Endometriosis and Cannabis: All You Need to Know

Women who suffer from severe endometriosis often say that it leads to the most excruciating pain imaginable. It is a poorly understood condition that impacts approximately 10% of women of childbearing age. An estimated 7.6 million women in the United States alone experience the debilitating agony of this condition. As many as 50% of infertile women have endometriosis.

Endometriosis is often so severe that it forces females to leave the workplace and receive expensive care. Aside from the cost, traditional treatments seldom have the desired effect. Rather than turn to dangerous opioids or ineffective over-the-counter pills, an increasing number of women are taking a chance on cannabis.

What Is Endometriosis?

Endometriosis is a common and chronic gynecological inflammatory condition. It occurs when the endometrium, i.e., the tissue that lines the inside of the uterus, grows outside of the uterus. The endometrium typically grows in the fallopian tubes, ovaries, and around the cervix. Occasionally, it is found outside the pelvic region in the abdominal cavity or diaphragm.

These tissue deposits cause an inflammatory reaction that results in scar tissue, severe pain, and adhesion formation. Experts believe the tissue deposits react to the same hormonal stimulation as normal endometrium. Consequently, symptoms are usually worse at particular times during the cycle, especially before and during a period.

One problem surrounding the condition is the low level of funding. The National Institutes of Health (NIH) had a budget of over $37 billion in 2018; endometriosis research received just $7 million.

Noemie Elhadad of Columbia University created an app called Phendo 2018 to help women worldwide. The goal of the app is to track the effects of endometriosis. By early 2019, the app had 6,000 participants in over 65 countries.

The American Society of Reproductive Medicine (ASRM) developed a staging system, which can be found below. Patients should note that the disease stage doesn’t necessarily indicate symptoms nor the best treatment to manage these symptoms.

  • Stage 1 & 2 is minimal to mild disease. In these stages, women will likely have smaller, shallower lesions. Scar tissue might be present.
  • Stage 3 & 4 is moderate to severe disease. Sufferers may have deeper lesions, plus adhesions between the uterus and bowels. There is also a chance of cysts.

Endometriosis Symptoms

By far, the most common symptom of endometriosis is excruciating pain before and during periods. The pain may be worse than typical menstrual cramps, and basic pain medication may not always work. It is also normal for this pain to last up to several days.

The condition is a chronic inflammatory reaction, leading to adhesions and pain. Adhesions occur when scar tissue attaches to separate organs or structures.

Other symptoms may also occur around menstruation, such as:

  • Fatigue
  • Painful bowel movements
  • Pain during sexual activity
  • Rectal bleeding
  • Constipation or diarrhea
  • Insomnia
  • Pain during ovulation
  • Endometriosis also increases the risk of infertility.

What Is It Like to Live with Endometriosis? – Diagnosis & Treatment

“Hell” is the word women often use to describe life with endometriosis. Jill Fuersich is the co-founder of Endo Warriors, and she spoke of how the condition has negatively impacted her life. According to Jill, back and leg pain joined the agony caused by her bowels and bladder. Eventually, she couldn’t function any longer and lost her job.

Even the diagnosis isn’t easy. A study by Hadfield et al., published in Human Reproduction in 1996, found that the average amount of time to diagnose endometriosis was 11.73 years (standard deviation 9.05 years) in the United States. In other words, women could have the condition for over ten years without realizing it! Fast forward a couple of decades, and little has changed.

Lack of diagnostic tools means that the scale of the problem is unknown. Tests to check for endometriosis include:

  • Pelvic exam
  • Ultrasound
  • Magnetic resonance imaging (MRI)
  • Laparoscopy

There is a specific diagnosis of endometriosis that requires a surgical biopsy. Many women with the condition have had at least one surgery. Numerous experts consider the laparoscopic removal of the endometrium as the most effective method of treatment.

In 2014, the Endocrinology Society had a meeting to determine the costs associated with endometriosis. It was discovered that the average healthcare cost in the first year after diagnosis was over $13,000! To make matters worse, Medicare covers only a fraction of the cost of laparoscopic surgery for the condition.

Other treatment options include pain medication, such as opioids and NSAIDs. Women with endometriosis also have the option of hormone therapy. However, a growing number of women use cannabis for endometriosis symptom relief.

Marijuana & Endometriosis – The Science

Like many pharmaceutical solutions, endometriosis treatments usually mask the symptoms but do little to treat the underlying cause. In contrast, there is some evidence that cannabis works with the endocannabinoid system (ECS) to combat numerous aspects of endometriosis.

Endocannabinoids (cannabinoids the body creates naturally) regulate the ECS. These endocannabinoids are found throughout the body. It’s thought that these chemicals help keep the body in a state of balance.

The body contains cannabinoid receptors known as CB1 and CB2 (GPR 55 is possibly a third). CB1 receptors are found primarily in fatty tissue, the liver, the brain, and the vascular system. CB2 receptors are located in some areas of the brain and on immune cells throughout the body.

medical-marijuana-for-endometriosis

THC activates the brain’s dopamine reward system via the CB1 receptors. This reaction causes the intoxicating high and occasional feelings of euphoria caused by using cannabis. THC also activates CB2 receptors, which is a significant contributor to the cannabinoid’s anti-inflammatory effects. Remember, endometriosis is an inflammatory disease. Meanwhile, CBD is potentially capable of desensitizing TRPV1, a pain receptor.

Marijuana & Endometriosis – The Studies

A study by Dmitrieva et al. published in the Pain journal in December 2010 looked at endocannabinoid involvement in endometriosis. The team found that CB1 receptor agonists decrease, and CB1 receptor antagonists increase, managing the pain associated with endometriosis in rats. The researchers wrote that this finding suggested the ECS “contributes to the mechanisms underlying both the peripheral innervation of the abnormal growths and the pain associated with endometriosis.”

marijuana-for-endometriosis

A study by Leconte et al., published in The American Journal of Pathology in December 2010, looked at cannabinoid agonists’ effects on endometriosis in mice. When they activated specific CB receptors in these mice, the team found that the receptors inhibited endometriotic tissue from increasing.

Armour et al. published a survey in BMC Complementary and Alternative Medicine in January 2019. Amongst 484 Australian women with endometriosis, cannabis was the most highly-rated self-reported method of reducing pain.

Ongoing Research on Cannabis for Endometriosis

The lack of funding means recent studies are few and far between. In April 2019, however, an Israeli company named Gynica announced its plans to begin preclinical studies to monitor cannabis’s effect on women with endometriosis. The goal is to find the best compound or combination of compounds to address the issue.

Final Thoughts on Marijuana & Endometriosis

At present, women with endometriosis face a regular cycle of intense pain with few treatment methods available to combat it. Over-the-counter painkillers or opioid medications are one possible treatment option, but these may not work for everybody.

Additionally, women with endometriosis face a five-figure sum to have surgery that isn’t guaranteed to succeed. As a result, cannabis may be one additional treatment option some women try.

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