Endometriosis is a notoriously painful condition that affects approximately 1 in 10 women. It is characterised by the presence of endometrial tissue, which should only be found inside the uterus, in other areas of the abdomen.
In the UK there are almost as many women with endometriosis as there is with diabetes, that’s around 1.7 million individuals. The impact of this condition is felt on an individual level and more widely, costing the UK approximately £8.2 billion per year in loss of work, treatments and healthcare costs.
These numbers offer a stark reflection of how this silent condition strongly affects patients and the economy. So can medical cannabis help combat endometriosis?
The pain of treating a condition with an unknown cause
Despite being officially discovered and named 100 years ago, the exact causes and mechanisms behind endometriosis are poorly understood. It is not life-threatening but certainly is often a painful disease that can impact fertility.
Several as yet unproven theories exist including retrograde menstruation, immune dysfunction with the lymph dispersing tissue or even metaplasia – the process of a cell changing into another type of cell that has different actions, in the case of endometriosis cells are also in the wrong location.
Ectopic endometrial tissue often leads to lesions which can be found in different areas of the abdomen, on the ovaries, bowel and bladder. Unfortunately, these lesions are not excluded from reacting to hormonal fluctuations of a woman cycle, they slough off creating debris or cysts in the abdomen, in turn, activating inflammatory immune responses.
The combination of lesions and the immune response causes severe pain for many endometriosis patients. Other symptoms can include infertility, dysmenorrhoea, heavy or irregular bleeding as well as gastrointestinal discomfort.
The role of the Endocannabinoid System in female reproductive health
The endocannabinoid system (ECS) is a complex biological system made up of receptors and cannabis-like compounds that the body naturally produces – endocannabinoids. The ECS plays many important roles in modulating and maintaining balance in various systems of the body.
Of the two types of cannabinoid receptors in the body, both are expressed in the uterus. CB1 receptors are principally found in the brain and central nervous system and CB2 receptors are largely dispersed in the immune system and gastrointestinal tract, surprisingly both can also be found in the female reproductive organs.
Research shows us endocannabinoid levels vary greatly coinciding with a woman’s menstrual cycle. Signalling within the ECS is also thought to be important in pregnancy, with ECS dysfunction associated with early miscarriage.
Finding safe and effective means of pain management is of extreme importance in women’s reproductive health.
It’s relatively well established that the ECS is implicated in pain management as a whole. In relation to endometriosis-related pain, a 2016 study showed endometriosis patients exhibited lower levels of CB1 receptors than control subjects, which was inferred to be impairing mediation of pain sensation.
Cannabinoids could ease the pain of endometriosis
Cannabinoids, specifically THC and CBD, have been investigated for their anti-inflammatory properties. As inflammation is a key aspect in the pathology of endometriosis, targeted cannabinoid treatments may have implications on inflammation and pain for these patients.
CBD is also prescribed to aid in alleviating chronic and severe pain. Instead of acting via the ECS, CBD functions on the same pathways as non-steroidal anti-inflammatory drugs, like ibuprofen.
NSAIDs are often prescribed from endometriosis pain however, long term use is known to be a risk factor for a variety of illness and can have side effects. CBD oil appears to lack the negative gastrointestinal side effects that are commonly caused by NSAIDs.
Whilst CBD has a generally benign safety profile, you should still consult with your healthcare practitioner before initiating any new treatment.
The potentials for cannabinoids in treating endometriosis continues
As endometrial lesions establish they initiate the creation of new blood vessels to feed their growth, this process is called angiogenesis. Cannabinoid agonists have been researched for their impact on the processes of angiogenesis in endometriosis models.
In this research, the inhibition of endometrial lesions creating new vessels and proliferating shows there is potential for managing disease progression.
CBD oil has also been shown to block migration of endometrial cell lines, where THC was shown to do the opposite. Such interesting investigations are still isolated to the Petri-dish yet no less important, as it is this kind of data that will inform future research.
Currently, there is still insufficient evidence to declare medical cannabis could attenuate disease progression in patients with endometriosis. However, animal and human trials have provided enough positive data to warrant further investigation.
Medical cannabis can help address pain management
Until evidence on the mechanisms of action and efficacy of medical cannabis in endometriosis is uncovered, the positive results of medical cannabis on pain management are robust enough to consider it as a potential pain management option for endometriosis patients, under the care of a physician.