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Can Cannabis Help Endometriosis Patients?

Overview

Cannabis can provide significant relief for endometriosis, by modulating and activating the endocannabinoid system — a key system which affects this condition. 

While some treatments and surgeries exist to treat this condition, they are not always effective at alleviating the often intense pain that comes with endometriosis, so more options are desperately needed for the women who are suffering from this challenging and painful condition. Cannabis is one potential therapy currently being researched. 

How Cannabis Works on Endometriosis 

To get a good idea of how cannabis might be able to help with endometriosis, we first need to understand how endometriosis is affected by the endocannabinoid system. This crucial system in the human body is made up of endocannabinoid receptors (called CB1 and CB2), endocannabinoids (natural chemicals in the human body which activate or modulate CB1 and CB2 activity), and enzymes which metabolize the endocannabinoids and clear them from the body. This system is tasked with maintaining homeostasis — and keeps many of our most important functions in balance. Modulating functions like sleep, hunger, pain, anxiety, nausea and energy metabolism, the endocannabinoid is a vital system for maintaining our ongoing health. 

While this system is usually activated by our own internal endocannabinoids, they can also be stimulated by chemicals in cannabis called cannabinoids. These chemicals work similarly to our natural endocannabinoids.

As it turns out, the endocannabinoid system is also involved in endometriosis and its associated pain. Researchers had suspected this might be the case because women reported reduced pain when using cannabis for their endometriosis. Specifically, scientists hypothesized that the endocannabinoid system was involved in both the development of endometriosis, and in the manifestation of it’s associated pain. The found several pieces of evidence to support their theory. 

For one thing, studies have recently found that sensory and sympathetic nerve fibers actually sprout branches into these abnormal tissue growths, innervating them with sensation and allowing them to feel pain. These fibers are rich with CB1 receptors, and thus can be modulated with endocannabinoids or the cannabinoids in cannabis (which can both activate CB1). Not only are the fibers and growths rich in CB1, but so are the neurons from which these fibers sprout. 

Researchers explain that all of this could suggest that the endocannabinoid system plays an important role in the progression of endometriosis and the sprouting of innervating fibers. 

We can also see in fertility research that higher levels of anandamide (a CB1 stimulating endocannabinoid) at ovulation and lower levels at implantation is important for a successful pregnancy. Alterations in these endocannabinoid signaling can even lead to miscarriage, so we know that the endocannabinoid system plays an important role in the female reproductive system.  

There is also a significant increase in endocannabinoid levels, along with decreased levels of CB1 receptors, in women with endometriosis compared to those without endometriosis. This result suggests a negative feedback loop in pain regulation, which may impair the capability of the endocannabinoid system to control pain in endometriosis patients. 

All of this evidence has even led some researchers to describe endometriosis as an “endocannabinoid deficiency” condition.

Medical Studies on Cannabis and Endometriosis

So it’s clear that the endocannabinoid system plays an important role in endometriosis, but does that mean that cannabis can help treat it? To find out, we need to look at the research on cannabis as a treatment for endometriosis in human subjects.  

Of course, using cannabis to treat gynecological problems is nothing new. Cannabis actually has an ancient tradition of being used as a medicine in obstetrics and gynecology. It’s been used historically to treat conditions like dysmenorrhea, dysuria, hyperemesis gravidarum, and menopausal symptoms. And to this day, many women report positive effects from using cannabis for endometriosis pain. 

Still, there are very few studies (and no clinical studies) which actually research the impact of cannabis on endometriosis in humans. But we do have two recent survey based studies which asked women suffering from endometriosis how cannabis worked for them. 

The first study looked at women with endometriosis aged 18 to 45, who live in Australia. They asked about what types of self-management methods the subjects used to work with their endometriosis symptoms, along with questions about changes in symptoms or medication use, costs, and adverse events. Seventy-six percent of respondents reported using self-management techniques, and 13% of those subjects said they used cannabis. Those who did use cannabis reported high levels of pain reduction (7.6 of 10), with 56% also reporting that they were able to reduce pharmaceutical medications by at least half. These women reported the greatest improvements in sleep, nausea and vomiting, and adverse effects were relatively rare (10%) and minor. 

The authors of this study argue that these results warrant follow-up with more clinical studies to confirm cannabis’ potential to treat endometriosis. 

In another 2019 survey, patients responded to questions about their experience with cannabis and CBD (another cannabinoid) for the management of endometriosis and pelvic pain. The majority reported that it was moderately or very effective. 

Endometriosis and CBD

In the same 2019 survey where cannabis was reported to be very or moderately effective in 75.9% of cases, researchers also asked about CBD. Around a third of respondents reported having tried CBD, with more than half of these reporting CBD to be very or moderately effective. 

Among both of the participant groups, cannabis was most likely to be reported as very effective, while CBD was most likely to be reported as moderately effective.

This study gives more evidence of cannabis’ helpful role for endometriosis, and shows that it is a common treatment being used. It also sheds light on the relative efficacy between CBD and whole plant cannabis — suggesting that cannabis might be more effective that CBD alone. 

Side Effects 

While there hasn’t been much clinical research on using cannabis for endometriosis, in the studies we do have, adverse effects were relatively rare (affecting around 10% of patients) and were generally minor. In general, side effects from cannabis are modest but can include symptoms like mild difficulties in concentration and memory,  impaired coordination, increased appetite, nausea, racing heart, light-headedness, dry mouth, and fatigue. 

In addition, cannabis may interact with some drugs in a harmful way — slowing their metabolism and consequently increasing the amount of the drug present in the bloodstream. This could lead to overdose issues with certain medications. Those taking other medications should always consult with a doctor before beginning cannabis use to ensure there are no conflicts with pre-existing medications. 

Cannabis Side Effects

About Endometriosis

Endometriosis is a chronic, painful gynecological disorder. It happens when the endometrium, which is the tissue that lines your uterus, grows in other parts of the body, usually in the pelvic organs like your ovaries, fallopian tubes, and tissue lining your pelvis. 

During your regular menstrual cycle, the endometrial tissue gets thicker, and then it breaks down and bleeds, causing menstruation. The trouble is that endometrial tissue in other parts of the body has no way to leave your body, so it becomes trapped, causing pain and irritation. 

Endometriosis is quite common, affecting around 10% of women worldwide, or approximately 176 million women. It usually appears between the ages of 25 and 40, but it can begin as soon as a young woman starts menstruating, and continue until menopause. Occasionally, the impact of scarring from endometriosis lasts even beyond menopause.

Endometriosis is a chronic condition that can seriously affect your life, but there are treatments that can relieve the symptoms and reduce consequences like infertility.

The most common symptom of endometriosis is pelvic pain, mostly during menstruation. However, the symptoms of endometriosis can vary widely. Some women have a lot of pain, while others may barely notice it. The pain of endometriosis can get worse over time. 

The amount of pain that you feel isn’t always related to the stage of your endometriosis. Some women have extreme pain, but a mild form of endometriosis, while others with severe endometriosis feel little pain. 

Other symptoms of endometriosis include:

  • Painful periods (dysmenorrhea), with the pain beginning a few days before your period. You might feel cramps in your abdomen and lower back.
  • Pain during or after sex
  • Pain during bowel movements or when urinating, particularly during your period
  • Diarrhea, constipation, bloating, nausea, and/or feeling excessively tired, particularly during your period
  • Infertility 
  • Unusually heavy periods

Endometriosis often causes adhesions, which are sticky patches of endometrial tissue that join organs together, and ovarian cysts, which are fluid-filled cysts like a “blood blister” in the ovaries. These cysts and adhesions can lead to a lot of pain. 

Endometriosis is one of the most common causes of infertility. Some 24-50% of women who experience infertility have endometriosis. Sometimes, surgery to remove cysts, adhesions, and scar tissue can restore fertility. 

The pain and discomfort of endometriosis often lead to depression.

Endometriosis still commonly goes under-diagnosed, because it’s often dismissed as “normal” period pain, so it’s important to go to a gynecologist and relay your symptoms. You’ll begin by talking about your symptoms, and you can expect your doctor to carry out a full physical examination and a pelvic exam. 

To fully confirm the diagnosis, your doctor will order a hysteroscopy. This is a minor surgical procedure done under anesthetic. The doctor inserts a thin tube with a camera on the end (laparoscope) through a tiny incision in your abdomen, to check the size, extent, and location of cysts, adhesions, and endometrial growths.

As well as diagnosing endometriosis, your gynecologist will try to classify the stage of your endometriosis. Stages range from stage 1, which is considered minimal, to stage 4, which is classed as severe. The stage of endometriosis depends on:

  • How far the tissue has spread throughout the body
  • Which pelvic structures are involved
  • The extent of adhesions in the pelvic cavity
  • The amount of blockage in the fallopian tubes

It’s not clear what causes endometriosis, but there are a few theories. These include:

  • Retrograde menstruation, meaning that some of the menstrual tissue backs up through the fallopian tubes and gets implanted elsewhere in the pelvic cavity. 
  • Endometrial tissue travels through the blood and lymphatic system, and gets implanted in other parts of the body. 
  • Hormones or immune factors cause the local cells in the abdomen, reproductive organs, or anywhere in the body, to transform into endometrial cells.
  • Endometrial cells are accidentally deposited in the abdominal wall during surgery like a hysterectomy or a cesarean section.
  • An immune system disorder prevents the body from recognizing and destroying endometrial tissue that’s growing outside of the uterus.

Risk factors for developing endometriosis include:

  • Having a close relative with endometriosis
  • Heavy periods
  • Short menstrual cycles of fewer than 27 days
  • Giving birth for the first time aged over 30
  • Abnormalities of the uterus
  • A caucasian background

There’s no cure for endometriosis, but there are treatments that can reduce the pain, and specific treatments to help with infertility. Your doctor will consider elements like how much pain you are in, whether you are trying to get pregnant, your general health, and your preference for different medications or procedures, in order to create your treatment plan. 

If you have little to no pain, your doctor will usually recommend “watchful waiting” to see if it gets worse. In general, your doctor will start with minimally invasive treatments, and only move to stronger treatments like surgery if those ones fail. 

Medication 

Pain medication is usually the first line of treatment for endometriosis. You might be prescribed over-the-counter NSAIDs like ibuprofen, or naproxen sodium.

If you’re not trying to get pregnant, you might be prescribed hormone therapy. Hormone therapy can reduce or entirely eliminate the pain of endometriosis, slow down the growth of endometrial tissue, and prevent new areas of endometrial tissue from forming. Hormone therapy includes:

  • Hormonal contraceptives, like birth control pills, patches, and vaginal rings, combine estrogen and progestin to prevent ovulation and reduce menstrual flow.
  • Progestins can be pills, intrauterine devices, injections, or implants. They can stop you from menstruating and prevent the growth of endometrial tissue.
  • Gonadotropin-releasing hormone agonists and antagonists lower your estrogen levels to stop you menstruating, creating a “medical menopause.”
  • Danazol is a derivative of testosterone that reduces the amount of estrogen in your body.

Surgery

Sometimes, the best way to treat endometriosis is through minimally invasive surgery. Gynecologists can use a laparoscopy to remove small, painful endometrial growths. 

A laparotomy is more extensive surgery to remove as much of the endometrial tissue as possible, without damaging the healthy tissue. 

If you don’t see any improvement from any of the above-mentioned treatments, your doctor might recommend a full hysterectomy to remove your uterus and possibly also your ovaries. However, this removes any option of becoming pregnant and can have a serious impact on your health, so it’s only used as a last resort. 

Alternative therapies

Some women find that alternative therapies like Chinese medicine, acupuncture, immune therapy, and changes to your diet can help relieve the pain of endometriosis.

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Can Cannabis Help Endometriosis Patients?

by Emily Earlenbaugh, PhD

Overview

Cannabis can provide significant relief for endometriosis, by modulating and activating the endocannabinoid system — a key system which affects this condition. 

While some treatments and surgeries exist to treat this condition, they are not always effective at alleviating the often intense pain that comes with endometriosis, so more options are desperately needed for the women who are suffering from this challenging and painful condition. Cannabis is one potential therapy currently being researched. 

How Cannabis Works on Endometriosis 

To get a good idea of how cannabis might be able to help with endometriosis, we first need to understand how endometriosis is affected by the endocannabinoid system. This crucial system in the human body is made up of endocannabinoid receptors (called CB1 and CB2), endocannabinoids (natural chemicals in the human body which activate or modulate CB1 and CB2 activity), and enzymes which metabolize the endocannabinoids and clear them from the body. This system is tasked with maintaining homeostasis — and keeps many of our most important functions in balance. Modulating functions like sleep, hunger, pain, anxiety, nausea and energy metabolism, the endocannabinoid is a vital system for maintaining our ongoing health. 

While this system is usually activated by our own internal endocannabinoids, they can also be stimulated by chemicals in cannabis called cannabinoids. These chemicals work similarly to our natural endocannabinoids.

As it turns out, the endocannabinoid system is also involved in endometriosis and its associated pain. Researchers had suspected this might be the case because women reported reduced pain when using cannabis for their endometriosis. Specifically, scientists hypothesized that the endocannabinoid system was involved in both the development of endometriosis, and in the manifestation of it’s associated pain. The found several pieces of evidence to support their theory. 

For one thing, studies have recently found that sensory and sympathetic nerve fibers actually sprout branches into these abnormal tissue growths, innervating them with sensation and allowing them to feel pain. These fibers are rich with CB1 receptors, and thus can be modulated with endocannabinoids or the cannabinoids in cannabis (which can both activate CB1). Not only are the fibers and growths rich in CB1, but so are the neurons from which these fibers sprout. 

Researchers explain that all of this could suggest that the endocannabinoid system plays an important role in the progression of endometriosis and the sprouting of innervating fibers. 

We can also see in fertility research that higher levels of anandamide (a CB1 stimulating endocannabinoid) at ovulation and lower levels at implantation is important for a successful pregnancy. Alterations in these endocannabinoid signaling can even lead to miscarriage, so we know that the endocannabinoid system plays an important role in the female reproductive system.  

There is also a significant increase in endocannabinoid levels, along with decreased levels of CB1 receptors, in women with endometriosis compared to those without endometriosis. This result suggests a negative feedback loop in pain regulation, which may impair the capability of the endocannabinoid system to control pain in endometriosis patients. 

All of this evidence has even led some researchers to describe endometriosis as an “endocannabinoid deficiency” condition.

Medical Studies on Cannabis and Endometriosis

So it’s clear that the endocannabinoid system plays an important role in endometriosis, but does that mean that cannabis can help treat it? To find out, we need to look at the research on cannabis as a treatment for endometriosis in human subjects.  

Of course, using cannabis to treat gynecological problems is nothing new. Cannabis actually has an ancient tradition of being used as a medicine in obstetrics and gynecology. It’s been used historically to treat conditions like dysmenorrhea, dysuria, hyperemesis gravidarum, and menopausal symptoms. And to this day, many women report positive effects from using cannabis for endometriosis pain. 

Still, there are very few studies (and no clinical studies) which actually research the impact of cannabis on endometriosis in humans. But we do have two recent survey based studies which asked women suffering from endometriosis how cannabis worked for them. 

The first study looked at women with endometriosis aged 18 to 45, who live in Australia. They asked about what types of self-management methods the subjects used to work with their endometriosis symptoms, along with questions about changes in symptoms or medication use, costs, and adverse events. Seventy-six percent of respondents reported using self-management techniques, and 13% of those subjects said they used cannabis. Those who did use cannabis reported high levels of pain reduction (7.6 of 10), with 56% also reporting that they were able to reduce pharmaceutical medications by at least half. These women reported the greatest improvements in sleep, nausea and vomiting, and adverse effects were relatively rare (10%) and minor. 

The authors of this study argue that these results warrant follow-up with more clinical studies to confirm cannabis’ potential to treat endometriosis. 

In another 2019 survey, patients responded to questions about their experience with cannabis and CBD (another cannabinoid) for the management of endometriosis and pelvic pain. The majority reported that it was moderately or very effective. 

Endometriosis and CBD

In the same 2019 survey where cannabis was reported to be very or moderately effective in 75.9% of cases, researchers also asked about CBD. Around a third of respondents reported having tried CBD, with more than half of these reporting CBD to be very or moderately effective. 

Among both of the participant groups, cannabis was most likely to be reported as very effective, while CBD was most likely to be reported as moderately effective.

This study gives more evidence of cannabis’ helpful role for endometriosis, and shows that it is a common treatment being used. It also sheds light on the relative efficacy between CBD and whole plant cannabis — suggesting that cannabis might be more effective that CBD alone. 

Side Effects 

While there hasn’t been much clinical research on using cannabis for endometriosis, in the studies we do have, adverse effects were relatively rare (affecting around 10% of patients) and were generally minor. In general, side effects from cannabis are modest but can include symptoms like mild difficulties in concentration and memory,  impaired coordination, increased appetite, nausea, racing heart, light-headedness, dry mouth, and fatigue. 

In addition, cannabis may interact with some drugs in a harmful way — slowing their metabolism and consequently increasing the amount of the drug present in the bloodstream. This could lead to overdose issues with certain medications. Those taking other medications should always consult with a doctor before beginning cannabis use to ensure there are no conflicts with pre-existing medications. 

Cannabis Side Effects

About Endometriosis

Endometriosis is a chronic, painful gynecological disorder. It happens when the endometrium, which is the tissue that lines your uterus, grows in other parts of the body, usually in the pelvic organs like your ovaries, fallopian tubes, and tissue lining your pelvis. 

During your regular menstrual cycle, the endometrial tissue gets thicker, and then it breaks down and bleeds, causing menstruation. The trouble is that endometrial tissue in other parts of the body has no way to leave your body, so it becomes trapped, causing pain and irritation. 

Endometriosis is quite common, affecting around 10% of women worldwide, or approximately 176 million women. It usually appears between the ages of 25 and 40, but it can begin as soon as a young woman starts menstruating, and continue until menopause. Occasionally, the impact of scarring from endometriosis lasts even beyond menopause.

Endometriosis is a chronic condition that can seriously affect your life, but there are treatments that can relieve the symptoms and reduce consequences like infertility.

The most common symptom of endometriosis is pelvic pain, mostly during menstruation. However, the symptoms of endometriosis can vary widely. Some women have a lot of pain, while others may barely notice it. The pain of endometriosis can get worse over time. 

The amount of pain that you feel isn’t always related to the stage of your endometriosis. Some women have extreme pain, but a mild form of endometriosis, while others with severe endometriosis feel little pain. 

Other symptoms of endometriosis include:

  • Painful periods (dysmenorrhea), with the pain beginning a few days before your period. You might feel cramps in your abdomen and lower back.
  • Pain during or after sex
  • Pain during bowel movements or when urinating, particularly during your period
  • Diarrhea, constipation, bloating, nausea, and/or feeling excessively tired, particularly during your period
  • Infertility 
  • Unusually heavy periods

Endometriosis often causes adhesions, which are sticky patches of endometrial tissue that join organs together, and ovarian cysts, which are fluid-filled cysts like a “blood blister” in the ovaries. These cysts and adhesions can lead to a lot of pain. 

Endometriosis is one of the most common causes of infertility. Some 24-50% of women who experience infertility have endometriosis. Sometimes, surgery to remove cysts, adhesions, and scar tissue can restore fertility. 

The pain and discomfort of endometriosis often lead to depression.

Endometriosis still commonly goes under-diagnosed, because it’s often dismissed as “normal” period pain, so it’s important to go to a gynecologist and relay your symptoms. You’ll begin by talking about your symptoms, and you can expect your doctor to carry out a full physical examination and a pelvic exam. 

To fully confirm the diagnosis, your doctor will order a hysteroscopy. This is a minor surgical procedure done under anesthetic. The doctor inserts a thin tube with a camera on the end (laparoscope) through a tiny incision in your abdomen, to check the size, extent, and location of cysts, adhesions, and endometrial growths.

As well as diagnosing endometriosis, your gynecologist will try to classify the stage of your endometriosis. Stages range from stage 1, which is considered minimal, to stage 4, which is classed as severe. The stage of endometriosis depends on:

  • How far the tissue has spread throughout the body
  • Which pelvic structures are involved
  • The extent of adhesions in the pelvic cavity
  • The amount of blockage in the fallopian tubes

It’s not clear what causes endometriosis, but there are a few theories. These include:

  • Retrograde menstruation, meaning that some of the menstrual tissue backs up through the fallopian tubes and gets implanted elsewhere in the pelvic cavity. 
  • Endometrial tissue travels through the blood and lymphatic system, and gets implanted in other parts of the body. 
  • Hormones or immune factors cause the local cells in the abdomen, reproductive organs, or anywhere in the body, to transform into endometrial cells.
  • Endometrial cells are accidentally deposited in the abdominal wall during surgery like a hysterectomy or a cesarean section.
  • An immune system disorder prevents the body from recognizing and destroying endometrial tissue that’s growing outside of the uterus.

Risk factors for developing endometriosis include:

  • Having a close relative with endometriosis
  • Heavy periods
  • Short menstrual cycles of fewer than 27 days
  • Giving birth for the first time aged over 30
  • Abnormalities of the uterus
  • A caucasian background

There’s no cure for endometriosis, but there are treatments that can reduce the pain, and specific treatments to help with infertility. Your doctor will consider elements like how much pain you are in, whether you are trying to get pregnant, your general health, and your preference for different medications or procedures, in order to create your treatment plan. 

If you have little to no pain, your doctor will usually recommend “watchful waiting” to see if it gets worse. In general, your doctor will start with minimally invasive treatments, and only move to stronger treatments like surgery if those ones fail. 

Medication 

Pain medication is usually the first line of treatment for endometriosis. You might be prescribed over-the-counter NSAIDs like ibuprofen, or naproxen sodium.

If you’re not trying to get pregnant, you might be prescribed hormone therapy. Hormone therapy can reduce or entirely eliminate the pain of endometriosis, slow down the growth of endometrial tissue, and prevent new areas of endometrial tissue from forming. Hormone therapy includes:

  • Hormonal contraceptives, like birth control pills, patches, and vaginal rings, combine estrogen and progestin to prevent ovulation and reduce menstrual flow.
  • Progestins can be pills, intrauterine devices, injections, or implants. They can stop you from menstruating and prevent the growth of endometrial tissue.
  • Gonadotropin-releasing hormone agonists and antagonists lower your estrogen levels to stop you menstruating, creating a “medical menopause.”
  • Danazol is a derivative of testosterone that reduces the amount of estrogen in your body.

Surgery

Sometimes, the best way to treat endometriosis is through minimally invasive surgery. Gynecologists can use a laparoscopy to remove small, painful endometrial growths. 

A laparotomy is more extensive surgery to remove as much of the endometrial tissue as possible, without damaging the healthy tissue. 

If you don’t see any improvement from any of the above-mentioned treatments, your doctor might recommend a full hysterectomy to remove your uterus and possibly also your ovaries. However, this removes any option of becoming pregnant and can have a serious impact on your health, so it’s only used as a last resort. 

Alternative therapies

Some women find that alternative therapies like Chinese medicine, acupuncture, immune therapy, and changes to your diet can help relieve the pain of endometriosis.

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