Chronic pelvic pain is one of the predominant symptoms of endometriosis, a condition that affects up to 10% of women of reproductive age. Many women struggle to find appropriate, safe, and effective methods to manage their pain. A number of patients use over-the-counter pain medication. Some women with endometriosis are also turning to cannabis products such as cannabidiol (CBD) and medical marijuana formulations for complementary pain management.
Pain in endometriosis
Excision surgery, Dr. Seckin’s area of expertise and treatment preference, is currently the gold standard of treatment for endometriosis. Other approaches such as pain medications and cannabis can only help manage the pain. They cannot treat the disease as such.
What are cannabis products?
CBD is the second most prevalent active ingredient in the cannabis plant, after tetrahydrocannabinol (THC). THC is the main component in marijuana that produces the famous “high”. Conversely, CBD, by itself, does not cause the “high”. CBD oil is available in many forms. These include creams, oils, capsules, and skin patches, with varying amounts of CBD.
Are these products legal?
While access to CBD products is now more widespread, the U.S. Food and Drug Administration (FDA) only approved one CBD proctuct, Epidiolex. This medication contains a purified form of CBD for the treatment of seizures associated with Lennox-Gastaut syndrome or Dravet syndrome, two serious forms of epilepsy, in patients, ages 1 and older. The FDA also approved it for the treatment of seizures associated with tuberous sclerosis complex in patients of the same age. Nevertheless, the laws regarding CBD products vary from state to state, but a doctor’s prescription is often necessary.
Cannabis and endometriosis
There has been some research on the use of cannabis products for pain management in endometriosis.
A survey among women with surgically confirmed endometriosis, ages 18 to 45, in Australia showed that more than 75% of them reported using self-management approaches to manage their symptoms in the previous six months. Of these, 15% reported using cannabis. Effectiveness in pain reduction was high (7.6 out of 10), and 56% of women were able to reduce pharmaceutical medication use by at least half. They reported the greatest improvements in sleep, nausea, and vomiting. They reported only a few adverse effects. The researchers concluded that the illicit use of medical cannabis seems to be common in Australia. They also commented on the limited amount of evidence for its clinical efficacy against endometriosis-associated symptoms.
In another study in New Zealand, women with a reported diagnosis of endometriosis and/or polycystic ovary syndrome indicated that 79.8% of the respondents used cannabis, mainly to improve pain and sleep. Over 80% of the participants reported that cannabis had improved their pain and lowered their medication use. They also reported great improvements for sleep and nausea or vomiting. More than half were able to completely discontinue a medication, in most cases pain medications that contained opioids, indicating that cannabis can be a potential alternative to narcotics.
While these results look promising for the use of cannabis to manage the symptoms of endometriosis, it is important to note that clinical evidence regarding the effectiveness of CBD and medical cannabis products is still scarce.
Importantly, some unwanted side effects, such as ovulation and fertility impacts, have also been suggested. Human clinical studies are still necessary in this area. Dr. Seckin’s book, “The Doctor Will See You Now” discusses this topic, as well as other alternative strategies to manage painful symptoms, which impact so many areas of a woman’s life.