experienced by a majority of women in their life is caused by an excess of prostaglandins and gets worse with inflammation. This is where pain-killers that block the enzymes producing prostaglandins aid to provide relief. CBD — the non-psychoactive substance of the cannabis plant — promises relief by preventing endocannabinoids in our system from being broken down so they can de-sensitize channels transmitting pain.
Additionally, CBD has some anti-inflammatory characteristics that could furtherly help with period pain. So far few human studies have been done on the impact of CBD alone and none on CBD for period pain, nevertheless, they do seem promising for the most part.
One advantage that speaks for CBD is that it’s considered very safe short-term, more work will have to be done to explore possible long-term effects. If you ever studied the package insert of your normal pain-killer you might be aware of the list of side-effects, in that regard trying CBD doesn't seem unreasonable.
It is a more natural approach to support pain management and we’re all different so it could help some women really well. It does seem like CBD has to be consumed daily for the best effect which makes it less attractive for someone as forgetful as me. The price point — 1,12 £ per day accumulates to more than 400 £ per year — , the lack of clear recommendations on dosage as well as no clear guidance for producers nor objective testing of product quality means that I personally will not try it out for now. I say for now because as soon as there is more guidance on dosage and more importantly, on criteria for product quality (I am supposed to take this daily so it better be good) I’d love to give it a try.
