Welcome to our Women’s Health Week special where we meet nurse practitioner Caroline Dwyer from specialist medical cannabis consultancy CA Clinics. Caroline is an experienced addiction and sexual health specialist with extensive experience in treating women’s health issues. Here she answers some common questions around women’s health and the breakthroughs that are being made with medicinal cannabis. Emma Castle reports.
Emma Castle, Cannabiz: What are the main women’s health issues that medical cannabis can treat?
Caroline Dwyer, CA Clinics: Premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), endometriosis, menopause, anxiety, insomnia, fibromyalgia and vaginismus.
Because of the anti-inflammatory, anti-spasmodic and analgaesic properties of medical cannabis, it’s helpful for a number of conditions.
In female health, especially gynaecological health, we learn a lot about treating the symptoms of pain but it’s more about how we treat the patient and help them manage what they are going through. We know that medicinal cannabis works quite well for this.
Regarding delivery modes, you can use CBD oil, soft gels, wafers or dried flowers (smoked/inhaled).
We are also looking at things like medicinal cannabis-soaked tampons or suppositories that could be used at the source to relieve pain and cramping.
CBD oil can assist with easing the mood disruption and insomnia that often occur in menopause, but it also changes the psychology of how the person deals with those symptoms.
The same goes for sexual dysfunction, especially vaginismus – yes it’s physiological, but it’s also psychologic.
What medicinal cannabis does is change the psychology of the pain response. When someone has had chronic, intense pain for a long time, medical cannabis can calm the pain down, but it can also ease the anxiety around the experience of pain.
We have to be careful with prescribing CBD oils that are blended with THC for these conditions because women who take anything with THC in it risk losing their driving licence.
THC can stay in your body for several weeks which means that if you have a roadside drug test, you will get a positive result.
Cannabiz: Will medicinal cannabis ever be used in childbirth?
Caroline Dwyer: No, not at this stage because it’s too much of a grey area. We know women who have used cannabis during pregnancy are more likely to have lower birth weights and children with hyperactivity disorders but there hasn’t been enough research to support the use of medical cannabis products during pregnancy.
Cannabiz: Does medicinal cannabis interact with other medications?
Caroline Dwyer: CBD as a standalone doesn’t have any psychoactive properties so it can be used in combination with other medications.
For example, I work with veterans who are on anti-depressants because they suffer from post-traumatic stress disorder (PTSD) and anxiety, benzodiazepines for pain and sedatives for sleep. After trialling CBD oil, many are able to reduce the dosage of their other medications which is a positive for their overall health.
Cannabiz: How does medicinal cannabis help treat mental health issues?
Caroline Dwyer: The wonderful thing about medicinal cannabis is that it treats the physical but it also treats the psychological. It’s particularly helpful for treating anxiety and conditions where there is a co-morbidity of chronic pain coupled with anxiety.
Cannabiz: Are more women coming to you?
Caroline Dwyer: Yes, as word-of-mouth spreads. As people have a good experience and get good results, there are more women coming to me for information.
I am out there talking to GPs and palliative care teams all the time. The answer is education.
We know that there is a risk of getting a dry mouth and dizziness with CBD products but you have to weight up risk with the reward and try to get the best results with the least side effects. If we can get rid of the stigma attached to it and look at how it works and what the benefits are for the individual, it could be amazing.
Cannabiz: What is the pathway to treatment?
Caroline Dwyer: GP referral if your GP has TGA NSW approval to prescribe medical cannabis. Alternatively, you can get your GP or psychologist to refer you to CA Clinics so that one of the in-house GPs or specialists can review your case.
If you meet the criteria for a prescription, CA Clinics will fax the prescription off to be processed by the pharmacy and the CBD product will be sent directly to your address.
This process can take up to one month to complete.
Case study: a 30 year-old woman with endometriosis
Caroline Dwyer: The patient had been in chronic pain since she was a teenager and had had several laparoscopic surgeries to remove endometrial tissues with little to no effect.
When I saw her, she was dosing on opiates which were causing constipation, drowsiness and she couldn’t drive.
She was looking for something that would give her a better quality of life.
While medicinal cannabis won’t take the pain from a nine to a two, it will take it from a nine to maybe a four or five. But what it will do is slow down the pain response.
This woman started using medical cannabis and less of the opiate medication.
Subsequently, her quality of life was better and because she was using CBD oil only, she could drive. It didn’t eradicate the pain but she was able to get out and move around so it was good for her psychological state.