Menstrual-Linked Vomiting Can Mimic Cannabinoid Hyperemesis in Cannabis Users | Research

The takeaway

Two adolescent cases show that cyclic vomiting linked to the menstrual cycle can be mistakenly attributed to cannabis use, and hormonal treatment resolved symptoms despite continued cannabis use.

emergency medicine clinicians, gastroenterologists, pediatricians, gynecologists

What the researchers found

Two adolescent patients with heavy cannabis use and cyclical vomiting were initially suspected of having cannabinoid hyperemesis syndrome. Further investigation revealed that vomiting episodes correlated with the menstrual cycle (catamenial CVS). Hormonal contraceptive therapy successfully treated the vomiting in both cases, even though cannabis use continued.

Why it matters

Cannabinoid hyperemesis syndrome (CHS) is increasingly diagnosed in cannabis users with cyclic vomiting. These cases demonstrate that menstrual-linked cyclic vomiting can be misdiagnosed as CHS, leading to unnecessary cannabis cessation demands and missed effective treatments.

The numbers in context

2 adolescent cases. Both had heavy cannabis use and cyclical vomiting. Both successfully treated with hormonal contraception. Both continued cannabis use without recurrence of vomiting.

How the study worked

Case report of 2 adolescent patients presenting with cyclical vomiting and heavy cannabis use. Clinical investigation included menstrual history correlation and treatment trial with hormonal contraception.

What this study cannot tell us

Only 2 cases reported. Cannot establish prevalence of misdiagnosis. No standardized diagnostic criteria applied. Possible that hormonal treatment coincidentally resolved symptoms.

How to read the evidence

Case report with only 2 patients provides limited evidence, though the clinical lesson is important.

When this study was published

Recently published case report.

The bigger picture

As CHS awareness grows, there is a risk of over-attributing all cyclic vomiting in cannabis users to cannabis. Careful clinical evaluation, particularly menstrual history in female patients, is essential for accurate diagnosis and appropriate treatment.

Questions still open

How often is catamenial CVS misdiagnosed as CHS in cannabis-using women?
Should menstrual history assessment be standard in CHS diagnostic workups?

Common questions

What is the difference between CHS and catamenial CVS?

Cannabinoid hyperemesis syndrome is caused by heavy cannabis use and resolves with cessation. Catamenial CVS is cyclic vomiting linked to the menstrual cycle, treatable with hormonal therapy. Both can cause similar symptoms in cannabis-using women.

Can you have cyclic vomiting from something other than cannabis?

Yes. Cyclic vomiting syndrome has multiple causes, including menstrual cycle triggers, migraines, and metabolic conditions. Cannabis use does not automatically mean cannabis is the cause.

Read the original research

The Clinical Conundrum of Cyclic Vomiting in the Cannabinoid User: Simply Cannabinoid Hyperemesis or Could It Be More?

ACG case reports journal, 12(5), e01711

View on PubMed ↗Publisher’s paper ↗

Citation

Sinan, Kenan; Beydoun, Serina; Lulgjuraj, Tony. (2025). The Clinical Conundrum of Cyclic Vomiting in the Cannabinoid User: Simply Cannabinoid Hyperemesis or Could It Be More?. ACG case reports journal, 12(5), e01711. https://doi.org/10.14309/crj.0000000000001711