Endometriosis and medical cannabis
Research from the University of Queensland shows that about 1 in 9 Australian women suffer from endometriosis, a condition where the endometrial-like tissue grows outside of the uterus.
Depending on the severity of endometriosis, the condition can be life-changing. The condition can often come with unbearable chronic pain, and side effects can include problems with the bladder, bowels and even fertility.
Treatment for endometriosis ranges from natural therapies to surgical intervention. In the past few years, many women have turned to cannabis to help treat endometriosis symptoms. Today, a number of surveys and studies have shown that both CBD and THC are beneficial for endometriosis and the symptoms of the condition.
In this article, Dr Amy Gajjar, an RACGP certified GP and integrative medicine specialist explains endometriosis, traditional treatments for endo and how cannabis is helping to treat endometriosis. Topics covered include:
- What are the signs and symptoms of endometriosis? | 00:28
- When should an individual seek a doctor’s help for endometriosis? | 01:55
- How is endometriosis diagnosed? | 02:45
- Can cannabis help to treat endometriosis? | 03:38
- Can CBD or CBD oil help treat endometriosis? | 04:40
- Can THC help treat endometriosis? | 05:21
- What are the side effects of cannabis for endometriosis? | 06:16
- What type of cannabis is normally prescribed for endometriosis? | 07:13
- Are there cannabis topicals for endometriosis?
- What is the typical dosage of cannabis for endometriosis? | 08:33
- What are the traditional treatments for endometriosis? | 08:58
- What are the side effects of traditional endometriosis treatment? | 12:46
- What does the research say about cannabis for endometriosis? | 14:40
What are the signs and symptoms of endometriosis?
Endometriosis is a chronic inflammatory condition where endometrial-like tissue grows outside the uterus. This wayward tissue can then grow on organs like the ovaries, fallopian tubes, cervix, the appendix, the uterus and bladder as well as some other abdominal areas. Because of the diversity of locations, the condition can cause a number of different symptoms.
Common symptoms of endometriosis are:
- Bladder pain
- Consistent premenstrual symptoms
- Heavy, painful periods
- Lethargy, fatigue and trouble sleeping
- Pain during sex
- Pain in the lower back, hips and thighs
- Pain with bowel movements
- Pelvic pain
And, because of the pain symptoms, those with endometriosis can find themselves extremely anxious and even depressed.
When should an individual seek a doctor’s help for endometriosis?
Occasional period pain is normal. However, if you experience ongoing persistent medical symptoms of consistent pain or heavy, painful periods where standard painkillers aren’t helping you should seek medical assistance.
“One of the issues is that women have gotten used to having painful periods. It’s like stress, we accept stress as a normal day to day thing. I think there’re a lot of women out there who think that having painful periods is just normal, but they’re not.”
So, when the pain is affecting your quality of life, whether it be at home, at work or causing functional disability, it’s very important to seek help.
How is endometriosis diagnosed?
Clinical symptoms and history are really important to the diagnosis. Due to the nature of the symptoms, a diagnosis of endometriosis starts by ruling things out. Research shows that there is often a large delay in time between the first visit to a doctor and a diagnosis of endometriosis diagnosis. Currently the average diagnosis is between 7 and 10 years.
Your doctors will want to understand the type of period you’re having along with any symptoms, so it’s highly recommended that prior to your visit you track your cycle and symptoms for a few months. When seeing a doctor make sure you explain as many of the symptoms as possible.
The only definitive way to diagnose endometriosis is with a laparoscopy. A laparoscopy is a minimally invasive, relatively safe surgery where a camera (a laparoscope) is inserted into the pelvis via a small cut near the navel. The doctor uses the camera to see the pelvic organs and look for any signs of endometriosis.
Can cannabis help treat endometriosis?
Yes. There are cannabinoid receptors throughout the body, mainly in the central and peripheral nervous system, the immune system and organs. Cannabinoid receptors have also been found in the endometrium and gut linings.
Cannabis has two main chemicals (cannabinoids) called THC and CBD, that can interact with the cannabinoid receptors. Both cannabinoids can have benefits in the treatment of endometriosis.
One of the key features of endometriosis is inflammation. Cannabis has anti-inflammatory properties. Another symptom of endometriosis is pain (often chronic). Studies show that cannabis is beneficial for chronic pain. Endometriosis can also cause other comorbidities like anxiety and depression, both of which cannabis can help.
We know historically that cannabis has been used for thousands of years. Apparently even Queen Victoria used it for heavy painful periods.
Can CBD or CBD oil help treat endometriosis?
Yes, CBD oil can help treat some patients with endometriosis. Endometriosis causes major inflammation which is one of the reasons that individuals experience pain. CBD and CBD oils are known to have anti-inflammatory properties. CBD is also known to have mild analgesic properties which is important for reducing the pain that comes along with endometriosis.
While there have been very few studies about endometriosis and CBD specifically, we know that many chronic pain patients benefit from CBD and CBD oil. There are also many individual patient case studies which show that CBD oil can help with endometriosis.
Can THC help treat endometriosis?
Yes, THC can help treat some patients with endometriosis. THC is known for its analgesic properties (as well as its psychoactive properties).
There are a number of studies that show the positive impact of THC for many types of pain.
A Spanish study looked at endometriosis in mice. The study found that not only did THC have analgesic and antispasmodic (reduces muscle spasm) properties but it also inhibited the development of endometrial cysts.
What are the side effects of cannabis for endometriosis?
When we look at side effects of cannabis we have to break it down into CBD and THC individually.
With CBD, the most common side effects are: dry mouth, fatigue, and disrupted sleep and nausea (at very high doses). Most of these side effects resolve over time and with correct dosing. There is however a small proportion of patients who will not be able to use CBD at all for a number of reasons.
With THC, side effects are light-headed or dizziness and sometimes increased anxiety. Some patients also may feel drowsy. Again, these symptoms can often be avoided with the correct titration and dosing. CBD can also help mitigate some of the negative side-effects of THC, specifically the anxiety.
What type of cannabis is normally prescribed for endometriosis?
Each individual’s body and response to cannabis is different so there isn’t really a specific cannabis or CBD oil that’s best for endometriosis.
The most common formulation of cannabis prescribed for endometriosis is CBD oil which is taken orally. Doctors often start with CBD because it has anti-inflammatory properties and can help with pain. It also has a smaller side effect profile than THC, which is still very limited. CBD oil is a great foundation for medical treatment.
If CBD alone isn’t enough or you’re used to consuming cannabis then doctors will typically add in some THC. Research has shown that THC can help with relieving pain. Scientists also believe that using the whole plant, THC, CBD and the other cannabinoids and terpenes that naturally occur in the plant offer greater health benefits through what’s called the “entourage effect”.
If you’re experiencing lots of breakthrough pain (rapid onset pain) your doctor may prescribe flower which is inhaled through a vaporiser. Inhaled cannabis provides fast relief of symptoms, where oils take longer to kick in but benefits are felt for a longer period of time.
What about cannabis topicals or CBD creams for endometriosis?
When researching cannabis for endometriosis, patients often find information about cannabinoid topicals or CBD creams for the treatment of pain. While there are topicals and creams for the treatment of pain, these types of cannabinoid treatment are not currently available in Australia.
Cannabis creams and topicals can be beneficial for the treatment of endometriosis however we’ll have to wait until they are available locally.
What is the typical dosage of cannabis for endometriosis?
Many of our modern pharmacological treatments have standardised dosages. Cannabis is a very personalised medicine and dosages will vary between patients. Dosages will depend on genetic factors, your lifestyle and comorbidities.
The dosage of CBD or THC that’s right for you may be different for someone who is the same height and weight and lives a similar lifestyle to you. Cannabis dosages always start low and go slow. Doctors will start you on a medication they believe will be best for you and then titrate you up over the course of a few weeks to a month.
The goal of administration and titration is to find the minimal effective dose so you get maximum effects with few side effects.
What are the traditional treatments for endometriosis?
Endometriosis treatments can be divided into three categories:
- Natural medicine
- Medical (pharmacological)
There are many things a doctor can do to help you from a lifestyle and complementary medicine point of view that can help with endometriosis.
While treatments will vary based on an individual’s needs, looking at an individual’s overall health can help reduce symptoms. Inflammation for example, is one of the key drivers of many chronic illnesses, including endometriosis.
Dr Gajjar often works with her patients on lifestyle and dietary changes.
We can aim for a more anti-inflammatory diet like a Mediterranean style diet. We can take out, or at least reduce, inflammatory foods. Moderating things like gluten, dairy, sugar, or alcohol can really help.
Exercise, physical activity and sleep can also play a huge factor in improving endometriosis symptoms.
You don’t want to do too much or too little exercise – you need to find a balance. And, you need to get adequate sleep. It’s been proven that not getting enough sleep can increase inflammation. Seven to eight hours is really important but more than nine and less than six isn’t great.
Meditation and yoga, particularly moving areas around the lower back and hips can have a good impact on inflammation.
Studies have shown that 10 or15 minutes of meditation a day over a two to three month period actually upregulated anti-inflammatory genes. So, meditation’s not just for relaxation and chilling out. They’re actually a lot of great internal processes that happen when we meditate.
Finally, there are other botanical/nutritional medicines that can be useful. Nutrients like magnesium, zinc, B complex and omega-three can be really helpful.
Curcumin, which is the active ingredient from turmeric has been shown to be a potent anti-inflammatory. There’ve been studies where curcumin was on par with Voltaren as pain relief.
Finally, herbs like Vitex can help elevate progesterone. Vitex can help restore the estrogen progesterone balance that happens to go off in endometriosis.
The first-line treatment for endometriosis pain is often painkillers, especially nonsteroidal anti-inflammatory drugs (NSAID) like Ibuprofen and Voltaren.
If a stronger painkiller is needed GPs may prescribe one called Mefenamic acid, a NSAID.
The oral contraceptive pill is a commonly used method to treat endometriosis. The problem with the pill is that it’s introducing more Estrogen into the system, which in some cases is actually part of the problem.
Doctors may also use other progesterone methods such as the Mirena coil. The Mirena coil, a hormonal intrauterine device (IUD) can be inserted into the uterus in general practice or during a laparoscopy. The IUD has been shown to reduce pain and symptoms in some patients.
There are also other progesterone methods such as Dienogest and some GnRH agonists which are injections that switch off the release of the reproductive hormones, inducing a menopause-like state.
The main surgical method is a laparoscopy to remove the endometriosis lesions. This is the only form of treatment that changes the physiology of your body (addressing the root cause), whereas all other forms of treatment support in reducing symptoms.
What are the side effects of traditional endometriosis treatment?
Pharmacological method side effects
The NSAIDs that are commonly used for pain relief can have gastric side effects. They can cause inflammation in the lining of the stomach leading to ulcers for individuals who are taking them for a long period of time.
Contraceptive pills have standard symptoms such as: headaches, migraines, increased blood pressure, nausea, irregular bleeding spotting, ms. People also can experience weight gain and mood changes such as depression.
The pill can also change the gut microbiome. Our gut microbiome is key to our overall health. Finally, the pill is also known to increase copper which can lead to the loss of other important minerals like magnesium, zinc and iron as well.
Progesterone methods can also lead to issues with thyroid health. And, these methods often mask symptoms rather than getting rid of them.
Surgical method side effects
Surgical methods also have side effects. Unfortunately, endometriosis can recur and it’s possible that you could have post-surgical complications.
What does the research say about cannabis for endometriosis?
There is a growing volume of research around cannabis and endometriosis. It’s been proven that the endocannabinoid system plays a part in endometriosis. There’s been research which has shown the positive impact of THC on inhibiting the development of endometriosis. And, a local Australian survey/study showed that women using cannabis to treat endometriosis were finding relief in their symptoms.
Case studies, individuals’ stories and the fact that the TGA is approving cannabis for endometriosis shows that cannabis has a place in the treatment of endometriosis. While we’re seeing promising results, no clinical trials have proven that cannabis can treat endometriosis.
Cannabis is not a magic bullet. It’s not a first-line treatment in Australia and is supplementary to other treatments. Just like any other medication, cannabis doesn’t work for everyone.
If you think that medical cannabis might be right for you, please consult your GP or another medical professional.