Written by: Veronica Paz Booth, Item 9 Labs Educator
March is Endometriosis Awareness Month. We want to take this opportunity to educate our community about a painful condition that many women face that can be soothed with cannabis. Endometriosis is a condition where tissue that typically grows inside of the uterus, the endometrium, grows outside of the uterus. This tissue can grow on the ovaries, fallopian tubes, and other areas of the abdomen. The tissue responds to hormone cycles just like it does inside of the uterus, so every month, alongside the menstruation cycle, the tissue builds up and then breaks down as it sheds. Unlike the regular tissue, the shedding from misplaced cells is often trapped within the body which can cause pain and scarring. This condition is the leading cause of chronic pelvic pain in women and can lead to anxiety and depression among sufferers. There is no cure for endometriosis, but there are options to keep the condition in check. Some of these options of treatment are painkiller and/or hormone therapy and/or surgery.
How the cells arrive to these areas outside the uterus is still unknown, but once they get there they migrate to other areas of the body, including reclaiming areas where tissue has been surgically removed, recruit blood veins to supply nutrients, and grow nerve endings that increase perception of pain.
Women who suffer from this condition could benefit from high CBD, low THC cannabis strains (in tincture and/or flower), high CBD topicals and high CBD vaginal suppositories. If THC is not tolerated, whole plant hemp-derived CBD extracts would be preferred over isolates.
The entourage effect suggests that the compounds of the cannabis plant work synergistically, meaning that all parts of the plant work collectively to create the overall effects. Even though many cannabinoids and terpenes are found in just fractions of a percentage in the plant, they matter, and they are part of the pharmacodynamic effect of the plant. Studies and anecdotal evidence show that CBD works better, and smaller doses are needed with the presence of THC and other phytochemicals. Whole plant cannabis extracts have demonstrated two to four times greater effects than isolated THC in studies.
The endocannabinoid system (ECS) regulates cellular migration. Imbalances in the ECS have been linked to reproductive conditions and complications. Studies show that other biological targets outside of the ECS also regulate some of the symptoms and complications of endometriosis. When GPR18, a receptor outside of the ECS, is stimulated, it will increase cellular migration. CBD has been shown to be an antagonist to this receptor meaning that CBD should help prevent the spread of this tissue. THC on the other hand, activates this receptor which can encourage endometrial cell migration. For this reason it is recommended that women who use THC, for immediate pain relief for example, counterbalance with CBD.
TRPV1 vanilloid receptor is a gated ion-channel that usually causes pain when stimulated and is a receptor which can be overly expressed in sufferers of endometriosis. CBD activates and desensitizes this receptor, and it may be the reason why there is much anecdotal evidence of women successfully using CBD for endometriosis pain-relief.
High CBD cannabis strains also contain THC. If using these strains, the patient will also benefit from the pharmacodynamic effects of THC which can be beneficial for immediate pain relief.
High THC strains and products may be used as a “rescue” when relief is needed most.
Women who used cannabis as treatment to their endometriosis also reported improvements in other symptoms such as gastrointestinal problems, nausea, anxiety, depression, and sleep.
Good to know: While primarily found in the brain and central nervous system, CB1 receptors of the ECS are highly expressed in the uterus.
REFERENCES
1 Moore G. 7 Ways Cannabinoids Combat Endometriosis. Foria. 2020. Retrieved from: https://www.foriawellness.com/blogs/learn/how-cbd-thc-endometriosis-pain-relief
2 Endometriosis. Chronic Pain Research Alliance. 2020. Retrieved from: http://www.chronicpainresearch.org/Endometriosis
3 Biles M. CBD and Cannabis for Endometriosis. Project CBD. 2020. Retrieved from: https://www.projectcbd.org/medicine/cbd-cannabis-endometriosis
4 Russo E. Taming THC: Potential Cannabis Synergy and Phytocannabinoid-Terpenoid Entourage Effects. British Journal of Pharmacology. 2011. Retrieved from:
5 Coop A. USMC 602 Module 4 Lectures. 2020. The University of Maryland School of Pharmacy.
6 Kossen J. Is Cannabis Better for Chronic Pain Than Opioids? Leafly. 2016. Retrieved from: https://www.leafly.com/news/health/cannabis-for-chronic-pain-vs-opioids
7 Bouaziz J, On A, Seidman D, Soriano D. The Clinical Significance of Endocannabinoids in Endometriosis Pain Management. US National Library of Medicine. 2017. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5436335/
8 Kim L. UCSF Study Finds Medical Marijuana Could Help Patients Reduce Pain with Opiates. University of California San Francisco. 2011. Retrieved from: https://www.ucsf.edu/news/2011/12/98498/ucsf-study-finds-medical-marijuana-could-help-patients-reduce-pain-opiates
9 Sinclair J, Armour M. 1 in 10 women with endometriosis report using cannabis to ease their pain. The Conversation. 2019. Retrieved from: https://theconversation.com/1-in-10-women-with-endometriosis-report-using-cannabis-to-ease-their-pain-126516
10 Eddington E. USMC 602 Module 5 Lectures. University of Maryland School of Pharmacy. 2020
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