The Trillion Dollar Blind Spot in Cannabis: Women’s Health

A Japanese national estimate put the annual productivity cost of menstrual and menopausal symptoms at around US$14.65 billion. Most of it, 12.59 billion, was presenteeism and only 2.07 billion was absenteeism. Nearly 80% of women surveyed said their symptoms affected their work productivity. Women with endometriosis lose an average of 10.8 hours of work weekly, mainly through reduced effectiveness while working rather than absence. In the UK, perimenopause and menopause are estimated to cost businesses 14 million working days a year, equivalent to £1.88 billion in lost productivity, with 10% of women leaving the workforce entirely, and one in four considering it. Finally, a finding from one US study should stop every operator in this industry. A 2025 study of women with uterine fibroids working in healthcare found that women reported that 33% lost productivity driven by presenteeism, at an estimated cost of $387 per week. Women who were undiagnosed reported higher presenteeism and overall work impairment than those who had received a diagnosis. Diagnosis itself recovers productivity. Women are waiting years for it.

No Evidence, No Funding for Women’s Health Problems

This gap in funding for women’s health is inherited, not invented.

• Only 8.8% of NIH research spending from 2013 to 2023 targeted women’s health research. That share declined as a proportion of overall funding even as the agency’s budget rose.
• For endometriosis specifically, expected NIH funding in 2022 was around $16 million, 0.038% of the budget, or about $2.00 per patient per year.

Women were generally excluded from clinical trials until the 1990s; the NIH inclusion policy was only codified into federal law in 1993. The consequence is documented. The US Government Accountability Office found that of ten prescription drugs withdrawn from the American market from January 1997, eight posed greater health risks for women. Four of those caused more adverse events in women even though they were widely prescribed to both women and men. Had those drugs been tested in trials that reported data by sex, those reactions would have been found before the market, not after. 50 years of male-default data is now being retrofitted at enormous cost. Meanwhile, McKinsey values the global endometriosis treatment market at $180-220 billion, with few assets currently in the pipeline.

Creating Solidarity in the Cannabis Industry

I founded EmpowHer Cannabis Society because the pattern above kept repeating in front of me, jurisdiction by jurisdiction. We now have more than 1,000 members across 43 countries. The thing that strikes me is not how different the markets are: it is how identical the gap is. The regulatory frameworks for legal cannabis in the UK, Germany, Portugal, Uganda, and New Zealand have almost nothing in common. What they share is that in none of them can you find a dossier, a registry field, or a reimbursement submission that treats female-predominant conditions as a primary indication rather than a footnote. That consistency tells you it isn’t a regulatory problem. It’s a design problem, and design problems are fixable by the people doing the designing.

What We Already Have, And What We Don’t

Women are already self-managing with cannabis. This is happening at scale for conditions medicine has historically underfunded and ignored. The patient signal for cannabis use is there; the evidence is not.

• Endometriosis affects up to one in ten women of reproductive age, more than 170 million worldwide, and an estimated 60% of cases remain undiagnosed. A correct diagnosis takes an average of ten years and at least seven visits to a health practitioner.
• In a survey of 912 respondents run through the Endometriosis Research Center Charité in Berlin across Germany, Austria and Switzerland, 114 used cannabis for self-management. They rated it the most effective strategy available to them at 7.6/10. 90% were able to reduce their pain medication, and the largest improvements were in sleep at 91% and menstrual pain at 90%.
• An Australian survey of 484 women with surgically diagnosed endometriosis found cannabis rated the most effective of every self-management technique reported, ahead of heat packs, dietary change and exercise.

The cohorts already exist inside our registries. In the UK Medical Cannabis Registry’s analysis of hypermobility-associated chronic pain, women made up 80.83% of participants. Against all of that, a 2025 scoping review of cannabis use in endometriosis found nine completed studies covering 1,787 participants. Every single one was cross-sectional, just asking patients how they felt. Not one was a proper trial comparing cannabis against a placebo.” Worse, we can’t even see how many patients there are properly More than 30% of women in one study reported not disclosing their cannabis consumption to their doctor, citing fear of breaking the law, losing a driving licence, or losing a job to workplace drug testing.

Harm Reduction Is The Commercial Argument for Legal Cannabis

Up to this point, the case rests on what patients report about how they feel. That matters, but it’s easy to dismiss. The data on women and opioid use is different. It tracks something concrete and measurable: whether people taking cannabis end up needing fewer opioids. Every milligram of opioid avoided means lower risk of dependency and overdose, and lower cost to health systems. That’s where legal cannabis stops being a hopeful idea and becomes a commercial and public health argument.

• In New York State’s Medical Cannabis Program, 204 adults prescribed opioids for chronic pain were tracked over 18 months. Average daily dose fell from the equivalent of 73.3mg of morphine to 57mg, a 22% reduction.
• A survey of 525 chronic pain patients using medical cannabis alongside opioids found 40.4% had stopped opioids entirely and 45.2% had reduced them, with 65.3% sustaining that change beyond a year.
• In an Australian pain clinic comparison, median opioid dose at twelve months was 2.7mg/day in the cannabinoid group against 42.3mg/day in controls.

I’ll say the uncomfortable part: a category built on selective evidence is a category waiting to be dismantled. Fibromyalgia, chronic pelvic pain, and hypermobility cohorts skew heavily female, and they are precisely where long-term opioid prescribing lands. The risk profile isn’t sex neutral. Preclinically, females are more sensitive to the reinforcing effects of cannabinoids, and clinical data suggests women progress more rapidly from cannabis use disorder, sometimes described as the telescoping effect, and are more likely to experience withdrawal symptoms. Female-specific data is needed for safety as much as for efficacy. Anyone selling to women without wanting to know that is not building a business; they are building an exposure.