Endometriosis is a severe and often debilitating chronic inflammatory condition. It affects approximately 10% of reproductive aged people (190 million) with a female
reproductive system on a global scale (World Health Organization, 2021). This condition is defined by endometrial glands, stroma, or other cells found growing outside of the uterus, in locations such as on the ovaries or on the pelvic peritoneum.
Endometriosis is characterized by pain (often severe), infertility, psychological distress and fatigue, dysmenorrhea (menstrual cramps), dyschezia (constipation), dyspareunia (painful intercourse), dysuria (painful urination), and chronic non-menstrual pelvic pain. In addition, comorbidities often include bladder pain or irritable bowel syndrome.
Over 95% of cases with deep infiltrated endometriosis report suffering from extreme levels of pain. Furthermore, symptoms can begin as early as adolescence and have a negative impact on the developing brain.
Since a definitive diagnosis requires surgery, many go undiagnosed for some time after symptoms begin. With many variables and pathways involved, the exact cause of endometriosis is mostly unknown. The general belief is that a combination of hormonal, immunological, and neurological factors contribute to the disease’s development. There is no cure available today, only symptom management.
The endocannabinoid system (ECS) plays an important role in the mechanisms involved in endometriosis development, disease maintenance and pain. The ECS is also involved in the immune response, and demonstrates antiproliferative and antifibrotic effects.
CB1 receptors are highly expressed in the uterus, whereas both CB1 and CB2 receptors are highly expressed in human oocytes. One of the main enzymes of the endocannabinoid system, Anandamide (AEA), is found in the fluids of the female reproductive tract and ovaries. AEA plays an important role in several key functions including folliculogenesis, preovulatory follicle maturation, oocyte maturation, and ovulation.
In terms of current scientific research regarding cannabis and endometriosis, there is a fair number of studies available with promising results. Currently, there are only two trials exploring the use of cannabinoids as a treatment for endometriosis pain, NCT03875261 and NCT04527003 (National Institute of Health, 2022).
The current therapeutic options available for endometriosis patients include diet changes, surgery, and pain relieving or anti-inflammatory medications. Unfortunately, these options are associated with severe unwanted side effects, high rates of recurrence and only seem to provide limited efficacy.
Cannabinoids are commonly used by chronic pain patients and many people with endometriosis are turning to cannabis for relief. Varied expression of cannabinoid receptors, enzymes, and endocannabinoids will affect how a person responds to treatment.
Cannabis has the potential to serve as a therapeutic option for those seeking a more natural treatment, with significantly less side effects than current pharmaceutical therapies. While the ECS has great potential to act as a promising target for treatment of endometriosis, it is important to note that the biphasic effects of the cannabinoid D9-THC may result in undesired outcomes. Lower concentrations of this cannabinoid may increase cancer cell proliferation, but at higher concentrations D9-THC has shown to decrease cancer cell proliferation. This presents as one of the biggest issues for people attempting to determine proper dosage from home.
As always, we recommend speaking with a licensed medical professional before starting a new cannabis regime. To learn more about the potential benefits of cannabinoid therapy, please reach out to our care team!
By: Jazmin Oliver / Cannabis Science Consultants
- Andrieu, T, Chicca, A. Pellegata, D., Bersinger, N., Imboden, S., Nirgianakis, K., Gertsch, J., Mueller, M. Association of endocannabinoids with pain in endometriosis, PAIN: January 2022 – Volume 163 – Issue 1 – p 193-203. doi: 10.1097/j.pain.0000000000002333
- Bouaziz J, Seidman DS, Soriano D. The Clinical Significance of Endocannabinoids in Endometriosis Pain Management. Cannabis Cannabinoid Res. 2017 Apr 1;2(1):72-80. doi: 10.1089/can.2016.0035.
- Sanchez, P. Vigano, A. Mugione, P. Panina-Bordignon, M. Candiani. The molecular connections between the cannabinoid system and endometriosis, Molecular Human Reproduction, Volume 18, Issue 12, December 2012, Pages 563–571. https://doi.org/10.1093/molehr/gas037
- Saunders P., Horne A., Endometriosis: Etiology, pathobiology, and therapeutic prospects, Cell, Volume 184, Issue 11, 2021, Pages 2807-2824, ISSN 0092-8674, https://doi.org/10.1016/j.cell.2021.04.041.
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