Endometriosis and Cannabis: All You Need to Know

Could cannabis ease the pain?


Women who bear the full brunt of endometriosis will explain that it leads to the most excruciating pain imaginable. It is a poorly understood condition that impacts between 10% and 20% of women of childbearing age. An estimated 7.6 million women in the United States alone experience the debilitating agony of a condition ignored mainly by the federal government. Also, up to 50% of infertile women have endometriosis.

Cynics will point out that most of the Fed is male, and have no idea how painful the condition is. 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 marijuana.

What Is Endometriosis?

It is a common and chronic gynecological inflammatory condition. Endometriosis occurs when the tissue that usually grows inside the uterus does so outside instead. The condition tends to happen in the fallopian tubes, ovaries, and around the cervix. Occasionally, you find it outside the pelvic region in the skin, diaphragm, and brain.

These deposits of tissue 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. As a consequence, symptoms are usually worse at particular times during the cycle, especially during ovulation, and before and after a period.

One of the biggest problems surrounding the condition is the complete lack of funding. The National Institutes of Health (NIH) has a budget of over $37 billion per annum; endometriosis research received just $7 million in 2018, a figure likely to drop when we see the statistics for 2019.

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. Patients should note that the stage of disease doesn’t necessarily indicate symptoms nor the best treatment to manage these symptoms.

Stage 1 & 2 is minimal to mild disease. You will likely have superficial peritoneal endometriosis, small deep lesions, and mild filmy adhesions with no endometrioma (cysts). Stage 3 & 4 is moderate to severe disease. You may have profoundly invasive endometriosis with moderate/extensive adhesions between the uterus and bowels. There is also a chance of cysts.

Endometriosis Symptoms

By far, the most common symptom of endometriosis is terrible pain before and during periods. The pain is significantly worse than ‘typical’ menstrual cramps, and basic pain medication does little or nothing. It is also normal for this appalling pain to last for several days.

The condition triggers a chronic inflammatory reaction, leading to adhesions to go along with the pain. Adhesions occur when scar tissue attaches separate organs or structures.

There are also cyclical symptoms that develop a few days before menstruation and vanish within a few days of menstruation ceasing. It also refers to a situation where your symptoms only happen during menstruation. They return the following month after the menstrual cycle. Other symptoms include:

  • Infertility
  • Fatigue
  • Painful bowel movements, especially during the time of a period
  • Pain during sexual activity
  • Cyclical rectal bleeding
  • Cyclical intestinal complaints such as constipation or diarrhea
  • Weight gain
  • Insomnia
  • Pain during ovulation
  • Fungal infections

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 mean Standard Deviation delay in the diagnosis of endometriosis was 11.73 +/- 9.05 years in the United States. In other words, you could have the condition for over 10 years without realizing it! Fast forward a few decades, and little has changed.

Lack of diagnostic tools means that the scale of the problem is unknown. Tests to check for endo 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 at least one surgery under their belt. Many experts consider the laparoscopic removal of endo as the most effective method of treatment. However, this particular procedure costs over $20,000.

Back in 2014, the Endocrinology Society had a meeting to determine the costs associated with endometriosis. It 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. Little wonder, then, that patients see marijuana as a cheaper and more effective solution.

Other treatment options include pain medication, such as opioids and NSAIDs. You also have the option of hormone therapy. However, a growing number of women believe Mary Jane is their best friend when it comes to endometriosis symptom relief.

Marijuana & Endometriosis – The Science

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

Endocannabinoids (cannabinoids your body creates naturally) regulate the ECS. You find these endocannabinoids throughout the body. These chemicals keep your body in a state of balance. It stands to reason that people with medical conditions are ‘out of balance’ and endocannabinoids could help bring them back.

The body contains cannabinoid receptors known as CB1 and CB2 (GPR 55 is likely the third one). You find the CB1 receptors primarily in fatty tissue, the liver, the brain, and the vascular system. You mainly find CB2 receptors in some areas of the brain and on immune cells throughout the body.

THC activates our 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, endo is an inflammatory disease. Meanwhile, CBD is capable of desensitizing TRPV1, a pain receptor.

There is also research that shows that marijuana interacts with the GPR18 receptor. It works with weed’s cannabinoids and our body’s natural endocannabinoids. CBD blocks activation of the GRP18 receptor, an action that possibly prevents endometrial cells from migrating.

THC may also cause the migration of cells through the activation of the GPR18 receptor. As a result, endo patients could consider combining THC and CBD when treating the condition.

There is a chance that a compromised ECS causes endometriosis. In theory, using marijuana to ‘top-up’ your production of endocannabinoids should improve your symptoms. There are a few studies to back weed up in this case.

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 increase, and CB1 receptor antagonists decrease, hyperalgesia associated with endo. The researchers wrote that this finding suggested the ECS “contributes to the mechanisms underlying both the peripheral innovation of the abnormal growths and the pain associated with endometriosis.”

Your body usually prevents the growth of abnormal cells and destroys them before they become an issue. However, this process of apoptosis is impaired in people with endometriosis and similar medical conditions. The ECS is heavily involved in stopping cell growth and apoptosis. When you activate specific CB receptors, they potentially stop cancer cells from multiplying.

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

Armour et al. published the results of a survey in BMC Complementary and Alternative Medicine in January 2019. Amongst 484 Australian women with endometriosis, marijuana 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 the effect of weed on women with endometriosis. The goal is to find the best compound or combination of compounds to address the issue, possibly.

Over in the United States, Dr. Holly Harris received two grants worth $1.6 million to study the disease in March 2019. Her research does not involve the effect of cannabis on endometriosis.

Final Thoughts on Marijuana & Endometriosis

At present, women with Endo face a regular cycle of intense pain with few treatment methods available to combat it. They can try OTC painkillers which are all but useless, or risk addiction by using opioids. If and when these ‘treatments’ don’t work, they get to pay a five-figure sum for a surgery that isn’t guaranteed to succeed.

The fact is, the issue of endometriosis is shamefully ignored by governments all over the world. An increasing number of women are turning to weed for help because it is affordable, legal in some places, and most importantly, it works for a lot of them!

Unfortunately, you will wait years for physicians in legal states to finally acknowledge that cannabis is worth diagnosing for women with endometriosis. If you want to heal without the intoxicating high of marijuana, you can try CBD derived from industrial hemp.

Foria Wellness is one of the few companies that specialize in providing cannabinoids for menstrual pain relief, and it could also help women with endo. For women in severe pain, such a product is worth its weight in gold; if it alleviates the agony even a little.