Effects of cannabis ingestion on endometriosis-associated pelvic pain and related symptoms

Abstract

Background The use of cannabis for symptoms of endometriosis was investigated utilising retrospective archival data from Strainprint Technologies Ltd., a Canadian data technology company with a mobile phone application that tracks a range of data including dose, mode of administration, chemovar and their effects on various self-reported outcomes, including pelvic pain. Methods A retrospective, electronic record-based cohort study of StrainprintTM users with self-reported endometriosis was conducted. Self-rated cannabis efficacy, defined as a function of initial and final symptom ratings, was investigated across the included symptom clusters of cramps, pelvic pain, gastrointestinal pain, nausea, depression, and low libido. Cannabis dosage form, dose and cannabinoid ratio information was also recorded. Results A total number of 252 participants identifying as suffering endometriosis recorded 16193 sessions using cannabis between April 2017 and February 2020. The most common method of ingestion was inhalation (n = 10914, 67.4%), with pain as the most common reported symptom being treated by cannabis (n = 9281, 57.3%). Gastrointestinal symptoms, though a less common reason for cannabis usage (15.2%), had the greatest self-reported improvement after use. Inhaled forms had higher efficacy for pain, while oral forms were superior for mood and gastrointestinal symptoms. Dosage varied across ingestion methods, with a median dose of 9 inhalations (IQR 5 to 11) for inhaled dosage forms and 1 mg/mL (IQR 0.5 to 2) for other ingested dosage forms. The ratio of THC to CBD had a statistically significant, yet clinically small, differential effect on efficacy, depending on method of ingestion. Conclusions Cannabis appears to be effective for pelvic pain, gastrointestinal issues and mood, with effectiveness differing based on method of ingestion. The greater propensity for use of an inhaled dosage delivery may be due to the rapid onset of pain-relieving effects versus the slower onset of oral products. Oral forms appeared to be superior compared to inhaled forms in the less commonly reported mood or gastrointestinal categories. Clinical trials investigating the tolerability and effectiveness of cannabis for endometriosis pain and associated symptoms are urgently required.

The experiences of endometriosis patients with diagnosis and treatment in New Zealand

“…In a 2021 retrospective cohort study of 252 endometriosis patients using cannabis, 57.3% were using it to treat their endometriosis-related pain ( 57 ). Patients reported that cannabis use was effective for their pelvic pain, gastrointestinal issues and mood ( 57 ).…”

“…In a 2021 retrospective cohort study of 252 endometriosis patients using cannabis, 57.3% were using it to treat their endometriosis-related pain ( 57 ). Patients reported that cannabis use was effective for their pelvic pain, gastrointestinal issues and mood ( 57 ). In a study of Australia and New Zealand-based endometriosis patients using cannabis for their pain it was reported that 72.0% and 88.2% of patients respectively, were illicitly obtaining cannabis to treat their endometriosis symptoms ( 58 ).…”

Role of the endocannabinoid system in the pathophysiology of endometriosis and therapeutic implications

“…It is evident that pain relief is a major factor that EMS patients seek in their treatment, as discussed here. Based on patient surveys and preliminary studies, some cannabinoids seem to be effective in this domain, as well as showing efficacy against EM-associated gastrointestinal, sleep, and mood symptoms (Sinclair et al 2020;Sinclair et al 2021a). EMS patients using cannabis have been able to reduce dosages of other medications like non-opioid and opioid analgesics, antineuropathics, antidepressants, and antianxiety medications by at least 50% (Armour et al 2021;Sinclair et al 2021b).…”

Approach to Pain in Endometriosis Patients: Systematic Literature Review

“…Another plant, Cannabis sativa, is also addressed in pain management, due to the direct and/or indirect effects of its active principles D9-tetrahydrocannabinol (THC) and cannabidiol (CBD) on specific receptors in the endocannabinoid system. Although several different receptors are present in this system, cannabinoid receptors 1 (CB1) and 2 (CB2) present mostly in central and peripheral presynaptic neurons are the most explored, with anandamide being its main neurotransmitter [58].…”

“…The presence of CB1 and CB2 receptors was reported in different regions of the oocytes, according to the stage of maturation, as well as the presence of anandamide in the reproductive tract fluids. In the secretory phase, an important increase in CB1, mRNA and endometrial proteins was observed, a fact associated with the ability of progesterone to regulate the expression of these receptors [58]. In addition, a significant increase in anandamide associated with a decrease in CB1 expression has been observed in women with endometriosis, a situation that can impair the control of pain symptoms, aggravating chronic pelvic pain, dysmenorrhea and dyspareunia [58].…”