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7 Ways Cannabinoids Combat Endometriosis

When Foria first released its cannabinoid infused suppositories, the team was pleasantly surprised by the response from people who suffer from endometriosis.

The Foria team wasn’t surprised that these products worked for endometriosis pain — just how well they worked.

Though many folks are already familiar with the pain-relieving effects of CBD and THC, scientists have uncovered numerous ways that cannabis and hemp extracts could actually target the root causes of various conditions — including endometriosis.

Research indicates that cannabinoids could treat endometriosis by:

  • Stopping cell proliferation
  • Preventing cell migration
  • Inhibiting lesion vascularization (blood vessels)
  • Inhibiting lesion innervation (nerves)
  • Blocking synthesis of inflammatory prostaglandins
  • Modulating the immune response
  • Desensitizing nerves that transmit pain

But which cannabinoids have which effects?

And should you be using THC only? CBD only? Or some combination?

Whether you’re already using cannabinoids for your endometriosis, or you’re considering an experiment with them, we highly recommend reading on to learn about the effects of THC & CBD on endometriosis.

If you’ve been diagnosed with endometriosis, then you’re probably already aware that there’s currently no cure. The treatments offered by doctors — including painkillers, hormone therapy, and risky surgical procedures — are aimed at merely holding the endometriosis in check. And they are often ineffective at that.

This is why many endometriosis sufferers are seeking holistic approaches to deal with their recurrent symptoms – through diet and other lifestyle changes – and incorporating cannabinoids (like CBD and THC) into their treatment routines.

What is Endometriosis?

Let’s start with a bit of background first. (If you’re already deeply familiar with endometriosis, feel free to skip ahead to the cannabinoid therapies section down the page.)

Endometriosis is a frequently painful condition where tissue similar to that which normally lines the uterus – the endometrium – mistakenly grows outside of the uterus. Endometrial tissue can develop on the ovaries, fallopian tubes and other abdominal locations.

Although there is nothing intrinsically life-threatening about this tissue, it unfortunately responds to the hormones circulating in your body the same way it does in your uterus: Every month the endometrium builds up, then breaks down and sheds.

Unlike typical menstruation, the blood and tissue shed from these misplaced cells are frequently trapped in your body. This cyclical pattern can become excruciating — triggering inflammation and scarring as your body struggles to reabsorb the dead material.

For people who suffer from endometriosis, life is significantly more challenging: As a group, their quality of life goes down while anxiety and depression rates increase . Many endure the pain of endometriosis for years before being properly diagnosed — and it can be devastating to continue to get worse even while following prescribed treatments.

People with endometriosis typically suffer from at least one of the following symptoms:

  • Severe menstrual cramps
  • Painful intercourse
  • Painful urination or bowel movements
  • Chronic lower back, abdominal or pelvic pain
  • Diarrhea, constipation or nausea
  • Infertility or difficulty getting pregnant

How is Endometriosis Treated?

There is no known cure for endometriosis. Treatment focuses on symptom management while trying to prevent the endometriosis from spreading. Doctors typically suggest one or more of the following three treatment options:

  • Painkillers — The most widely-prescribed resource for dealing with endometriosis is an effective painkiller. Anti-inflammatory drugs (NSAIDs) and analgesic painkillers help sufferers cope with the painful symptoms of endometriosis, but do nothing to prevent the disease from progressing. Sometimes more extreme painkillers are prescribed, with debilitating systemic effects ( as one Foria client with endometriosis discovered before switching to cannabis therapy).
  • Hormones — Another popular prescription is for hormone therapy, which is thought to alleviate symptoms by reducing the strength and/or quantity of menstrual cycles. However, some patients respond poorly to hormone therapy.
  • Surgery — Doctors can surgically remove the misplaced endometrial tissue, which often provides tremendous relief. for a while. Unfortunately, there is a high risk of complications, and approximately half of patients will have their symptoms return within one year , requiring further treatment. Another surgical option is an ovariectomy — both surgical and natural menopause will end the cyclical nature of endometrial torture. Unfortunately, pain from permanent endometriosis scar damage could persist beyond menopause, requiring lifelong pain management.

What Causes Endometriosis?

In order to develop more effective treatments, scientists are working to piece together exactly how endometrial tissue thrives where it doesn’t belong. The most popular theory is that menstrual blood flows the wrong direction, carrying endometrial tissue to the fallopian tubes, ovaries or abdomen. Others speculate that environmental factors or toxins might cause the body to spontaneously produce endometrial cells in the wrong place.

However the initial cells arrive , once they are there, they grow and spread (similar to cancer cells) by somehow multiplying and avoiding destruction by the body’s security force. They recruit blood veins to supply nutrients and remove waste products (also like cancer), and they grow new nerve endings that increase pain perception. Also similar to cancer cells, endometriosis can migrate to other tissues in order to claim more territory — even reclaiming lost territory after surgery. Although endometriosis is considered a benign disease, patients whose bodies are unable to prevent the spread of endometriosis (due to genetics or environmental factors) also have a much higher risk for ovarian cancer .

Due to the similarities, some speculate that treatments that stop cancer from developing and spreading might do the same for endometriosis.

Cannabis & Endometriosis

People across the world use cannabis and hemp extracts to treat endometriosis, menstrual cramps and other gynecological complications — and they’ve been using them for millennia . In the last few decades, THC and CBD have been shown to be effective therapies with relatively few side effects.

One reason scientists are enthusiastic about these compounds is the recent discovery that the body’s natural endocannabinoid system is integral to the healthy functioning of the reproductive tract .

In fact, imbalances in these neurotransmitters are often linked to reproductive complications and diseases — including endometriosis — and it seems that careful use of phytocannabinoid supplements, topicals, and suppositories could make a huge difference in the underlying imbalance. How?

Cannabinoids Stop Cell Multiplication

Normally, your body has tools to prevent the growth of aberrant cells and to destroy them ( apoptosis ) before they become a problem. Unfortunately, apoptosis seems to be impaired in people who suffer from endometriosis and similar disorders.

The endocannabinoid system is involved in apoptosis and stopping cell growth. Perhaps the most famous application of these effects is in cancer treatments. When certain cannabinoid receptors are activated (either by the body’s endocannabinoids or by plant-sourced THC), they can prevent cancer cells from multiplying .

Similar research has shown that activating these receptors inhibits endometriotic tissue from proliferating in mice.

CBD: Preventing Cell Migration

A frustrating problem for patients who have their endometriotic lesions surgically removed is that the endometriosis frequently comes back. However, scientists recently discovered that endocannabinoids are involved in regulating cell-migration.

It turns out that molecules like CBD can stop endometriotic cells from migrating (by blocking the activation of the GPR18 receptor). However, molecules like THC that activate this receptor could potentially increase cell migration. This suggests that women who self-medicate with THC should consider counterbalancing its effects with CBD .

Starving the Bloodsuckers

In order for anything to grow, it needs a supply of nutrients. Likewise, endometriotic lesions can only proliferate if they develop a network of blood vessels (vascularization) in order to receive the required nutrients.

Although research on the influence of cannabinoids on endometriotic vascularization is limited, multiple studies have shown that both THC and CBD can inhibit vascularization of cancerous lesions.

CBD vs Painful Nerves

Some patients suffer from deep-infiltrating endometriosis — a more painful form of endometriosis that embeds deeper into abdominal tissue. One reason these lesions might be more painful is that they contain a much higher density of nerves than other lesions.

Endocannabinoids regulate nerve growth, and their receptors (CB1) are expressed on the nerves that innervate endometriotic lesions. Molecules like CBD interfere with innervation by preventing activation of this receptor. However, this might suggest that using THC without the counterbalancing effects of CBD could result in a long-term increase in endometriosis innervation.

CBD: Like Advil Without the Side-Effects

NSAIDs like Advil are one of the most frequently-prescribed treatments for endometriosis. NSAIDs work by inhibiting certain enzymes (named COX-2 ) that contribute to inflammation. Unfortunately, NSAIDs thin your blood and can have gastrointestinal side effects because they also inhibit other enzymes (such as COX-1 ). It turns out that CBD’s anti-inflammatory effects come with fewer of these side-effects because it specifically inhibits COX-2 but not COX-1 .

Cannabinoids Calm An Overactive Immune System

A large number of your body’s endocannabinoid receptors (CB2) are located on your immune system’s killer cells ( macrophages ). When these receptors are activated, they prevent macrophages from releasing inflammatory proteins ( cytokines ).

People who suffer from endometriosis become hypersensitized to inflammatory toxins and signals. Fortunately, THC activates CB2 receptors , which is a large contributor to THC’s anti-inflammatory properties. This is useful for out of control inflammation caused by an overactive immune system — though depressing the immune system isn’t always desirable.

CBD & THC vs Pain Signals

Nerves that innervate endometriotic lesions can increase the pain of endometriosis. These nerves also contain endocannabinoid receptors (CB1) , and when THC activates this receptor it can help decrease pain.

CBD also helps relieve feelings of pain, but through other targets. Most notably, CBD is capable of desensitizing the pain receptor TRPV1 .

Lifestyle Changes for Endometriosis

Scientists are still uncovering the different ways that cannabinoids like CBD and THC impact endometriosis, and standardized medical advice could be years away. Until then, careful self-experimentation is the best way to determine the optimal combination of cannabinoids to complement your current endometriosis treatment.

Many people with endometriosis have already incorporated cannabinoids into their self-care routine, and we encourage you to check out their testimonials before making your decision. To read about the personal stories and lifestyle changes that have helped other Foria clients gain control over their endometriosis, start here and here .

Whether or not you incorporate cannabinoids into your self-care routine, there are many alternative treatments available if a purely pharmaceutical or medical treatment is falling short.

Dietary changes often have profound effects on endometriosis symptoms. An anti-inflammatory diet that’s rich in omega-3 fatty acids, fiber and antioxidants is a good place to start. You may also find that acupuncture and meditation are effective tools for pain management. Additionally, other herbal supplements could target endometriosis in ways similar to cannabinoids.

As always, before making any changes to your endometriosis treatment, make sure to consult with a trusted medical professional.

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If you’ve been diagnosed with endometriosis, then you’re probably already aware that there’s currently no cure. This is why many patients are seeking holistic approaches to deal with their recurrent symptoms – through diet and other lifestyle changes – and incorporating CBD and THC into their treatment routine. Learn More.

More Women are Self-Treating Endometriosis with Cannabis and CBD — But is it Safe?

For the estimated 11 percent of American women between 15 and 44 living with endometriosis, symptoms like severe pain, fatigue, and nausea can profoundly disrupt their lives. Yet endometriosis remains under-diagnosed, with a lack of effective treatments.

That’s why many women are taking symptom relief into their own hands by using cannabis, according to a recent survey published this November in the Journal of Obstetrics and Gynaecology Canada. Other women are turning to cannabidiol (CBD) for pain relief, hoping to address the symptoms without the high.

“Pain relief in endometriosis is an important topic, as it can impact women on so many levels, including work, relationships, academic studies, and of course their mental health,” says study co-author Mike Armour, PhD, a post-doctoral research fellow in women’s health at Western Sydney University’s NICM Health Research Institute, a government-funded group that focuses on integrative and complementary medicine research and policy in Australia.

Dr. Armour’s team surveyed nearly 500 Australian women between the ages of 17 and 45 and found that 13 percent say they use cannabis to self-treat endometriosis symptoms. The authors estimate that their findings suggest approximately 10 percent of Australian women with endometriosis use cannabis for symptom and pain management.

Why are patients self-managing their symptoms?

Women frequently report that they can’t get endometriosis symptoms under control with recommended medications or surgery; there’s little evidence to show current treatments relieve endometriosis pain. NSAIDS like ibuprofen, for one, don’t appear to be effective, and there’s a strong potential for addiction and abuse with opioid painkillers. Although research suggests hormonal birth control can reduce symptoms, many women stop or avoid using it due to perceived side effects like mood swings and depression.

“Women with endometriosis often report that despite various medications, they have pain that is difficult to deal with,” Dr. Armour tells Florence Health. That’s why it’s not surprising they’re turning to cannabis and CBD, he adds, since limited studies suggest these drugs may (or may not) relieve pain.

The difference between cannabis and CBD

Cannabis is the most popular illicit drug in the United States; there has been a steady rise in use every year since 2007, with 7.7 percent of American adults reporting using it within the past month as of 2017. That may be in part because it’s well on its way to becoming a legal medical therapy. A total of 33 states and the District of Columbia have legalized medical marijuana to date; 11 states and D.C. also permit marijuana for recreational use, with another 16 states having decriminalized the possession of small amounts of the drug.

“Prescribing” CBD and Cannabis

Marijuana remains illegal at the federal level, so the act of prescribing it is still illegal, even in states that have legalized it. Physicians and some APPs can, however, write a recommendation for and discuss the benefits of the plant if the patient suffers from a qualifying condition covered by their local law (usually severe conditions like cancer, HIV/AIDS, glaucoma, or multiple sclerosis).

Because the Drug Enforcement Agency classifies cannabis as a schedule 1 drug — with more restrictions than even fentanyl or methadone — officially, there are “no currently accepted medical use and high potential for addiction.” It requires a rigorous approval process to study, so to-date there’s little peer-reviewed research. That leaves providers hesitant to recommend a drug that’s hasn’t been rigorously studied and whose contents and dosage aren’t regulated by the FDA.

Meanwhile, interest in cannabidiol, or CBD, has skyrocketed in recent years. While CBD is an essential component of marijuana, it doesn’t contain tetrahydrocannabinol (THC) and therefore doesn’t cause a “high.” A full 14 percent of American adults say they use CBD, according to an August 2019 Gallup poll, most often for pain (40 percent), anxiety (20 percent), and insomnia (11 percent).

Only one CBD-derived drug, which treats seizures in children, has been approved by the Food & Drug Administration (FDA). All 50 states have legalized CBD in some form, and retailers have added it to pretty much any product you can imagine — from cheeseburgers to toothpicks to mouth wash.

How can cannabis and CBD affect endometriosis?

Cannabis mimics endocannabinoids, natural molecules that act on the endocannabinoid system (ECS), which maintains homeostasis in the body. ECS receptors, in turn, are found throughout the human body. The ECS participates in a wide variety of processes, including pain, stress, sleep, metabolism, immune function and reproduction.

While research is lacking, Dr. Armour says there’s another reason to believe cannabis could have a particularly powerful effect on endometriosis pain. Both the uterus and ovaries have highly expressed cannabinoid receptors, he explains. Some researchers even think cannabis could slow the growth of endometrial tissue.

“The endocannabinoid system has been found recently to interact with specific mechanisms associated with pain,” explains Dr. Armour. “It also appears to play an important role in cellular proliferation and apoptosis, which may explain why cannabis is being used by women with endometriosis. However, little has been done clinically to investigate this currently.”

What the research says

While there’s little research into cannabis for pain, one recently published paper found it may can effectively reduce pelvic pain and opioid use. In Dr. Armour’s study, on average, respondents rated the effectiveness of cannabis a 7.6 out of 10, with 55 percent reporting they were able to reduce the need for pharmaceuticals by at least half. Women reported the greatest improvements in sleep and nausea/vomiting, with only 10 percent saying they experienced adverse side effects, like anxiety, drowsiness, and rapid heart rate.

CBD, meanwhile, appears to have analgesic, anti-inflammatory, and immunomodulatory properties — but “the jury is out at the moment as to whether it can provide as much potential pain relief in endometriosis as THC does,” says Dr. Armour.

What should you tell patients with endometriosis about using CBD or cannabis?

For now, researchers agree that there’s not enough research to make a conclusion about the benefits or risks of cannabis. People who are at risk of developing addiction or schizophrenia should avoid it altogether, while patients with lung disease should avoid smoking it since it causes airway inflammation, wheezing and chest tightness.

Understanding the risks

For patients interested in using cannabis, “talking with a physician who understands the ECS and has experience in prescribing cannabis is an important first step,” says Dr. Armour. “Like all medications, it still comes with certain risks.”

CBD, on the other hand, may seem less risky to recommend, as it doesn’t have the psychoactive effect of THC and no known risk of abuse or dependence, notes Dr. Armour. But there still are dangers.

Because CBD isn’t regulated by the FDA, it’s impossible to confirm the exact ingredients or concentration in any given supplement. The FDA has found some CBD products contain contaminants like pesticides and heavy metals.

What’s more, CBD can raise levels of certain medications. “[It’s] been shown in preclinical and case studies to change the way certain medications are metabolized. It appears to be of more concern than THC in this particular regard,” notes Dr. Armour. Providers should ask patients taking CBD about any other medications they’re on and closely monitor for adverse side effects, he adds.

Safer alternatives

Dr. Armour also calls out the other, nonpharmacological treatments that can address endometriosis symptoms. Some women find relief from heat packs, hot baths, and hot water bottles. Research suggests that acupuncture twice a week for several months may reduce pelvic pain, although it’s unclear whether the effect lasts after patients complete treatment. And a low-FODMAP diet may help improve any IBS-like symptoms. Just remind patients that this eating plan is for short periods of time.

References:

What Is the Low FODMAP Diet?, Academy of Nutrition and Dietetics.

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