Endometriosis is a chronic gynaecological condition affecting approximately 10% of people assigned female at birth. The condition is characterised by the growth of endometrial-like tissue outside of the uterus, leading to pain, inflammation, infertility, and other debilitating symptoms. The experience of symptoms and pain is unique to each patient and conventional medications often fall short in providing relief, and many have unwanted side effects and addiction potential. There is an urgent and unmet need for improved treatment options, and the unique compounds in Cannabis sativa hold promise as a therapeutic alternative for effective symptom management and improving quality of life.
Research suggests a link between endometriosis and imbalances in the body’s endocannabinoid system (ECS). The ECS regulates a range of physiological processes, including pain and inflammation response.
Cannabinoids, compounds found in cannabis, including delta 9-tetrahydrocannabinol (THC) and cannabidiol (CBD), can interact with the ECS to produce physiological effects that may offer therapeutic benefits. Cannabinoids have been suggested to reduce inflammation, pain, anxiety, gastrointestinal issues, and other symptoms experienced by people living with endometriosis. Further, because Cannabis acts through a different mechanism to traditional treatment options it may provide a viable alternative where other treatments are not well tolerated.
Cannabis has a long history of use in treating gynaecological conditions, dating back over 3000 years. Today, people continue to use Cannabis, both prescribed and illicit, to manage their endometriosis-related pain and other symptoms.
According to survey data from respondents in Australia and Aotearoa New Zealand about cannabis use:
1 in 10 with endometriosis are using cannabis to manage their symptoms.
Over 50% have reduced or completely stopped their current prescription medications, including opioids, non-steroidal anti-inflammatories, and antidepressants, since starting cannabis use.
Cannabis is rated highly for its effectiveness in relieving pain (>75%).
Cannabis reduced the severity of anxiety, depression, nausea, gastrointestinal and sleep issues.
The medicinal Cannabis formulation and method of administration will provide different physiological effects. Oral products provide longer-lasting baseline management of symptoms and may be more effective at relieving gastrointestinal issues. However, ingested cannabinoids undergo hepatic ‘first-pass’ metabolism, which reduces bioavailability and delays the onset on action (1 hour or more). Inhalation avoids first-pass metabolism and provides a fast onset of action (5-15 minutes) that is helpful for relieving breakthrough pain and other symptoms.
More in-depth research and randomised clinical trials are essential to better understand how medicinal Cannabis might be used as a treatment option for endometriosis. Ongoing studies in women’s health in both Aotearoa and Australia are investigating the benefits of cannabinoids and medicinal Cannabis for this purpose.
Thank you to A/Prof Mike Armour for his guidance in writing this summary.
References
Bouaziz J, Bar On A, Seidman DS, Soriano D. The clinical significance of endocannabinoids in endometriosis pain management. Cannabis and cannabinoid research. 2017 Apr 1;2(1):72-80.
Russo EB. Cannabis treatments in obstetrics and gynecology: a historical review. The Handbook of Cannabis Therapeutics 2014 May 22 (pp. 315-346). Routledge.
Armour M, Sinclair J. Cannabis for endometriosis-related pain and symptoms: it's high time that we see this as a legitimate treatment. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2023:118-20.
Armour M, Sinclair J, Noller G, Girling J, Larcombe M, Al-Dabbas MA, Hollow E, Bush D, Johnson N. Illicit cannabis usage as a management strategy in New Zealand women with endometriosis: an online survey. Journal of women's health. 2021 Oct 1;30(10):1485-92.
Sinclair J, Smith CA, Abbott J, Chalmers KJ, Pate DW, Armour M. Cannabis use, a self-management strategy among Australian women with endometriosis: results from a national online survey. Journal of Obstetrics and Gynaecology Canada. 2020 Mar 1;42(3):256-61.
Sinclair J, Collett L, Abbott J, Pate DW, Sarris J, Armour M. Effects of cannabis ingestion on endometriosis-associated pelvic pain and related symptoms. PLoS One. 2021 Oct 26;16(10):e0258940.
Armour M, Sinclair J, Chalmers KJ, Smith CA. Self-management strategies amongst Australian women with endometriosis: a national online survey. BMC complementary and alternative medicine. 2019 Dec;19:1-8.