Endometriosis is a challenging medical condition that affects a significant portion of women of reproductive age, 5-10%, characterized by symptoms like dysmenorrhea, dyschezia, dyspareunia, and non-cyclical pain. While hormonal contraceptives are often the first-line treatment, they may not provide relief for all patients and can lead to undesirable side effects. Surgical intervention is another option, but it does not guarantee a cure, with recurrence being common. In light of these limitations, researchers have started looking into the potential of cannabis derivatives as a means to alleviate the associated pain and discomfort.

One pre-clinical study conducted on female rats with surgically induced endometriotic foci focused on cannabidiol (CBD) as a potential novel therapeutic agent for endometriosis. It revealed that CBD acts by inhibiting inflammation and reducing oxidative stress in a dose-dependent manner. 

In addition to this research, another study sought to gauge the prevalence and effectiveness of cannabis in alleviating chronic pelvic pain, which is often associated with endometriosis and found that many patients with chronic pelvic pain reported using cannabis and experiencing pain reduction.

These findings align with the growing understanding of the endocannabinoid system (ECS). Research has already uncovered that various components of the endocannabinoid system (ECS) are present in uterine and endometrial tissues. The components of the ECS discovered to be relevant to patients with endometriosis potentially include the receptor sites CB1 (reduces pain), CB2 (reduces inflammation), TRPV1, and the endocannabinoids AEA and 2-AG, as well as their metabolizing enzymes FAAH and MAGL respectively.

Patients’ preferences, as indicated by surveys, often lean toward full-spectrum cannabis products THC or CBD-rich when self-managing their endometriosis. While these initial insights are promising, it is important to emphasize that more research is needed to comprehensively understand the effectiveness and safety of cannabis derivatives for treating endometriosis-associated pain. Patients should talk to their healthcare providers to explore all treatment options. The potential for cannabis-based therapies in addressing endometriosis is an evolving area of study that holds promise for improved pain management and enhanced quality of life for those affected by this condition.

References

• Bouaziz J, Bar On A, Seidman DS, Soriano D. (2017). The Clinical Significance of Endocannabinoids in Endometriosis Pain Management. Cannabis Cannabinoid Res., 2(1), 72-80. doi:10.1089/can.2016.0035. PMID: 28861506; PMCID: PMC5436335.
• Dmitrieva N, Nagabukuro H, Resuehr D, Zhang G, McAllister SL, McGinty KA, Mackie K, Berkley KJ. (2010). Endocannabinoid involvement in endometriosis. Pain, 151(3), 703-710. doi:10.1016/j.pain.2010.08.037. Epub 2010 Sep 15. PMID: 20833475; PMCID: PMC2972363.
• Lingegowda H, Williams BJ, Spiess KG, Sisnett DJ, Lomax AE, Koti M, Tayade C. (2022). Role of the endocannabinoid system in the pathophysiology of endometriosis and therapeutic implications. J Cannabis Res., 4(1), 54. doi:10.1186/s42238-022-00163-8. PMID: 36207747; PMCID: PMC9540712.
• Okten SB, Cetin C, Tok OE, Guler EM, Taha SH, Ozcan P, Ficicioglu C. (2023). Cannabidiol as a potential novel treatment for endometriosis by its anti-inflammatory, antioxidative and antiangiogenic effects in an experimental rat model. Reprod Biomed Online., 46(5), 865-875. doi:10.1016/j.rbmo.2023.01.018. Epub 2023 Feb 2. PMID: 36997400.
• Poli-Neto OB, Hallak JEC, Rosa-E-Silva JC, Crippa JAS. (2022). Is it the Ideal Time to Start Prescribing Cannabis Derivatives to Treat Endometriosis-associated Pain? Rev Bras Ginecol Obstet., 44(5), 449-451. doi:10.1055/s-0042-1749430. Epub 2022 Jun 13. PMID: 35697067; PMCID: PMC9948061.
• AE Reinert, M Hibner. (2019). Self-Reported Efficacy of Cannabis for Endometriosis Pain. Journal of Minimally Invasive Gynecology., Volume 26, Issue 7, Supplement. doi.org/10.1016/j.jmig.2019.09.682.