Hey there, welcome to Paging Dr. Gupta. This is the show where I get to hear from you, where I got to tackle some of your health questions and I get follow your curiosity and hopefully they lead us to some scientifically based answers. Well, this week we're gonna talk about my latest installment of the Weed documentary series. This is Weed 8. Hard to believe I've made eight of these documentaries over the years and this one focuses on women. I gotta tell you in many ways, it feels overdue. Women are now the fastest growing users of cannabis in the country. Just think about that, they're outpacing men. And I learned that for many women, cannabis can be a lifeline, especially for those who felt unseen by conventional medicine. So without further ado, let's get to your questions. My producer Kyra is back with us. Who do we have first?

'Hey, Sanjay, loved your doc. So happy that we have a bunch of good questions coming in on this. And first up, we have Erica in Canada, who's wondering, what do we actually know about the short and long-term effects on a baby if a mother uses cannabis during pregnancy and while breastfeeding?

'Okay, this is an important question. It has long-term implications. Some of you may be surprised or shocked just hearing this question, but we're going to dive into it, tell you what the research says right after this short break.

Welcome back to Paging Dr. Gupta. Today we answering questions about women and weed. First up, the effect on a baby if the mom uses cannabis during pregnancy and while breastfeeding.

First of all, I want to say that I think this was the most surprising, if not shocking, part of working on this investigation. The idea that women would use cannabis while pregnant and breastfeeding, that just wasn't something I'd even considered. But studies really do bear this out. Some studies show anywhere between seven to 20% of women continue to use cannabis when they become pregnant, when they are breastfeeding. Many of these women were using cannabis already, and they simply didn't stop.

Now, there's obviously all sorts of particular harms that can be associated with this, but I do want to point out a couple of headlines. First of all, cannabis does cross the placenta. There have been plenty of studies now that demonstrate this. Cannabis can also become concentrated in the breast milk. Very important, right? The dose of cannabis can actually be higher in the breasts milk than in the blood. So these are two really important considerations.

'Cannabis use has been associated with premature birth, low birth weight, preeclampsia, that's in the short term. Long term concerns are really more about developmental issues. And the answer there isn't black and white. There have been studies looking at cannabis use during pregnancy. That did find adverse outcomes in women and babies, but proof of a cause and effect relationship is not conclusive. Part of the problem is that it's actually really hard to do these studies. Women may not be forthright about their cannabis use. So the best studies actually look at blood testing of women, but these are small studies typically. There is also a lot of co-mingling of cannabis with other substances. Women may also be using alcohol, using tobacco. So the question becomes, what is actually due to cannabis? What is due to something else?

I did speak to a researcher for our documentary who has specifically studied what cannabis can do to the brain. They are seeing differences and weakening in the neural pathways of the brain that has been exposed to cannabis. Take a listen.

We're finding that kids exposed to cannabis prenatally are showing differences in structure as well as functioning about a decade later, so when they're in their early teen years. This is the hippocampus, as you know well. It's really important for emotional learning and memory. It has a high density of cannabinoid receptors, which is how we think that cannabis interacts with the brain and the body. And that area in particular seems to be really sensitive to developmental cannabis exposure.

Is there a most time when it comes to the brain.

In utero is when the system is really active and critical for for making sure that the brain is wired up properly but that continues as you well know through the adolescent period and even into young adulthood and that's when a lot of these systems are being crystallized.

That's an excerpt from our documentary with a developmental neuroscientist named Dr. Hilary Marusak. She's an associate professor of psychiatry and behavioral neurosciences at Wayne State University School of Medicine. She directs the division of cannabinoids in neurodevelopment.

And I wanted you to hear from her because it gives you an idea of just how far the research has come as well over the last 15 years since we started making these documentaries. There is now a person who directs a division of cannabinoids in neurodevelopment. Her point, I think, is that in utero is one of the times when the brain is going through the biggest period of development and growth. That should surprise no one.

So the latest guidance from the American College of Obstetricians and Gynecologists is that there's not a lot of rigorous data on the topic, but the basic warning against using cannabis during pregnancy and breastfeeding, that is something they strongly recommend.

Look, one thing I'll say, again, is that a lot of women are doing this, okay? And there's obviously a lot stigma associated with this. I admit that I was surprised by this. Talk to your doctor. Let your doctor know if this is something that is happening. They can help you weigh the risks. If you're taking this for depression or anxiety or something else, perhaps there's another option that may be better tested and even safer. It's really better than hiding it.

All right. Kyra, what do we have next?

Next up, we have Jody in New Jersey, who's asking, could marijuana products, especially edibles, help with perimenopause symptoms? If so, which ones and how? Like what's actually going on in the body?

Yeah, so the short answer to this question, Jody, is yes. More women are using cannabis to manage the symptoms of perimenopause and menopause. One thing I do want to point out, again, is that women are outpacing men when it comes to the use of cannabis. But what surprised me a little bit was that the growth is primarily coming from women between the ages of 45 and 60. That's what we found. And I think a lot of the reason for that is women are looking for alternatives to try and treat some of the symptoms that they develop during perimenopause and menopause.

Again, women have had a lot of their health complaints minimized or even flat out ignored. Hormone replacement therapy is still the gold standard for treating symptoms of menopause. But as you probably know, up until recently, even that had a black box warning on it.

So how could cannabis potentially work? Well, the endocannabinoid system... We all have an endocannabinoid system, we make our own internal cannabis essentially, which activates this endocannabinoid system. This system balances everything from sleep, to appetite, to pain, to memory. But according to research that we saw when we visited Israel a couple of years ago, is that this system starts to weaken as you age, and your endogenous cannabinoids become reduced.

So by taking in these exogenous, meaning extraneous or outside cannabinoids, it's thought that that can sort of reactivate your endocannabinoid system. It can make up for what your body no longer supports.

So, take some of the symptoms of perimenopause and menopause specifically. Sleep, hot flashes, mood, pain. Historically, there have not, again, been a lot of options for treating those types of menopausal symptoms, but we know that THC, for example, can be very beneficial for sleep. We know that it can be beneficial for anxiety. We know, interestingly, that it has an impact on the hypothalamus, which is the area of your brain that is responsible for temperature control. So that could potentially help with hot flashes. And we know that THC can also help with inflammation, which may help with the aches and pains sometimes associated with menopause.

It is challenging to get it right. It is challenge to find the right strain, the right dose. There's not a lot of studies around this, but that's part of the reason we do these investigations. It's part the reason that we spend a year talking to scientists all over the country and all over world to understand what is real and what is not. And what we can say is that there could be some benefit. Again, and we say this a thousand times during the documentary, there can potentially be harms, but there can be benefits as well, especially in a population of people. Who haven't had a lot of other options.

All right, we're gonna have more questions and answers about weed and women when we come back.

All right, I recognize that sound. Kyra, who do we have?

Next is Jessica from our home state of Michigan, and she's been using marijuana for about 20 years now to manage the pain from endometriosis. She's curious, Sanjay, what kind of real progress or advancements we're seeing when it comes to using marijuana as medicine.

Yeah, so first of all, we're making a lot of advancements when it comes to the research around marijuana as a medicine. And I think it's really important to acknowledge that. I've been reporting on this for 15 years. There were very few trials going on when we first started reporting on that. And now there's entire divisions within big academic centers. There are certain programs that are just dedicated to looking at the impact of women and cannabis.

'So a great deal of research that supports the use of cannabis for those in pain and specifically in the area of endometriosis. So the data shows that endometrial tissue expresses cannabinoid receptors. So that is most likely the mechanism by which cannabis could reduce pain and inflammation in that tissue specifically. There was a study out of Australia which found that 13% of women with endometreosis do already report using cannabis for symptom management. CBD in particular, one of the active ingredients in cannabis, is seen as an effective analgesic and has anti-inflammatory properties.

Now, there are some theories that endometriosis could be the result of a malfunctioning endocannabinoid system. Again, this is the system that cannabis influences when it enters the body. So by using cannabis, you could help this system function properly. In fact, one the leading cannabis researchers in the country, Dr. Stacey Gruber. GRUBER— you should look up her work. She's at McLean Hospital in Boston. She is currently studying the use of high CBD products specifically for patients with endometriosis.

Again, as part of your question here, there is a lot of support for the use of marijuana as medicine, and we're seeing a significant shift. As of March 1st, 2026, at least 40 states, the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands, have comprehensive laws and policies allowing for the medicinal use of marijuana. Eight additional states allow for limited access medical cannabis; that refers to low THC cannabis or CBD oil. Idaho, Kansas, and American Samoa do not allow for the use of medical marijuana or even low THC cannabis. That's how things stand now. Also keep in mind, President Trump signed an executive order last year to expedite the reclassification of marijuana, and that would enable more research to be done.

I think we got time for one more question.

Okay, Sanjay, last up we have Jennifer in Delaware who wants to know, are gummies or cannabis drinks actually any healthier for women than smoking?

Okay, yeah, so according to the Substance Use and Mental Health Services Administration, women are more likely to choose gummies. Okay, that's the headline. They're more likely choose gummys, beverages, and ointments and lotions versus men who are more like to use vapes and smoke.

Now I don't think I'll use the term healthier here. I don't necessarily want to use the terms healthier as it depends what you're using these products for and how. Edibles, of course, eliminate the risk of smoking and vaping. They eliminate the risks to the lungs. There are potential harmful toxins in vapes. The effects of the cannabis can also be faster and more intense. Edibles take longer to enter the system.

'But I will tell you this, because edibles take long to take effect, we're talking anywhere between 30 minutes to two hours, you can run into a problem called stacking. Stacking one dose on top of the other. Users don't get an immediate result. They think it's not working, so they take more. And that can lead to a very intense, unwanted dysphoric reaction. People have ended up in the emergency room because of this. Also, the effects of edibles can then last much longer than smoking, 12-plus hours.

Now, when it comes to cannabis drinks, there was a Harvard newsletter which said, the cannabinoids found in beverages, they are specifically formulated to dissolve in liquid. And that means they are also more easily and rapidly absorbed into the body's soft tissues. So you really need to be aware of the concentration of these drinks. I heard about a case where someone drank an entire drink and then looked at the label and realized that that was actually four particular portions. So they had taken four times as much as they were supposed to take. So you need to really be aware of what you're consuming here.

Overall, the research is more limited on the impact of edibles and beverages. Daily marijuana use, that can be problematic, could increase your risk of stroke and heart attack even if there is no prior history of heart disease and the person has never smoked or vaped tobacco. Weed has been linked to cardiac arrhythmias such as atrial fibrillation. But many participants in those cardiovascular studies are smoking or vaping marijuana instead of ingesting it. This is according to Dr. Peter Grinspoon, a primary care physician and cannabis specialist at Massachusetts General Hospital in Boston. He authored this book called Seeing Through the Smoke: A Cannabis Specialist Untangles the Truth About Marijuana. He is someone else you should look up if you're interested in this topic. There's a lot in that book that can help educate you.

Look, I don't think any doctor is gonna recommend smoking marijuana, unless someone maybe is in acute pain or has end of life cancer pain, is on chemotherapy. And in a case like that, they may want the faster pain relief that comes from inhaling. That's something Peter Grinspoon has said as well.

It's a big topic. It's topic that we're gonna keep reporting on. Thank you so much for your questions. Thank you, so much, for allowing us to have the conversation. That's all the time we have for in today's episode. Keep sending in the questions. And if you wanna catch the latest documentary called Weed 8— Women in Weed, it's available to stream now on the CNN app.

'And don't forget, there's something health-related you've been wondering about, send it to us. We might answer it next week. Record a voice memo, email it to pagingdrgupta at cnn.com. That's paging-dr-gupta-at-cnn.com or give us a call, 470-396-0832, and leave a message. Thanks for listening.