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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Cannabidiol and Management of Endometriosis Pain
The proposal is to conduct a randomized double-blind placebo-controlled pilot study to evaluate the effectiveness of cannabidiol on the management of endometriosis-related pain.
Subjects will be pre-screened from new and existing patients as well as from referral sites for the diagnosis of endometriosis. Potential subjects will be pre-screened for moderate to severe endometriosis associated pain (VAS > 3) greater than 6 months. Those meeting all inclusion and exclusion criteria that who are willing to participate will receive a detailed history and physical exam, appropriate bloodwork and undergo informed consented at the Screening Visit. Baseline survey data will be collected. During Screening, the patient’s will be asked to complete their daily electronic diaries and screened for daily reporting adherence.
Randomized subjects will receive either (1) placebo (2) low dose CBD (3) high dose CBD. This study will include an 8-week intervention period during which subjects will be asked to record daily electronic VAS scores, pain medication use and a number of other parameters. Subjects will return at week 12 for a 4 week post-treatment visit, where they can also chose to enroll in an optional pharmacokinetic study. Participants will complete the Endometriosis Health Profile-30 (EHP-30), Patient Global Assessments (PGAs), the Patient Global Impression of Change (PGIC) surveys and, if partnered and sexually active, the Female Sexual Function Index at various time points. Patients will also have bloodwork done to assess for circulating markers of inflammation, circulating CBD concentration levels and liver dysfunction throughout the study duration. Subjects will be screened for side effects and asked to record pain medication use throughout the duration of the study. Study drug compliance will be assessed.
At the completion of the study, all subjects will be offered the opportunity to do pharmacokinetic testing with sublingual CBD until a maximum number of 4 patients are enrolled. The testing will include 24 hours of monitoring with sequential blood draws to determine the pharmacokinetic parameters of sublingual CBD after administration and one salivary pH. They will be discharged at 24 hours and asked to return to the clinic at 48 hours for one final lab draw.