Benefits, Harms, and Costs
- 1.Cannabis use is increasing, and women are commonly using cannabis for recreational and medical reasons (high).
- 2.Use of cannabis, especially products containing tetrahydrocannabinol, can induce or worsen psychosis and worsen depression (high).
- 3.Study results concerning the association between cannabis and anxiety are conflicting, and this association requires further evaluation (high).
- 4.Use of cannabis, similar to use of other intoxicating substances, may be associated with high-risk sexual activity (low).
- 5.There is no evidence that contraceptive methods are altered by cannabis use (low).
- 6.There is limited evidence that frequent cannabis use may affect female fertility (moderate), but frequent use can diminish male fertility (moderate).
- 7.There is no evidence for cannabis use for management of perimenopausal symptoms (very low).
- 8.There is no evidence that cannabis products improve chronic pelvic pain (low).
- 1.Women should be screened for cannabis use, as they are for other substance use (strong, moderate), and further exploration of its impact should be initiated (strong, moderate).
- 2.Cannabis use can be screened for using appropriate screening tools (conditional, moderate)
- 3.A trauma-informed care approach and harm reduction should be used when inquiring about cannabis use (strong, low).
- 4.The fact that a woman uses cannabis should not influence her choice of contraceptive method (strong, moderate).
- 5.Couples should be counselled that cannabis use appears to affect male fertility and may have an impact on female fertility (conditional, moderate).
- 6.Sleep disturbances in the perimenopausal period should be characterized and other management modalities trialed before women consider using any cannabis product for this indication (strong, moderate).
- 7.Women should be counselled about the lack of evidence for using cannabis products to treat chronic pelvic pain (strong, moderate).
Abbreviations:2-AG (2-arachidonoyl glycerol), CB1 (cannabinoid 1), CB2 (cannabinoid 2), CBD (cannabidiol), CUDIT-R (Cannabis Use Disorder Identification Test Revised), CYP (cytochrome P450), GABA (gamma-aminobutyric acid), GnRH (gonadotropin-releasing hormone), mRNA (messenger ribonucleic acid), PTSD (post traumatic stress disorder), Δ9-THC or THC (delta-9-tetrahydrocannabinol), SBIRT (Screening, Brief Intervention and Referral to Treatment), TRH (thyrotropin-releasing hormone), TrpV1 (transient receptor potential cation channel subfamily V member 1)
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This document reflects emerging clinical and scientific advances as of the publication date and is subject to change. The information is not meant to dictate an exclusive course of treatment or procedure. Institutions are free to amend the recommendations. The SOGC suggests, however, that they adequately document any such amendments.
Informed consent: Everyone has the right and responsibility to make informed decisions about their care together with their health care providers. In order to facilitate this, the SOGC recommends that health care providers provide patients with information and support that is evidence-based, culturally appropriate, and personalized.
Language and inclusivity: While the SOGC as a rule uses gendered language, in respect for our mission to advance women’s health, there are contexts in which it is important to use gender neutral language, and to be fully inclusive. The SOGC recognizes and respects the rights of all people for whom the information in this document may apply, including but not limited to transgender, non-binary, and intersex people. The SOGC encourages health care providers to engage in respectful conversation with their patients about their gender identity and preferred gender pronouns and to apply these guidelines in a way that is sensitive to each person’s needs.