The Effects of Cannabis on Female Reproductive Health Across the Life Course

Abstract

Introduction: Cannabis is commonly used for its medicinal and therapeutic benefits and is also widely used as a recreational drug. Cannabis use has been increasing in Canada, including among Canadian women of reproductive age. Post-legalization, further increases in cannabis use are expected due to increased availability and lowered perceptions of harm. Although cannabinoids are well known for their effects on the central and peripheral nervous systems, endocannabinoid receptors have also been characterized throughout the female reproductive tract. Cannabinoids may affect many aspects of female reproductive health, including fertility, pregnancy outcomes with neonatal implications, and menopause. Purpose: To provide a comprehensive review of trends in cannabis use among women and review the impact of cannabis across the female reproductive lifespan. Methods: We searched PubMed and Cochrane Library databases using keywords and MeSH terms. Included studies reported the potential impact of cannabinoids on female fertility, pregnancy, transmission to breast milk, neonatal outcomes, and menopause. Results: The existing literature is primarily concentrated on the effect of cannabis use in pregnancy and breastfeeding, with little exploration of its impact on fertility and in later life. Studies are limited in number, with small sample sizes, and are hampered by methodological challenges related to confounding and other potential biases. Conclusions: There remain critical gaps in the literature about the potential risks of cannabis use, particularly in vulnerable populations, including pregnant women, women who are breastfeeding, and their infants. Given the rise in the prevalence of cannabis use, new, robust investigations into the consequences of cannabis exposure on female reproductive health are needed.

Cannabis: A Toxin-Producing Plant with Potential Therapeutic Uses

“…Cannabis inhalation during the luteal phase of the menstrual cycle may result in transient suppression of levels of prolactin and LH [206]. Nevertheless, there is no conclusive evidence of cannabis' effect on menstruation or on levels of estrogens, progesterone, testosterone, prolactin, LH, or FSH in women [207,208].…”

Pregnant and lactating people’s strategies to mitigate the risk of cannabis consumption

“…Clinical evidence indicates that we may expect some prenatally exposed children to have a low birth weight, be born before term, or exhibit neurodevelopmental and behavioral challenges in childhood. 26 , 29 – 31 However, few participants were able to specify the risks they anticipated, and so they may not associate outcomes such as low birth weight with their cannabis use, especially if the child grew well after birth and was a typically developing infant. When participants reported not observing any impact, this may represent a focus on other aspects of pregnancy or infant development, such as a normal anatomical scan, positive reports from clinicians that the pregnancy is progressing well, typical weight gain after birth, or meeting expected infant development milestones.…”

“… 27 , 28 Current literature indicates an association between cannabis use and low birth weight, 26 , 29 neurodevelopmental, executive functioning, and psychopathology problems in childhood 30 and a potential association with preterm birth. 31 This body of research is still evolving and more well-controlled studies are required. 26 , 29 The existing clinical evidence mainly concerns smoked cannabis; there is little evidence available about how changing the form or composition of cannabis may impact clinical outcomes.…”

Prenatal cannabinoid exposure: why expecting individuals should take a pregnancy pause from using cannabinoid products

“…The FDA-approved THC-based medications further cloud the issue of whether individuals should use these drugs during pregnancy. The available evidence suggests adverse consequences of cannabinoid exposure on female reproductive health, pregnancy, and altered trajectories of fetal development and long-term health outcomes (see Figure 1 ) ( 20 , 35 – 37 ). Additionally, 48%–60% of individuals continue consuming cannabinoids during pregnancy and lactation, which affects approximately 34% of all pregnancies ( 19 , 22 , 38 ) The self-disclosed prevalence of cannabinoid usage during pregnancy ranges from 2% to 5% in most studies but increases to 15%–28% among young, socioeconomically challenged, urban individuals( 19 ).…”