Written evidence submitted by Alternaleaf UK [RHW0043]

Executive Summary

Alternaleaf UK welcomes the opportunity to submit written evidence to the Women and Equalities Select Committee's inquiry into women's reproductive health. We would also welcome the opportunity to give oral evidence and would be pleased to meet committee members to further their understanding if requested.

This submission highlights the significant treatment gaps in women's reproductive healthcare, particularly for conditions like endometriosis, and presents evidence for medical cannabis as an effective alternative treatment option that could help address current inequalities in care.

About Alternaleaf UK and the Montu Group

Alternaleaf is part of the Montu Group, one of the world's leading medicinal cannabis companies. Our integrated ecosystem streamlines the patient experience from beginning to end while establishing new benchmarks in cannabis care in the UK. 

Founded in 2020, Montu has safely and effectively treated over 200,000 patients across the globe with medical cannabis-based treatments. 

Alternaleaf is the UK’s leading telehealth medical cannabis clinic and the sister clinic to Montu Pharmacy. Through Alternaleaf, patients have specialised consultations with a consultant and receive tailored prescriptions and medicines securely delivered to their homes. 

To be eligible for medicinal cannabis, a patient must have been offered at least two conventional treatments which didn't fully improve their condition or produced unwanted side effects. For example, medication, therapy or physiotherapy. A patient must also not be pregnant or be breastfeeding, nor have a history of psychosis or schizophrenia.  

Alternaleaf does not host consultations with or prescribe medicinal cannabis to patients under 18 years of age and adopts a more cautious approach to treating patients under the age of 24. Alternaleaf patients must always give permission to the clinic to discuss their treatment with their NHS GP to ensure that GPs can continue to deliver effective holistic oversight of patient care. 

The Montu and Alternaleaf clinics and pharmacy are registered with the UK regulators including the Care Quality Commission (CQC) and the General Pharmaceutical Council (GPhC). All our clinicians working in the service are experienced and UK registered. 

Introduction

As recognised in the Committee’s previous inquiry, women in the UK face some of the longest delays and greatest barriers to diagnosis and treatment for reproductive health conditions in the developed world. Conditions such as endometriosis, adenomyosis, and polycystic ovary syndrome (PCOS) can cause debilitating pain, fatigue, and mental health impacts, yet are frequently dismissed or inadequately managed within the NHS.[1]

The scale of unmet need is stark. NHS gynaecology waiting lists have more than doubled since 2020, leaving over 630,000 women waiting for care.[2] A survey by the Royal College of Obstetricians and Gynaecologists (RCOG) found that almost 90% of healthcare professionals believe these waiting times are harming patients’ quality of life, while 88% of patients reported worsening symptoms as they wait.[3] For those with endometriosis, the average time to diagnosis is an unacceptable eight years.[4] These delays leave women without effective treatment during some of the most critical years of their lives.

Since 2018, cannabis-based medicinal products (CBPMs) have been legal in the UK. However, despite mounting evidence of their effectiveness in managing chronic pain and women’s health conditions, access on the NHS remains extremely limited. Prescribing is largely confined to children and adults with rare, severe forms of epilepsy, adults with vomiting or nausea caused by chemotherapy, and people with muscle stiffness and spasms caused by multiple sclerosis (MS).[5]

In practice, this means many women are left managing debilitating pain with long-term paracetamol or opioid use, despite well-documented risks of dependency, organ damage, and overdose.[6] Others turn to illicit cannabis to self-medicate. Around 1.4 million people in the UK are estimated to use cannabis to manage health conditions outside of medical oversight.[7] Patients who do eventually access CBMPs through private clinics often do so only after undertaking their own research, reflecting both limited clinical awareness and a systemic failure to inform women of the full range of legally available treatments.

This is not simply an issue of patient choice. The lack of NHS access and signposting for CBMPs constitutes a matter of health inequality, disproportionately affecting women with reproductive health conditions. It restricts access to regulated and potentially transformative therapies, forcing many into unsafe or unaffordable alternatives. This submission provides evidence of the benefits of CBMPs, highlights patient experiences, and sets out recommendations for ensuring women are signposted to alternative treatments they can access legally.

Treatments for Women’s Reproductive Health Conditions

Around half of Alternaleaf’s female patients are being treated for chronic pain, with a significant number of patients managing pain related to gynaecological conditions such as endometriosis and polycystic ovaries. In a recent survey of female patients living with chronic pain, we found that over half (57%) had been living with chronic pain for more than 10 years before starting medical cannabis treatment. This underlines the extent to which women endure prolonged suffering before being offered effective alternatives.

Women with conditions such as endometriosis are typically prescribed a combination of painkillers and hormonal treatments as first-line management.

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, are routinely recommended to manage period pain, though their effectiveness for endometriosis-specific pain is limited.[8] Hormonal contraceptives, including the combined oral pill, progestin-only pill, intrauterine systems (e.g., Mirena coil), and gonadotrophin-releasing hormone (GnRH) analogues, are also widely used to suppress menstruation and reduce pain.[9] While these options can provide relief for some, many women experience insufficient pain control, intolerable side effects, or are unable to continue treatment due to fertility considerations.³ In severe cases, surgery to excise or ablate lesions is offered, though recurrence is common. Collectively, these limitations leave a large proportion of women with persistent, debilitating symptoms despite years of conventional treatment.

There is a growing body of evidence to support the role of cannabis in treating chronic pain. Medical cannabis refers to cannabis-derived treatments prescribed for specific conditions. It contains active compounds called cannabinoids, which work with the endocannabinoid system (ECS) to support pain relief, mood balance, and inflammation reduction.[10] The two best known cannabinoids are Tetrahydrocannabinol (THC) and cannabidiol (CBD). THC refers to the psychoactive, provides pain relief and relaxation, while CBD (Cannabidiol) – non-psychoactive, supports inflammation and anxiety reduction.[11]

A 2024 study showed that medicinal cannabis is as effective as opioids in terms of patients’ pain relief and physical functioning.14 Unlike opioids, however cannabis-based medicines carry a much lower risk of dependence or addiction and crucially remove the chance of accidental overdose, a leading cause of death linked to opioid prescribing.15 

Medicinal cannabis works by harnessing cannabinoids - naturally occurring compounds in the cannabis plant - to interact with receptors in the body’s endocannabinoid system. These receptors influence how pain signals are transmitted and processed. By binding to pain receptors and nerve cells, cannabinoids can slow down the body’s pain response, reducing both the intensity and persistence of discomfort. 16 

This is particularly relevant in the context of women’s reproductive health. A 2022 review examined the analgesic potential of medical cannabis in relation to menstrual and gynaecological pain. Dysmenorrhoea, commonly known as period pain, is estimated to affect up to 90% of women of reproductive age.[12]

The review highlighted that three key receptors relevant to cannabis - CB1, CB2, and TRPV - are present in the muscular outer layer of the uterus, known as the myometrium. This layer is responsible for the contractions that occur during menstruation and are a primary source of cramping and pelvic pain.

Cannabinoids, the active compounds in medical cannabis, are able to bind to these receptors. Stimulation of the CB1 receptor has been shown to reduce excitability in uterine muscle cells. In practical terms, this means that CB1 activation can help relax the smooth muscle tissue of the uterus, thereby dampening the severity and frequency of contractions. The TRPV receptor, which is also involved in pain perception and inflammation, may further contribute to reducing the intensity of cramp-related pain when activated by cannabinoids.

This mechanism offers a plausible biological explanation for why many women with endometriosis, dysmenorrhoea, or treatment-resistant pelvic pain report significant improvements in their symptoms when using cannabis-based products. It suggests that the therapeutic effect is not only subjective or anecdotal, but rooted in measurable interactions between cannabinoids and uterine physiology.

Studies have also shown that there might be underlying pleiotropy, genetic links, between endometriosis and mental health conditions like anxiety and depression, not just as a response to pain.[13]

CBPMs may offer a unique therapeutic advantage for some patients in this context. The interaction of cannabinoids and key receptors within the brain such as the pre-frontal cortex, amygdala and hippocampus helps to regulate pain, mood, memory, immunity and stress, having a positive impact on mental health conditions.[14]

Patient Case Study:

Saff, a young professional from Manchester has lived with endometriosis for a number of years, and details how living with chronic pain has impacted her life, at it’s worst leaving her suicidal. She was originally prescribed chemically induced menopause, a common first line treatment for endometriosis which involves hormone injections and oestrogen based HRT to mitigate menopausal symptoms. HRT however, can cause heavy bleeding and severe migraines. Not being able to cope with the side effects of her treatment, Saff stopped and looked into alternatives herself. Whilst online she found others who had found relief for their endometriosis in medical cannabis and began to explore the process for being prescribed medical cannabis.

Since starting medical cannabis, Saff has ceased taking painkillers like tramadol and codeine, and has seen significant improvements in her pain, nausea, fatigue, and overall mood. Accessing medical cannabis has allowed her to manage her endometriosis, her anxiety, and her migraines, as well as allowing her to get back to work.

Saff’s story underscores the challenges many face in managing complex gynaecological conditions - and the importance of access to a broader range of treatment options, including medical cannabis.

Dedicated Support for Women

Alternaleaf now supports tens of thousands of female patients, with numbers in the UK increasing 50% every three months over the past year.

Sharing their experiences of conversations with GPs related to chronic pain, patients reported that they didn’t feel their pain was taken seriously. Only 13% of those surveyed believed their pain was taken seriously. One anonymous patient said, “I was told to simply lose weight, ignoring the fact that I’m in too much pain to move most days.” Another shared that she was “stuffed full of painkillers and left to get on with it”.  

A 2025 survey of 500 NHS doctors, commissioned by Alternaleaf found that 79% of NHS doctors and 82% of NHS GPs said that the UK is over-reliant on prescribing opioids to manage chronic pain symptoms. A further 76% of NHS doctors said they believe treatment options for women’s health conditions, including endometriosis, perimenopause, and PMDD, are too limited. 80% of NHS GPs said they would be open to prescribing medical cannabis for women’s health conditions if it were part of the NHS toolkit.

As a result, in October 2025, Alternaleaf UK will become the first medical cannabis clinic in the UK to launch a dedicated women’s health service. The women’s health arm will be led by Nabila Chaudhri, Medical Director at Alternaleaf and a registered pharmacist. The team will be made up of gynaecologists and women’s health specialists, specially trained in prescribing medical cannabis for conditions such as endometriosis and symptoms associated with peri-menopause, such as anxiety and depression.

Equalities and Inclusivity

Women with reproductive health conditions in the UK often face systemic inequalities that worsen outcomes and delay access to effective treatments. The previous report undertaken by this committee found that diagnostic delays for conditions such as endometriosis and adenomyosis can be extremely long, sometimes several years, during which women experience pain, disruptions to work and education, and negative mental health effects. 

A 2024 report from Endometriosis UK based on a survey of 4,371 people in the UK who had received an endometriosis diagnosis, found that almost half had visited their GP 10 or more times with symptoms before receiving their diagnosis. 70% had visited five times or more, 52% had visited A&E at least once and 20% reported seeing a gynaecologist 10 or more times before being diagnosed, and 78% had been subject to comments dismissing their concerns.[15]

Cannabis stigma compounds these inequalities. Despite CBMPs being legally available since 2018, awareness among clinicians remains limited and NHS access is extremely restricted. Private clinics and specialist prescribers currently provide an important pathway for patients, yet these options are rarely signposted by GPs or NHS services. As a result, many women remain unaware that CBPMs are a legal and clinically valid treatment option, leaving significant unmet need in reproductive health care.

At the same time, YouGov polling suggests that around 1.4 million people in the UK are self-medicating with illicit cannabis for health conditions, demonstrating both the scale of unmet need and the risks posed by unregulated supply.

Expanding safe, regulated access to CBMPs has the potential to reduce these disparities. By building on the clinical experience already generated within the private sector, integrating cannabis-based medicines into reproductive healthcare would create additional treatment options for women whose needs are not met by conventional therapies. Normalising and further researching CBMPs in women’s health could help address gender-based health inequalities and ensure that reproductive health policy reflects the lived experiences of patients.

Recommendations

It is clear that medical cannabis, can play a significant role in helping female patients manage long-term conditions, such as endometriosis and chronic pain. 

However, despite the legislation, access remains limited, and patients that could benefit from medicinal cannabis are not being provided the proper care through challenges such as a lack of awareness of legislation and signposting of treatments, persistent stigma, and discrimination from police, employers and landlords. 

A major barrier to access is the lack of formal education and training for clinicians on the safe and effective use of cannabis-based medicines. Most medical curricula and postgraduate training programmes do not cover this area, leaving many healthcare professionals underinformed or hesitant to prescribe. This is particularly problematic in women’s health, where reproductive conditions such as endometriosis, chronic pelvic pain, and severe menstrual disorders are often under-recognised and undertreated. By providing clinicians with evidence-based education on cannabis-based medicines, including their mechanisms of action, safety profiles, and potential benefits for symptom management, the healthcare system can better equip professionals to support women who may benefit from these treatments.

Women with reproductive health conditions frequently report feeling dismissed, stigmatised, or not taken seriously by healthcare providers. This challenge is compounded when cannabis-based medicines are involved, as patients often encounter outdated views, misinformation, or assumptions that their use is recreational rather than therapeutic. Such stigma can deter patients from disclosing their use of cannabis-based medicines, undermine trust in their clinicians, and limit open discussions about treatment options. Proactive efforts to reduce stigma, including clear NHS and professional guidance, dissemination of up-to-date evidence, and patient-centred communication, are essential to ensuring that women are treated with dignity and have equitable access to the full range of therapeutic options available.

Moreover, medicinal cannabis is currently prohibited from being prescribed electronically. This can incur disruption and inconvenience to patients, who are suffering from long-term and chronic conditions. Secondary legislation could bring the prescribing practices for medicinal cannabis into line with other products – also improving patient security and safety.  
  

Regulatory structures and capacity, including within the MHRA, is limited and often contradictory, including on issues such as product labelling and advertising. Montu and Alternaleaf fully support all efforts to ensure patient safety but believe greater consistency by regulators is required to ensure patients are aware of the widest possible range of options in the management of long-term and chronic conditions. Clear and consistent regulatory guidance from the MHRA is required to support effective product labelling, high standards and accessibility for patients.  

Cannabis-based medicines should not be seen in isolation but rather as one component of a comprehensive reproductive health strategy that addresses pain, mental health, quality of life, and socioeconomic disparities. For women with conditions such as endometriosis, PCOS, and chronic pelvic pain, traditional treatments often fail to provide adequate relief, leading to long-term suffering and reduced participation in education, employment, and social life. Integrating medical cannabis into reproductive health strategies acknowledges its potential role in improving outcomes where conventional options fall short. This recognition would also encourage further research, guide clinical practice, and ensure that reproductive health policy reflects the diverse therapeutic needs of women.

Conclusion

Thank you for the opportunity to submit written evidence to the important and timely inquiry.

It is clear that there is an urgent need to improve awareness, education and access to effective treatments for women with chronic gynaecological conditions such as endometriosis, dysmenorrhoea, and polycystic ovary syndrome.

Women living with these conditions face prolonged diagnostic delays, frequent dismissal of symptoms, and significant physical and psychological burdens. Conventional treatments, including NSAIDs, hormonal therapies, and surgery, often fail to provide adequate relief, leaving many women with chronic pain, anxiety, and reduced quality of life.

It is clear that CBPMs offer a promising complementary treatment option for women sffering with reproductive health conditions. Research shows that cannabinoids act both locally, on uterine tissue, to reduce painful contractions, and centrally, on brain regions including the prefrontal cortex, hippocampus, and amygdala, to modulate pain, mood, stress, and immunity. CBPMs can therefore address the multidimensional impact of conditions like endometriosis, including both physical symptoms and the mental health challenges linked through pleiotropic genetic mechanisms.

Currently, access to CBPMs in the UK remains limited, not due to legal restriction, but because these treatments are rarely signposted by GPs or NHS services. Many women are unaware that safe, regulated, and clinically supported options exist, which results in ongoing unmet need and, in some cases, self-medication via unregulated sources.

We urge the Committee to consider our recommendations, and would welcome the opportunity to give oral evidence, and would be pleased to meet members of the committee to further their understanding if requested. 

Further information 

For further information, please contact Richard Guest, General Manager, Marketing and Public Affairs, Alternaleaf UK via montu@inhouse.london. 

September 2025