Around 190 million individuals across the planet suffer from endometriosis.
Endometriosis can severely impact the quality of life. The good news is that a wide array of effective treatments are available, one of which could be cannabis.
As a plant that harbors an abundance of potent compounds, it’s not surprising that many are turning to medicinal cannabis for relief from endometriosis symptoms.
What is endometriosis?
This medical condition occurs when the endometrial tissue lining the inside of the uterus, called the ‘endometrium,’ grows outside of the uterus.
Endometrial tissue overgrowths may be found on the fallopian tubes, ovaries, and intestines.
In rare cases, endometrial-like tissue may accumulate in other areas of the body such as the lungs, bowel and brain.
Just like normal uterus-lined tissues, the endometrial-like tissue found in endometriosis patients becomes thick, before breaking down and bleeding with every passing menstrual period.
These misplaced tissues are still responsive to hormonal fluctuations, which is what causes ongoing menstrual-like symptoms elsewhere.
The main difference is that endometriosis prevents the blood from escaping the body and therefore it gets stuck.
Patients who are diagnosed with endometriosis may commonly notice the formation of cysts called ‘endometriomas’.
As a direct effect of the cysts invading the ovaries, surrounding tissue can get irritated.
Consequently, bands of scar tissue (‘adhesions’) develop, which often results in organs and pelvic tissues sticking together.
Endometriomas are serious and can cause complications such as with ovulation, interfere with fertility and infertility treatments, pain, increase the risk of ovarian cancer, and may need surgery.
Endometriosis facts and figures
The exact cause or causes of endometriosis are still unknown, with researchers and clinicians looking into different theories which are likely all to be contributory.
The leading theory at this point is “retrograde menstruation,” a problem with the direction of menstrual flow that causes shed tissue to spread and implant outside the uterus.
It is also thought that cells outside the uterus simply transform into the wrong cell type. Pelvic surgery like C-sections may also cause displacement of uterine cells that causes endometriosis.
Some scientists suggest that excessive tissue growth outside of the uterus may occur as a result of increased hormone levels.
Estrogen is known to worsen these growths and symptoms, but may not necessarily cause the misplacement of the cells by itself.
According to the World Health Organization (WHO), approximately 10% of individuals assigned female and birth across the globe are diagnosed with endometriosis.
In the U.S. alone, the Office on Women’s Health estimates that 11% of individuals (more than 6.5 million) begrudgingly deal with endometriosis.
There could be much more than this, however, since many endometriosis symptoms overlap with other types of medical conditions.
In fact, it is not unheard of for doctors to miss the diagnosis for 5-10 years.
Infertility is believed to affect somewhere in the range of 30%- 50% percent of individuals assigned female at birth (AFAB) with an endometriosis diagnosis, most of whom tend to be aged between 15 and 49.
Endometriosis treatments: What is currently available
While there is no known “cure” as such for endometriosis, there are certain types of medication that can help in reducing or completely stopping symptoms such as hormonal therapy including hormonal IUDs and birth control, OTC pain relievers, opioids, heat therapy, complementary and alternative medicine (CAM), and surgery.
Many endometriosis patients report symptoms such as nausea, diarrhea, excessive bloating, constipation, pain when urinating/having sex, and spotting/bleeding between menstrual cycles.
Individuals with endometriosis tend to have low progesterone levels, medical experts also recommend using progesterone to oppose the effects of estrogen.
Endometriosis patients generally have abnormally high levels of a type of estrogen called ‘estradiol’, which essentially kicks the disease into high gear.
Another type of therapy that is gaining popularity among endometriosis patients is pelvic floor therapy.
Based on the findings of a small 2021 study, regular pelvic floor physical therapy helped diminish endometriosis symptoms.
However, a 2021 systematic review of more exercise studies showed that the effects of physical activity like flexibility and strength training, cardiovascular fitness, and yoga on endometriosis symptoms are still unclear.
In cases where the symptoms of endometriosis reach their most severe, doctors will normally advise the patient to undergo laparoscopic surgery.
Unfortunately, some patients may have to undergo repeat surgery as well as go back on hormonal therapy if they are not trying to get pregnant.
Non-pharma options to manage endo pain
Cannabidiol (CBD)
Cannabidiol (CBD) is one of over 140 different cannabinoids found within the cannabis plant. It is often suspended in oil (e.g., CBD oil) and this is currently the most common way it is administered medically.
What has generated a lot of interest in CBD is that it is considered non-intoxicating (doesn’t make you feel ‘high’), unlike delta-9-tetrahydrocannabinol (THC).
Most recreational or illicit cannabis is bred to have high levels of THC which is why most people associate using cannabis with feeling ‘high’.
Both CBD and THC are likely to play a role in the therapeutic benefits of medicinal cannabis.
What is CBD used for?
Cannabidiol has shown anticonvulsant, anti-inflammatory, anxiolytic and antidepressant activity in various scientific models.
Currently, the majority of clinical (in humans) research surrounding CBD has focused on its anticonvulsant activity in childhood epilepsy.
While research is continuing to evolve in this area at a rapid pace, currently there is no well-designed clinical research showing CBD can improve the pain or symptoms of endometriosis, however, many are reporting anecdotally that it does.
I want to know more about THC and CBD – what do they do?
As previously mentioned, THC is the main cannabinoid responsible for the feeling of being “high”.
However, it is incorrect to think that THC does not exert important pharmacological activities and is only used recreationally.
THC binds to specific cannabinoid receptors throughout the body to produce its therapeutic effects. In fact, it was studies into cannabis that identified an entire neuromodulatory system that we knew nothing about – the endocannabinoid system - which is integral for controlling homeostasis across many body systems.
We produce our own cannabinoids in the body which bind to the same receptors that certain cannabinoids like THC interact with.
Studies have shown THC plays an important role in pain management through its analgesic and anti-inflammatory activity.
Furthermore, studies have also demonstrated that THC exerts antioxidant, antiemetic (reducing nausea and vomiting) and sedative actions.
Not surprisingly, THC is found in many medicinal cannabis products around the world, either alone or with defined amounts of CBD, to manage chronic pain and other conditions.
Unlike THC, CBD does not cause any noted intoxicating effects, and is perhaps best known for assisting certain patients in reducing seizures observed in intractable epileptic conditions.
That being said, CBD has noted analgesic, anti-inflammatory and antiemetic activity also, along with recent research highlighting its ability to reduce anxiety and ease depression via working on serotonin receptors (5HT1A).
These are just two of over 140 different cannabinoids that have been identified in cannabis, and researchers from around the world are busy investigating the therapeutic potential of many others at the moment.
Here’s the rundown on the evidence for cannabis and endo
What exactly is medicinal cannabis? How does it differ from cannabis obtained from illicit sources?
This is a very commonly asked question and an important one to address. Cannabis has long been used as a medicine by our ancestors and is comprised of hundreds of different chemicals, many of which have pharmacological activity.
At the moment, a particular class of chemicals known as cannabinoids is attracting a great deal of research interest, with over 140 different cannabinoids being identified within the Cannabis genus.
Of these, THC and CBD have received the most research attention and are currently the main cannabinoids standardized in medicinal cannabis products.
The term standardization simply means that the levels of these cannabinoids are tested to be within very strict and consistent amounts in every single batch of medicinal product produced, whether that be an oral oil, capsule or dried Cannabis flower.
Think of this like going to take Panadol for a headache – each tablet has 500mg of paracetamol per tablet, and is tested rigorously to ensure this is the case from batch to batch.
Medicinal cannabis and illicit cannabis come from the Cannabis plant, but that is where most similarities end.
It is the difference in their cultivation and manufacture, and the fact that one is legal and one is not, that separates the two.
Medicinal cannabis is grown to very strict quality assurance standards and must comply with specific regulatory guidelines to be free from microbial contamination, pesticide residues, aflatoxins and heavy metals.
Medicinal cannabis plants are grown in highly controlled environments so that variability in their chemical composition is minimized, allowing for reproducible levels of THC, CBD and other chemicals depending on the chemovar (chemical variety) of cannabis grown.
The products that are manufactured from these plants must comply with Good Manufacturing Practices (GMP) to ensure quality and safety for end users.
Lastly, and perhaps most importantly, is that medicinal cannabis is prescribed, and your condition monitored, by a medical doctor...an important consideration to ensure you have the right product for your condition and you can be monitored for side effects or potential drug interactions with other medications you may be taking.
On the other hand, illicit cannabis does not necessarily comply with any of these quality requirements, so the chance of obtaining consistency, standardized levels of cannabinoids or being sure it is free from adulteration or contamination is simply unknown.
Furthermore, most illicit cannabis used for recreational purposes is grown to be high in THC, the chemical most responsible for the feeling of being high, with minimal amounts of other cannabinoids typically present.
Whilst illicit cannabis is being used for therapeutic purposes in the States and numerous other countries, most people prefer to know exactly what is in their medicine.
The cost of illicit cannabis is also notably cheaper than legal medicinal products, but this will likely change as more legal medicinal cannabis companies come online and scale up the size of their cultivation facilities.
Endometriosis and medical cannabis what the research says
Based on the findings of a study published by the Public Library of Science, medicinal cannabis was subjectively able to reduce pelvic pain, treat gastrointestinal problems and positively influence mood.
The study analyzed data from self-assessments of 252 participants, all of whom claimed to have endometriosis. Using the StrainprintTM app, they logged 16193 cannabis sessions stretching from April 2017 to February 2020.
Similarly, a 2021 survey of 213 New Zealand individuals with endometriosis and/or PCOS found promising results for symptomatic relief and even opioid substitution from using cannabis.
According to the results, “The most common outcomes that cannabis was used for were to improve pain relief (95.5%) and to improve sleep (95.5%).
Respondents reported that their symptom was “much better” for pain (81%), sleep (79%), and nausea or vomiting (61%).
Over three-quarters (81.4%) indicated cannabis had reduced their normal medication usage. Over half (59%) were able to completely stop a medication, most commonly (66%) analgesics. Opioids (40%) were the most common class of analgesic stopped.”
The pain-relieving and anti-inflammatory qualities of cannabidiol (CBD) make this non-psychotropic cannabinoid stand out for endometriosis patients.
There’s also CBD’s psychotropic counterpart, delta-9 tetrahydrocannabinol (THC) which, in a separate preclinical study, was shown to help reduce endometriosis-associated pain.
Researchers gleaned a fascinating key takeaway from the study—daily use of cannabis dosed at 2mg THC per kilogram of body weight resulted in reduced mechanical hypersensitivity, pain, and discomfort, as well as improved cognitive function without modifying the anxiogenic phenotype (causing anxiety).
The COVID-19 pandemic has also caused an increased interest in cannabis for managing endometriosis symptoms according to a new international 2022 study.
Many individuals who had never tried cannabis before reported starting their consumption during this time because of the restricted healthcare appointment access, increased stress and anxiety, and delayed surgery.
Talk to your doctor
Before using canabis it is recommended to first speak with your primary health care provider,—usually, the state board posts a registry of doctors, and other healthcare personnel who can legally prescribe cannabis on its website—to talk about health status and assess their medical history.
A face-to-face medical examination used to be required before the pandemic, but that requirement has largely been waived by now. This means it is now easier than ever to get your medical cannabis card online.
Some other considerations to think about before trying medical cannabis for endometriosis include:
Talking with a doctor about what other treatment options you have tried
Discussing your current medication use and whether you desire to become pregnant
If your job falls into an industry whereby the employees must abide by specific cannabis use standards
Whether or not your employer randomly carries out drug testing and/or forbids cannabis use in the workplace.
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Whether you’ve just been diagnosed, have been years struggling with pain for years, or have experienced surgery without much support, ELANZA is dedicated to providing simple, yet comprehensive access and support from endometriosis specialists, research experts, community, coaches, care navigators, physical therapists, classes, products & services.
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Managing the stress and mental health from endometriosis
Natural remedies for endometriosis pain and symptom management
Tools to manage flare ups and 'endo belly'
A comprehensive treatment plan that empowers you to become an active participant in your care
Note: The content on this page is for informational purposes only and is not intended to be professional medical advice. Do not attempt to self-diagnose or prescribe treatment based on the information provided. Always consult a physician before making any decision on the treatment of a medical condition.