Endometriosis, a painful long-term condition, affects about 11% of women in the U.S. No cure is yet known and it can lead to ovarian cancer or infertility. Now that we’ve gotten the bad news out of the way, we want to give some good news: CBD can provide endo relief. Learn more with this in-depth guide! Cannabis is becoming a popular choice for women with endometriosis. Does CBD oil help treat the condition aside from relieving endometriosis pain? This article points you to the right answers. Many women with endometriosis use cannabis and CBD for pain relief, and cannabis therapeutics may also limit the spread of endometrial cells around the body.
CBD for Endometriosis, Explained
Seeking an effective treatment for endometriosis can be exhausting and often disappointing. Although endometriosis is common and affects about 11% of women in the U.S., there is no medical cure for this disorder. This lack of effective treatments is why many women are turning to natural medicine for relief – and discovering CBD.
Cannabidiol (CBD), the main cannabinoid found in hemp plants, is widely praised for its usefulness in helping with endo discomfort. However, it’s not just popular opinion that backs using this cannabinoid for endometriosis: Some promising research also points at numerous ways that CBD could help this condition. In this article, we’d like to give you a closer look at how endometriosis affects your body, and why CBD might be the answer you’ve been seeking.
A Close Look at Endometriosis
To understand how CBD could help relieve endometriosis symptoms, let’s first take a closer look at endometriosis itself. Endometriosis is a painful disorder linked to the female reproductive system that is the result of uterine tissue growing outside the uterus. This tissue that normally lines the inside of the uterus is known as the endometrium, and it is programmed to thicken, break down and bleed during monthly periods.
This cyclical pattern works fine in the uterus, which clears out the old, discarded tissue through the vagina. But unfortunately, when endometrial tissue grows outside of the uterus, these discarded tissues become trapped and cannot leave the body. This often causes a lot of pain and inflammation, especially during the menstrual cycle, and can result in the common symptoms of endometriosis:
- – Chronic pelvic pain
- – Bleeding between periods
- – Severe menstrual cramps
- – Lower back or abdominal pain
- – Pain during sex
- – Pain during bladder or bowel movements
- – Moderate to debilitating inflammation
Stages 1 and 2 of endometriosis occur when there are minimal lesions and superficial implants around the organs. When the condition advances into stages 3 and 4, this is considered deep infiltrating endometriosis (DIE). This occurs when the scar tissues have infiltrated 5 millimeters of the pelvic organs and ovarian cysts have formed. The implants become deep and there are dense adhesions.
Although we don’t know the true cause of endometriosis, there are a few popular theories. One theory is that endometriosis arises from retrograde menstruation, which is when menstrual blood flows back through the fallopian tubes and into the pelvic cavity (instead of exiting through the vagina). Another theory is that hormones could mistakenly transform cells outside of the uterus into endometrial cells. There are still more theories, but none have been confirmed.
In addition to causing physical discomfort, endometriosis can also potentially impact the reproductive system. If the condition affects the ovaries, this can lead to the formation of endometriomas or ovarian cysts. In severe cases, endometriosis can lead to infertility or ovarian cancer, which is why it is always important to consult your doctor if you think you might have endometriosis.
Treatment for Endometrial Pain
Some common treatments doctors suggest for this condition are analgesic drugs, hormone therapy, and surgery. Each option comes with downsides, and it’s often difficult to know which – if any – will work for you. Here’s a more detailed explanation of these options and their possible side effects/complications:
- – Analgesics: Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most common pain medications recommended for endometriosis. This includes over-the-counter NSAIDs like ibuprofen, aspirin, and naproxen, as well as some prescription-strength NSAIDs. For NSAIDs to be most effective, they should be taken before the pain has started. However, this can be difficult to time if you have an irregular period. Additionally, some studies suggest that NSAIDs might not be very effective for endometriosis pain. For instance, one study suggested that as many as 70% of young women with endometriosis are resistant to NSAIDs. On the other hand, although opioids can be effective painkillers, they should only be used sparingly due to their highly addictive and potentially dangerous nature.
- – Hormone therapy: This type of treatment includes hormonal birth control, progestin therapy and gonadotropin-releasing hormone (Gn-RH), all of which can come with serious negative side effects. Hormones are used as messengers throughout our bodies, and their use can have far-reaching consequences that research is only starting to understand. For many women, hormonal birth control and progestin therapy can cause headaches, nausea and mood changes, while Gn-RH can cause artificial menopause.
- – Laparoscopic or laparotomy surgery: Both of these surgeries are designed to remove the problematic endometrial tissue. Since they are invasive procedures, they come with a general surgical risk: About 1% of surgeries can lead to organ injuries or other complications. Additionally, although surgery could help relieve your pain in the short term, endometrial implants grow back in about 20% of patients within five years of surgery.
CBD For Endometrial Pain
These days, almost everyone has heard about CBD and its many uses. However, it can sometimes be difficult to separate scientific evidence from marketing claims, which makes it difficult to decide if CBD has a place in your self-care routine. That’s why we’ve put together a straightforward review of what the research currently says about using CBD for endometriosis, including links directly to the research.
In order to compare the effectiveness of different natural strategies for helping with pain, researchers surveyed 484 women with endometriosis to discover which strategies (including dietary changes, yoga, exercise, meditation, heat, cannabis and CBD oil) were most useful. CBD ranked near the top , scoring an average of 6.3 for effectiveness when rated on a scale of 1 to 10.
In this study, cannabis (which contains both THC and CBD) ranked as even more effective than CBD alone. Additionally, compared to most other endometriosis treatment options, CBD has relatively few side effects. The side effects people experience most often when taking CBD include reduced appetite and drowsiness.
Studies like the above study which show that CBD is useful for coping with endometriosis pain are important milestones, but for most researchers, the more important question today is why does CBD help with endometriosis. What causes CBD to alleviate the symptoms of this painful condition? And that’s where things get a little more technical.
Juna created the Ease Collection specifically with our endometriosis community in mind. It has a complex ratio of CBG:CBD with added anti-inflammatory agents like turmeric. Juna’s Ease collection helps tackle endo pain from the inside and out with the ingestible and topical formats.
How could CBD provide Endometriosis relief?
Once it enters our bodies, CBD interacts with many targets including our endocannabinoid systems (ECS). The ECS is a biological system that’s deeply rooted in many of our bodies’ different systems, and scientists are only just beginning to unravel its many functions. So far, the ECS has been linked to homeostasis of our appetite, sleep, mood, and memory.
In addition to the endocannabinoid system, CBD also interacts with important receptors like TRPV1 (a pain receptor) as well 5-HT 1A (a serotonin receptor ). This diversity of targets helps explain the diversity of benefits that people experience with CBD. Below is a breakdown of the top ways that scientists currently believe CBD could help provide relief from endometriosis:
- 1. CBD could prevent cell proliferation and cell migration: Normally, if endometrial tissue started growing in the wrong location, our bodies would respond by identifying and destroying those cells in a process called apoptosis. Unfortunately, apoptosis is impaired in endo-sufferers, leading to a growth and movement of endometrial tissue outside of the uterus. Endogenous cannabinoids in the ECS play a large role in apoptosis, and activation of Cannabinoid Receptor-2 (CB2) could help activate apoptosis. CBD might help this process by increasing your body’s natural production of endocannabinoids, or directly affecting the CB2 receptor. Additionally, CBD blocks certain receptors like GPR18 that allow cells to migrate to other parts of the body.
- 2. CBD may inhibit inflammation: A major source of pain for endometriosis sufferers is the inflammation that arises from the body having to break down and absorb the material shed monthly by endometrial implants. Studies have shown that CBD may decrease cytokine production , which are proteins produced by your body that signal the immune system and can trigger inflammation. In animal subjects, CBD can inhibit pro-inflammatory cytokines and reduce inflammation. Cannabinoids are also said to help modulate the immune system, which could make them useful for other types of inflammatory health concerns.
- 3. CBD can help reduce pain: Ultimately, what most endometriosis sufferers need is something that can help reduce their pain. Countless people use CBD for pain reduction, which scientists think might in part have to do with its ability to desensitize pain-perceiving TRPV1 receptors . Additionally, other receptors that influence pain include the serotonin receptor 5-HT 1A as well as other ECS receptors that are better targeted by THC. This is why some people find that CBD products that include THC can be more effective at addressing pain, in which case you might want to try a full-spectrum CBD product which contains a little THC.
CBD research is still ongoing and more studies need to be done to confirm the efficacy of CBD on endometriosis. Always consult your doctor first before starting a new type of endo treatment.
Is CBD Right For Me?
Ultimately, only you can decide whether or not CBD is right for you. In order to help your decision process, here’s a short summary of the pros and cons of using CBD oil for endometriosis support:
- – Has anti-inflammatory properties
- – Could provide relief from endometrial pain
- – Is safe and tolerable
- – Comes from a natural source
- – Potential for other positive effects such as reduced anxiety and better sleep
- – Has minimal side effects
- – Lack of clinical trials on CBD for endometriosis in humans
- – Potential side effects include loss of appetite, dry mouth, diarrhea, and sleepiness
- – Not all CBD manufacturers are trustworthy and/or safe
Choosing the Right CBD Oil for Endometriosis Pain
CBD oil can provide a lot of great benefits with minimal side effects, but it might take some time to narrow down on the right products for your body . As we mentioned in the “Cons” section, not all CBD manufacturers are trustworthy. Due to the lack of regulatory oversight right now in the CBD industry, many dishonest manufacturers are pushing products that won’t be right for your condition or even contain what they claim.
Only one CBD product (Epidiolex) has been approved by the FDA, which is a drug used to treat a rare form of childhood epilepsy. Any other product claiming to be FDA-approved is making a false claim. Also, beware of CBD products marketed with unproven medical claims and of unknown quality/origins. Make sure to check the product label to verify exactly what you are putting in your body, and make sure it has been third-party tested .
Once you’ve identified a good manufacturer, the next step is deciding what kind of product is best for you. One of the first things you should decide is whether you want a full-spectrum, broad-spectrum or isolate CBD product. Full-spectrum CBD includes all of the cannabinoids naturally found in hemp, including CBD, THC (at a concentration of 0.3% or less), cannabigerol (CBG), and cannabinol (CBN). Broad-spectrum CBD includes all of these except THC. As we’ve mentioned previously, having THC as part of the regimen may provide increased pain relief.
CBG is another exciting up-and-comer in the cannabinoid world. It has a lot in common with CBD with its analgesic and anti-inflammatory properties. And not only does it soothe your physical symptoms, it can also provide a rapid mood-soothing effect as well. We’ve included this important cannabinoid in both our Ease tincture and CBD topical products to help with PMS and endo pain, inside and out. This combination of cannabinoids in a full spectrum product enhances its overall potency, which is not something available in most other CBD oils.
Broad-spectrum products specifically remove THC, while CBD isolate removes everything other than CBD. With an isolate, you not only lose out on the collaborative benefits of the other cannabinoids, but you also miss the other terpenes and plant phenolics that can help enhance CBD’s effectiveness. The synergistic benefit found in full-spectrum CBD products is called the entourage effect, which is thought to work by the overlapping and complementary activities of the individual components – as designed by nature. And that means more health benefits for you.
Time to Experience the Soothing Benefits of CBD
After choosing the product you want, you will then have to decide how much is appropriate to take for endo pain. Additionally, you’ll have to choose how to take it.
When it comes to dosage amount, it will depend on how much CBD the product contains, as well as how severe your pain is. Currently, without appropriate clinical studies, there is no standard recommendation for an appropriate dosage for endometriosis pain. Therefore, we advise caution. Although unlikely, taking an extremely high dosage of CBD may cause liver damage, as animal studies have indicated. It is best to consult your doctor when deciding dosage.
There are also a wide variety of ways to “take” CBD oil. CBD tinctures can easily be administered beneath your tongue. You can also vape CBD oil, or apply topical CBD creams. Or, you can consume edibles with CBD as an ingredient.
When taking CBD for endometriosis, you will probably be seeking quick pain relief. Vaping is often touted as the quickest way to absorb cannabinoids. However, be aware that vaping can cause side effects like allergic reactions, shortness of breath, and chest pain, and also might lead to long-term lung damage.
Oil, tinctures, capsules, soft gels, and gummies may take longer to reach your system than vaping, but will also allow the CBD to absorb into your system over time, producing a longer and more steady outcome. We find oils to be the best way to administer CBD. It is quick, and you can easily measure out the exact dose you want on the applicator before conveniently dropping it under your tongue.
Don’t Let Endometriosis Slow You Down
Our busy lives are filled with activity. Don’t let the pain of endometriosis slow you down from doing the things you love. CBD oil’s nourishing, soothing properties will get you back to feeling good again.
Here is what some endo-sufferers are saying about our product :
From Ashley B – @cenizaly
“I was unfortunately diagnosed with endo about 3 years ago, right after I had my son. This tincture has been amazing. The taste is very light. It is also very potent, which is something I was looking for. I incorporate this in my daily life for my endo and general well-being. It has helped tremendously with the pain and inflammation. Also realllly helps me focus and keeps my mental health in check.”
“Okay so Juna is a game CHANGER.
I had to jump on board and try out what I like to call #endometriosis friendly products, since I am someone who deals with anxiety which in return affects my physical health and flare ups associated with endo (bloating, discomfort, acne, etc.)
I started using this product about a week ago, adding drops to my morning drink every day. The effects I feel are tremendous! It has calmed my anxiety that I tend to feel upon waking up (specifically on busy days!) keeping me calm + collected. Overall, it’s a stress reliever. Currently balancing 2 jobs and 2 summer classes is not easy but this simple addition to my everyday routine has made it that much easier. It really surprised me how effective it is!
Juna’s Balance X an Ease are powered by earth’s most therapeutic ingredients to optimize your mind, body, and mood. Each drop contains 50 mg of CBD and can be used in your food/ beverage of choice or even under your tongue! All ingredients are certified organic MCT coconut oil, full spectrum hemp oil.”
Disclaimer: This content is for informational purposes only. It is not provided to diagnose, treat, cure, or prevent any disease or ailment. It should not be interpreted as instruction or medical advice to displace the advice of your doctor or other medical professionals. We recommend talking to your doctor to prepare a treatment plan for any diseases or ailments.
CBD Oil for Endometriosis Pain: Does It Help?
Endometriosis is an autoimmune disease involving the abnormal growth of cells similar to those found in the womb’s lining. According to statistics, the condition affects 1 in 10 of women of reproductive age — contributing to 176 million instances worldwide.
Researchers still don’t understand why endometrial tissue begins to grow in the uterus, spreading to the nearby pelvic organs, such as ovaries, bladder, and bowel.
The problem with endometriosis is that the errand cells start to bleed during the bleeding phase of a woman’s menstrual cycle. But unlike the normal cells, the ones triggered by endometriosis can’t pass their blood outside, causing inflammation, pain, and formation of scar tissues.
Today, we explore the benefits of using CBD oil and other types of cannabis extracts for endometriosis pain and related symptoms.
Can CBD Help with Endometriosis?
Women with endometriosis are typically prescribed pain medication, hormone therapy, or need to undergo laparoscopic surgery.
Hormonal treatments are known to cause undesirable side effects; for example, Gn-RH, a popular hormone, may trigger artificial menopause on top of causing headaches and bloating.
The efficacy of NSAIDs, such as ibuprofen, for EM-associated pain, is also questionable.
According to a review published in Deutsche Arzteblatt International, 70% of young women with endometriosis don’t respond to NSAID treatments .
That’s why alternative options, such as CBD oil, are becoming more popular for this disease.
The BMC Complementary and Alternative Medicine published a cross-sectional online survey that evaluated the efficacy of self-management strategies .
Among the most popular choices, such as hot compress, diet changes, yoga, and exercising, CBD oil scored a high place.
The study found that women who took CBD oil reported the highest pain relief scores among women who participated in the study.
Another study posted in Therapeutics and Clinical Risk Management mentioned that CBD produces anti-inflammatory effects. The author added that CBD was able to stop the release of proinflammatory cytokines in animals .
A follow-up cross-study published by Proc Natl Acad Sci USA confirmed these results, showing CBD’s immunosuppressive action through decreasing cytokine production .
Clinical Research On CBD & Endometriosis
So far, there have been no clinical trials examining the efficacy of cannabis medicine in women with endometriosis.
Two clinical trials are about to investigate the effects of phytocannabinoids on endometriosis pain and related symptoms.
In a Spanish open-label phase II trial, women with endometriosis-induced hyperalgesia will receive an oral spray with a 1:1 ratio of THC and CBD .
In another phase III double-blind placebo study, patients will be administered norethindrone acetate, a hormonal treatment, supplemented with either 10 mg or 20 mg of CBD for the management of endometriosis pain .
Gathering sufficient robust evidence to convince the medical world that cannabinoids are effective for endometriosis may take years. In the meantime, cannabis will undoubtedly play a significant role in the self-care routine of women around the world when it comes to easing their endometriosis pain.
How Does CBD Oil Work to Help with Endometriosis Pain?
The endocannabinoid system (ECS) is a vast network of endogenous cannabinoids, enzymes, and G-coupled receptors that are spread throughout the body.
These receptors (type 1 and 2) are present in the central nervous system, immune system, and peripheral organs. The main role of the ECS is to promote and maintain homeostasis in the body.
ECS modulation has been associated with therapeutic effects in several health conditions, including anxiety, insomnia, neurodegeneration, epilepsy, and chronic pain.
The CB1 receptor can be found in pain circuits; it also participates in producing pain-killing and anti-inflammatory effects. Meanwhile, the effects of CB2 receptor activity are mostly expressed in the immune system.
A 2017 study explained how THC and CBD act on these receptors. Their activity might be beneficial for women with endometriosis pain or even when their menstruation stops and other chronic pain conditions .
Several studies have implicated that CBD and other cannabis compounds can inhibit proinflammatory cytokines.
One study published in Pain journal found CB1 receptors in the rodent uterus. The research team suggested that CB1 receptors are a potential target treatment to curb hyperalgesia (sensitivity to pain) in that area .
The study also provided evidence that endocannabinoids and phytocannabinoids could be useful in alleviating endometriosis symptoms.
How to Use CBD for Endometriosis
There are several types of CBD to choose from; the three main types include full-spectrum CBD, broad-spectrum CBD, and CBD isolate.
Full-spectrum CBD contains the original phytochemical profile of the source plant, including minor cannabinoids, terpenes, flavonoids, and traces of THC. Read our Full-Spectrum CBD guide to learn more.
These compounds work synergistically to enhance the beneficial effects of the major cannabinoids and mitigate their potential side effects. This concept is known as the entourage effect.
Broad-spectrum CBD is much like its full-spectrum counterpart, save for the lack of THC. The intoxicating compound is removed from the extract after the initial extraction.
CBD isolate is exactly what it sounds like — pure cannabidiol. It occurs as whitish crystals that are then turned into a powder and mixed into different products. Isolates have no odor or flavor, and they also don’t evoke the entourage effect.
Let’s take a look at which type of CBD is more helpful in managing endometriosis pain.
Full-spectrum vs. Isolate: Which is Better for Endometriosis?
Focusing on individual cannabinoids and their mechanisms makes it easy to think that the cannabis plant has little to do with endometriosis.
Dr. Ethan Russo, a neuroscientist and passionate proponent of the entourage effect, underlines the importance of whole-plant cannabis medicine as a treatment for endometriosis and other conditions.
Russo says that there are “multiple components of cannabis that can be put together in the right preparation to treat endometriosis, both in terms of symptoms, the pain, and affecting the disease process itself. It’s rare these days that an issue like endometriosis or cancer or diabetes is going to be successfully treated with one agent.”
Conventional pharmacology tends to isolate a compound, give it a target, and observe how it deals with it — which can be very specific.
However, this pharmacology ignores the bigger picture, so it’s unlikely that one molecular mechanism will take care of the whole symptoms associated with endometriosis.
It’s worth noting that throughout human history, plants have been used medicinally. Synthetic drugs were developed later, but many of them are based directly or indirectly on plant-based chemicals.
CBD Oil for Endometriosis
CBD oil is the most popular form of CBD for endometriosis. It’s a thick hemp extract that is further diluted with a carrier oil for improved bioavailability — and bottled up with a dropper to make dosing easier.
CBD oil can be ingested in different ways. It can be taken under the tongue, where it should sit for around 60 seconds. The sublingual mechanism ensures a faster onset of effects, higher bioavailability, and better absorption. That’s because CBD enters the bloodstream directly through the tiny blood vessels in your mouth.
Other popular formats include capsules and gummies, which are better for people who dislike the taste of natural CBD oil and are looking for a precise dose in each serving.
Vaping is the fastest and most effective way to deliver CBD to your system. When you inhale CBD through a vape pen, it enters the bloodstream through the lung tissue, providing almost instantaneous effects.
CBD Cream for Endometriosis
A lot of women with endometriosis combine two forms of CBD oil — oral and topical.
When you take CBD oil, gummies, or capsules, they target EM symptoms from within, which is great for symptom control and reaching the underlying cause.
But, when you experience endometriosis flare-ups, they may require a more localized approach, such as a topical formulation.
Topical products like CBD creams, lotions, gels, and salves, are applied directly to the skin. From there, they interact with the skin’s CB2 receptors, producing a relaxing and anti-inflammatory response.
This, in turn, may contribute to effective pain control. Topicals can take between 10 and 60 minutes to start working, depending on the formulation.
CBD Dosage for Endometriosis
Most of our modern pharmaceutical medications come with standardized dosages and guidelines regarding their use.
On the other hand, CBD is a very personalized substance and can have different dosages even for people of the same height, weight, and lifestyle.
Cannabis dosages always start from low amounts and take time to gauge the effective dosage for each individual. Doctors will start you on a medication they believe will work best for you and then titrate the dose to adjust it to the severity of your symptoms and your individual body chemistry.
The goal of successful CBD dosage for endometriosis is to find the amount that gets you maximum effects with few side effects.
Can You Use Medical Marijuana for Endometriosis?
Yes, medical marijuana can be helpful in endometriosis. While CBD can effectively reduce EM pain, THC uses another important mechanism to benefit women with endometriosis.
With fewer CB1 and CB2 receptors in endometrial tissue available for endocannabinoids to bind with, the natural process of cell death (apoptosis) may be compromised, allowing for the malignant cells to multiply and spread.
Preclinical research indicates that endogenous, Phyto, or synthetic cannabinoids that target these two receptors can control the development of endometriosis.
In a 2017 study, the authors showed that drugs stimulating CB1 and CB2 receptors contributed to decreased proliferation and growth of endometrial tissue and its breakdown or what we call apoptosis .
While this may sound bad, apoptosis is a normal programmed cell death that’s part of their life cycle, and it’s disrupted in abnormal growth such as cancer or endometriosis.
This would explain why THC and potentially other molecules in cannabis would be symptomatically helpful and also target the actual pathology of endometriosis.
A recent study evaluating the effect of THC on a mouse model of endometriosis concluded that THC not only reduced pain markers but also inhibited the growth of an endometrial cyst.
Final Thoughts on CBD and Endometriosis
Animal and preclinical human studies have shown that CBD has anti-inflammatory and analgesic properties. These effects may be useful in targeting pain that is difficult to treat, such as the one triggered by endometriosis.
Since all cannabinoids and terpenes can interact with the endocannabinoid system, many of them have similar anti-inflammatory and antioxidative properties, whole-plant extracts appear to be the most effective form of cannabis treatment.
If you live in a place with a legal medical marijuana program, you can combine CBD oil with a high-THC product to optimize your treatment and use a holistic approach.
Currently, the only federally legal way to use CBD for endometriosis is by taking CBD oil and/or cream. This way, you can both support your endocannabinoid system and target localized pain.
A consultation with a doctor experienced in cannabis use should help you determine the right dosage and avoid negative interactions with any medication you might be taking.
- Armour, M., Sinclair, J., Chalmers, K.J. et al. Self-management strategies amongst Australian women with endometriosis: a national online survey. BMC Complement Altern Med 19, 17 (2019). https://doi.org/10.1186/s12906-019-2431-x (1)
- David Garcia Cinca, Hospital Clinic of Barcelona. (2019). Effect of Cannabinoid (THC / CBD 50%) on Hyperalgesia of Patients with Deep Endometriosis (EndomTHC). Available at: https://clinicaltrials.gov/ct2/show/NCT03875261 (2)
- Deimling, A.T. (2020). Cannabidiol and Management of Endometriosis Pain. Available at: https://clinicaltrials.gov/ct2/show/NCT04527003 (3)
- Dmitrieva, N., Nagabukuro, H., Resuehr, D., Zhang, G., McAllister, S. L., McGinty, K. A., Mackie, K., & Berkley, K. J. (2010). Endocannabinoid involvement in endometriosis. Pain , 151 (3), 703–710. https://doi.org/10.1016/j.pain.2010.08.037 (4)
- Bilgic, E., Guzel, E., Kose, S., Aydin, M. C., Karaismailoglu, E., Akar, I., Usubutun, A., & Korkusuz, P. (2017). Endocannabinoids modulate apoptosis in endometriosis and adenomyosis. Acta histochemical , 119 (5), 523–532. https://doi.org/10.1016/j.acthis.2017.05.005 (5)
Nina created CFAH.org following the birth of her second child. She was a science and math teacher for 6 years prior to becoming a parent — teaching in schools in White Plains, New York and later in Paterson, New Jersey.
CBD & Cannabis for Endometriosis
Endometriosis, the abnormal growth of cells similar to those in the lining of the womb, is a condition that affects 1 in 10 of women of reproductive age. That’s a staggering 176 million women worldwide. 1
For reasons still not fully understood, endometrial tissue begins to grow outside the uterus, gathering around the nearby pelvic organs such as the fallopian tubes, ovaries, bladder, and bowel. The trouble is, every time a woman goes through the bleeding phase of her menstrual cycle, so do the errant endometrial cells. Although in their case, there is nowhere for the blood to exit the body, causing pain, inflammation, and in some cases the formation of scar tissue.
Not all women experience the excruciating pain and heavy periods associated with the disease, but even in these less severe cases, if left untreated, endometriosis can lead to infertility.
‘A woman’s lot’
Carrie, 29 from the UK and author of The Endo Monologues, started noticing she had heavier periods than her friends at the age of fourteen. Like many women and girls with ‘problem periods,’ she was put on the pill which helped at first.
Women sufferers are frequently told to simply ‘put up with’ the pain as it’s part of being a woman.
“My pain kind of started to get worse in my late teens, early 20s,” recalls Carrie. “I was missing school, I started missing university. And it just felt like I had a hot knife piercing around my pelvic area and my back.”
Echoing the experience of most endometriosis patients, the pain was worse around her periods. “I’d be bed bound,” says Carrie. “Being on the pill kind of shortened it but it hurt to go to the toilet, it hurt to walk, it hurt to sleep, I couldn’t have sex, it just became unbearable.”
For years Carrie’s pain was not taken seriously, reflecting an overall gender bias in drug research and medicine itself. 2
It’s been reported that when it comes to pain, women are more likely than men to be given sedatives rather than actual pain medication, probably stemming from an erroneous link between women’s health and hysteria dating back to the Ancient Greeks. 3 This was certainly Carrie’s experience.
“I was made to think that I was just being overdramatic and that maybe I was just over exaggerating it because I wanted the attention and was almost being gaslit to be made to feel that it was in my head. They said, ‘Oh, well, you know, it’s just your period, that’s how it is.’ It very much got brushed aside.”
In Carrie’s case, accusations of promiscuity were even made by her doctor, and she was sent off to a STI [sexually transmitted infection] clinic before her symptoms were finally taken seriously. A laparoscopy revealed stage 4 endometriosis on her ovaries, uterus, bladder, bowl, and pouch of douglas. The stray endometrial tissue was surgically removed.
But endometrial cells are tenacious and persistent, and surgery provides only temporary respite from the pain. The tissue almost always returns accompanied by the all too familiar excruciating symptoms. In addition to over-the-counter pain medication, such NSAID s and paracetamol, standard treatments include the contraceptive pill or coil containing progesterone, which limits the development of endometriosis in a percentage of patients. (Estrogen on the other hand encourages endometriosis to grow and spread.)
With many patients still enduring unbearable pain, self-care methods such as breathing techniques, yoga, and stretching, as well as cannabis and CBD oil, are commonly used to bridge the gap. One Australian online survey interviewing women from an endometriosis support group found that cannabis and CBD oil were the most effective of all the self-care techniques for endometriosis pain. 4
For Carrie, CBD oil was a game-changer in managing her symptoms. With suggestions gleaned from endometriosis online forums, she began applying CBD lube, vaping CBD , and using CBD tinctures.
“I finished the bottle and I kind of thought, did it make a difference?” recalls Carrie. “And then after not taking CBD for a week, I realized how much pain I was actually in. And I was like, you know what, I’ve got to keep taking this. So I use the vape if I’m having a really bad flare-up, and I take it as an oil daily now to the point where I haven’t had to use over-the-counter painkillers for nearly a year. There’s been a couple of times when I’ve run out and I’m in so much pain that I’m stuck in bed or I’ve had to come home from work because I can’t move. So I use it religiously now. And it’s made such a difference to my pain levels and my mental health. I just feel better when I’m taking it.”
Endometriosis & Endocannabinoid Dysfunction
While cannabis brings pain relief to thousands if not millions of women around the world with endometriosis, it’s possible the plant’s therapeutic potential may stretch beyond just managing the pain and could limit the spread of endometrial cells around the body.
A dysfunction of the cannabinoid receptors ( CB1 and CB2 ) may explain why overeager cells are left unchecked in endometriosis.
In a similar way to cancer, endometrial cells tenaciously refuse to die and migrate to other parts of the human organism. When functioning optimally, the endocannabinoid system – the body’s innate regulating system – should be able to cause apoptosis (natural cell death) and prevent unwanted cell proliferation. However, in the case of endometriosis, for some reason the cells are left to run riot.
Exactly how or why this happens is not fully understood by medical scientists. Whereas copious anecdotal evidence attests to the efficacy of cannabis for symptom relief, the molecular mechanisms for these effects still need to be elucidated.
Could an endocannabinoid system deficiency be a contributing factor to the development of endometriosis? Project CBD posed the question directly to Ethan Russo, MD , who originally coined the phrase clinical endocannabinoid deficiency. Dr. Russo is currently the director of CR eDO Science, a company developing and commercializing cannabinoid-related innovations with medical, diagnostic, and industrial applications.
Russo suggests that a dysfunction of the cannabinoid receptors ( CB1 and CB2 ) may explain why overeager cells are left unchecked in endometriosis. “In endometriosis lesions compared to controls, there has been a decrease in both the CB1 and CB2 receptors,” he notes.
THC & Cell Death
It’s possible then to surmise that with fewer CB1 and CB2 receptors in endometrial tissue available for endocannabinoids to bind with, the natural process of apoptosis may be disrupted, allowing aberrant cells to multiply and spread. In preclinical research, cannabinoid compounds – endogenous, phyto or synthetic – that target these two receptors appear to control the development of endometriosis.
“In 2017 there was a study 5 ,” Russo recalls, “that showed that drugs that stimulate CB1 and CB2 both were responsible for decreased proliferation, growth of endometrial tissue, and promoting its breakdown or what’s called apoptosis. Which sounds bad, but this is a normal, programmed cell death that should occur in normal cells, and it’s lost in abnormal growth such as tumors, or in endometriosis. It helps to explain why THC [tetrahydrocannabinol] and potentially other components of cannabis would be symptomatically helpful, and also affect the actual pathological process of endometriosis.”
In a recently published paper 6 examining the effect of THC on a mouse model of endometriosis, the psychotropic cannabinoid not only reduced pain measurements but also limited the development of endometrial cysts.
But it’s not just THC ’s binding activity at CB1 and CB2 that Russo believes might limit the spread of endometrial cells. Other receptors beyond the canonical endocannabinoid system may also regulate the symptoms and progression of this disease.
CBD for Pain Relief
Endometrium patient forums are alive with anecdotal accounts of patients finding pain relief from taking CBD oil. This may well be attributable to CBD ’s activation of the TRPV1 vanilloid receptor, which can be overly expressed in endometriosis patients. 7 TRPV1 is a gated ion-channel that generally causes pain when stimulated.
“It’s made such a difference to my pain levels and my mental health. I just feel better when I’m taking CBD .”
According to Russo, “Cannabidiol is a stimulator of the TRPV1 receptor that is able to desensitize it. That’s a way of saying that after a little bit [of stimulation], the TRPV1 receptor doesn’t respond anymore. So it’s a way of treating pain.” Indeed, the soothing feel of a hot pad is partly thanks to mild activation of heat-sensitive TRPV1 receptors, which leads to desensitization and painkilling. 8
Russo also draws attention to “ GPR18 ,” another receptor that may play a role in endometriosis. GPR18 is activated by several endogenous lipid neurotransmitters that also interact with the endocannabinoid system. For example, GPR18 is known to bind with N-Arachidonyl glycine ( NAG ly), a compound formed when anandamide, the endocannabinoid, is metabolized by the FAAH enzyme. By inhibiting FAAH , cannabidiol ( CBD ) slows the breakdown of anandamide into NAG ly (a GPR18 stimulant) and other metabolites.
Says Russo: “We know that when GPR18 is stimulated, it will increase cellular migration. So in cancer, for example, if you have something that stimulates GPR18 , it makes metastasis more likely. As it turns out, some years ago, cannabidiol was shown to be an antagonist of the GPR18 receptor … Because CBD is an antagonist at this receptor, it should help prevent the abnormal spread of the endometrial tissue.” 9
However, as is often the case in preclinical cannabinoid research, there are more questions than answers and nothing is quite as clear cut as it seems. Contradictory findings are not uncommon when targeting a receptor like an on/off switch. Both THC and anandamide also activate the GPR18 receptor in preclinical studies, and activation of this receptor promotes endometrial cell migration – not exactly the desired therapeutic effect for an endometriosis patient. 10
Research conducted by Heather Bradshaw’s group at Indiana University suggests that endocannabinoid dysregulaton – specifically aberrant anandamide metabolism – may be a key factor in the etiology of endometriosis. And while CBD ’s potential to halt endometrial cell migration is speculative at this stage, its efficacy as a painkiller is much appreciated by women with endometriosis.
Whole Plant Cannabis Not Isolates
With all this talk of individual cannabinoids and their mechanisms, it would be easy to think that the cannabis plant in its entirety has no place in treating endometriosis.
A passionate proponent of the entourage effect, Dr. Russo is adamant about the importance of whole plant cannabis medicine as a healing modality for endometriosis and other conditions. 11 He maintains there are “multiple components of cannabis that can be put together in the right preparation to treat endometriosis, both in terms of symptoms, the pain, and affecting the disease process itself.”
“We’re dealing with complex problems here,” he says. “And it’s rare these days that an issue like endometriosis or cancer or diabetes is going to be successfully treated with one agent. You know, the tendency in traditional pharmacology is to pick a target and be very specific dealing with it. But it may be ignoring the bigger picture, so it’s rare that one molecular mechanism treating it is going to take care of the whole syndrome of associated symptoms.
“And this is a situation where I like to remind people that throughout human history, plants have been medicine … We’ve developed these new chemical entities – drugs – but a lot of those were related directly or indirectly to plant-based substances. And often, these are going to be not only as or more efficacious, but generally speaking, are going to have fewer side effects than some of the synthetic molecules that our bodies may not recognize or break down terrifically well. So they can tend to have a lot of associated toxicities.”
Endometriosis Clinical Research
In what is possibly yet another reflection of the underrepresentation of women’s health in scientific research, thus far no clinical trials have taken place examining the efficacy of cannabis medicine in women with endometriosis.
The closest example has been a randomized placebo trial studying the effectiveness of N-Palmitoylethanolamine ( PEA ), another endogenous lipid signaling molecule (and a close relative of anandamide), alongside trans-polydatin (a natural precursor of resveratrol), for the treatment of chronic pelvic pain associated with endometriosis. 12 The PEA /polydatin treatment showed some promise; it was more effective than a placebo in decreasing cramping, pain during intercourse, and general pelvic pain, but not as effective as a non-steroidal anti-inflammatory drug used in the trial.
Two phytocannabinoid clinical trials are in the offing. In a Spanish open label phase II trial, 13 a 1:1 ratio of THC and CBD will be administered in a bid to reduce hyperalgesia in endometriosis patients. While in another phase III double blind placebo study 14 patients will receive norethindrone acetate, a type of hormonal treatment, plus either 10mg or 20mg of CBD for the management of endometriosis pain.
But it will be years before sufficient robust evidence is gathered to convince the medical profession that cannabinoids are an effective way to manage endometriosis symptoms. In the meantime, cannabis will no doubt continue to play an indispensable role in the selfcare repertoire of women around the world in managing their endometriosis pain.
Dr Ethan Russo’s full interview about endocannabinoid deficiency can be heard on the podcast Cannabis Voices.
Mary Biles, a UK -based journalist, educator, and Project CBD contributing writer, is the author of The CBD Book (Harper Collins, UK ).
Copyright, Project CBD . May not be reprinted without permission.