Can cannabis help in the treatment of endometriosis?

Can cannabis help in the treatment of endometriosis? As a women owned, women focused company, we hear from so many women searching for relief from their pain and suffering related to dysmenorrhea (painful periods) and endometriosis. Endometriosis is a debilitating disease that significantly impacts the lives of millions of women worldwide. It is an inflammatory and chronic pain disease defined by the growth of endometrial tissue outside the uterine cavity. If left untreated, endometriosis may cause infertility, painful sex, and increase a woman’s risk of endometrial cancer.

Currently available treatments for endometriosis, including hormonal therapy and surgery, have a limited effect and can produce many unwanted side effects. Because of this, many women seek to self-manage pain and other unpleasant symptoms related to endometriosis by using cannabis and other natural alternatives to get some relief. So what does the science tell us about the usefulness of cannabis in treating endometriosis? Well, unfortunately, there are no human studies just yet.

However, an interesting study that just came out of Barcelona, Spain (1) suggests that THC may be useful in the treatment of pain and the spread of the disease. The researchers there developed a mouse model of endometriosis to study the potential therapeutic effects of THC. In this model, female mice develop symptoms similar to those experienced by women affected by the disease: debilitating pain and mild anxiety-like behavior. They also exhibit cognitive deficits that are likely related to many chronic pain syndromes. What they found was that mice treated daily with THC (equivalent to approximately a 24 mg dose in a 60 kg woman) had reduced pelvic pain and uterine innervation (nerve stimulation), as well as improved cognitive function.

Strikingly, THC also inhibited the development of endometrial cysts and ectopic endometrium (abnormal growth outside of the uterus), revealing many potentially therapeutic disease-modifying effects of THC. Of course, this study is far from conclusive but may help explain the relief many women find using cannabis who are suffering from endometriosis. So what about CBD? Again, while there are no studies on the effects of CBD on endometriosis, we do know that CBD may be useful in reducing pain and inflammation.

There are several biological mechanisms for this including CBD’s effects on inhibiting cyclooxygenase (COX) enzymes. Women with endometriosis have higher blood levels of pro-inflammatory cytokines and prostaglandins that can stimulate painful uterine contractions. Prostaglandins are formed with the help of COX-1 and COX-2 enzymes. Researchers have found that CBD and CBDA inhibit COX enzymes and reduce inflammation and pain (2, 3). So this is one of several ways that CBD may help to ease endometriosis-related pain.

Still much more research needs to be done in efforts to find safe and effective treatments for endometriosis that could include cannabinoids, as well as dietary and lifestyle changes. While the animal studies described above found that THC may be effective in treating endometriosis, the effective dose was still quite high. Of course, human trials will be needed to determine the effects of THC in women affected with endometriosis and to determine the lowest effective dose.

For now, a woman will need to experiment on her own to try to find the right dose and combination of cannabinoids that works best to help alleviate her symptoms. We recommend that for those that prefer to use a high CBD formulation, find a whole-plant, full spectrum extract rich in CBD, but also that contains some THC and other cannabinoids. Ratios that have been anecdotally found effective for endometriosis are high in CBD, such as a 3:1 or 20:1 CBD to THC tincture. Use high-quality tinctures that contain medicinal grade extracts and do not contain any sugar or additives that could contribute to inflammation. Keep a high THC ratio formula around (tincture or flower) for pain relief. Note that inhalation is the fastest delivery method and can be effective for severe, sudden pain.

Watch your diet! Because endometriosis is an inflammatory disease that is estrogen-dependent, women can alleviate symptoms by reducing intake of high sugar foods and beverages, as well as caffeine and alcohol. And let’s not forget about the mind-body connection. Stress reduction through meditation, qigong, yoga and mindfulness will help to reduce pain.

1. Escudero-Lara A, Argerich J, Cabañero D, Maldonado R. Disease-modifying effects of natural Δ9-tetrahydrocannabinol in endometriosis-associated pain. Elife. 2020;9. pii: e50356. doi: 10.7554/eLife.50356.

2. Costa B., Colleoni M., Conti S., Parolaro D., Franke C., Trovato A. E., Giagnoni G. Oral anti-inflammatory activity of cannabidiol, a non-psychoactive constituent of cannabis, in acute carrageenan-induced inflammation in the rat paw. Naunyn Schmiedebergs Arch. Pharmacol., 369, 294— 299 (2004). 3. Takeda S., Misawa K., Yamamoto I., Watanabe K. Cannabidiolic acid as a selective cyclooxygenase-2 inhibitory component in cannabis. Drug Metab. Dispos., 36, 1917—1921 (2008).