INTRODUCTION: U.S. adults increasingly report using cannabis for symptoms common in the menopause transition, but little is known about the association of menopause symptoms and midlife mental health with cannabis use. We examined these relationships in U.S. midlife women. METHODS: This was a cross-sectional survey of a national probability sample of U.S. women aged 45–64 from Ipsos KnowledgePanel in 2022, with past 30-day mood, menopause symptoms, and cannabis use assessed using self-report and validated questionnaires. Weighted, multivariable logistic regression models examined associations between predictor (mood and menopause symptoms) and dependent variables: 1) current inhaled/edible cannabis use, 2) frequent cannabis use (at least 20 days/month), and 3) cannabis use disorder (CUD), adjusted for sociodemographic and menopause-related factors. RESULTS: Participants (n=5,174; mean age SD, 54.8 5.7; 68% postmenopausal) reported vasomotor symptoms (42%), sleep difficulty (35%), sexual symptoms (27%), mood swings/irritability (25%), and urinary symptoms (25%). One in 10 reported current cannabis use. Of those, one-third reported frequent cannabis smoking, and 19% met criteria for CUD. Menopause and mood symptoms were associated with current cannabis use. Odds of frequent cannabis smoking were higher in those with mood swings/irritability (adjusted odds ratio AOR 1.62; 95% CI, 1.14–2.30), anxiety (AOR 1.92; 95% CI, 1.20–3.07), and depressive symptoms (AOR 2.23; 95% CI, 1.43–3.50). Similarly, odds of probable CUD were higher in those with vasomotor symptoms (AOR 1.77; 95% CI, 1.12–2.80), mood swings/irritability (AOR 2.32; 95% CI, 1.45–3.71), anxiety (AOR 3.04; 95% CI, 1.75–5.28), and depressive symptoms (AOR 4.42; 95% CI, 2.72–7.17). CONCLUSIONS/IMPLICATIONS: Mood and menopause symptoms were associated with current cannabis use, frequent cannabis use, and CUD among midlife women. Routine screening for cannabis use may be warranted for women with these comorbidities.
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