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More Women are Self-Treating Endometriosis with Cannabis and CBD — But is it Safe?

For the estimated 11 percent of American women between 15 and 44 living with endometriosis, symptoms like severe pain, fatigue, and nausea can profoundly disrupt their lives. Yet endometriosis remains under-diagnosed, with a lack of effective treatments.

That’s why many women are taking symptom relief into their own hands by using cannabis, according to a recent survey published this November in the Journal of Obstetrics and Gynaecology Canada. Other women are turning to cannabidiol (CBD) for pain relief, hoping to address the symptoms without the high.

“Pain relief in endometriosis is an important topic, as it can impact women on so many levels, including work, relationships, academic studies, and of course their mental health,” says study co-author Mike Armour, PhD, a post-doctoral research fellow in women’s health at Western Sydney University’s NICM Health Research Institute, a government-funded group that focuses on integrative and complementary medicine research and policy in Australia.

Dr. Armour’s team surveyed nearly 500 Australian women between the ages of 17 and 45 and found that 13 percent say they use cannabis to self-treat endometriosis symptoms. The authors estimate that their findings suggest approximately 10 percent of Australian women with endometriosis use cannabis for symptom and pain management.

Why are patients self-managing their symptoms?

Women frequently report that they can’t get endometriosis symptoms under control with recommended medications or surgery; there’s little evidence to show current treatments relieve endometriosis pain. NSAIDS like ibuprofen, for one, don’t appear to be effective, and there’s a strong potential for addiction and abuse with opioid painkillers. Although research suggests hormonal birth control can reduce symptoms, many women stop or avoid using it due to perceived side effects like mood swings and depression.

“Women with endometriosis often report that despite various medications, they have pain that is difficult to deal with,” Dr. Armour tells Florence Health. That’s why it’s not surprising they’re turning to cannabis and CBD, he adds, since limited studies suggest these drugs may (or may not) relieve pain.

The difference between cannabis and CBD

Cannabis is the most popular illicit drug in the United States; there has been a steady rise in use every year since 2007, with 7.7 percent of American adults reporting using it within the past month as of 2017. That may be in part because it’s well on its way to becoming a legal medical therapy. A total of 33 states and the District of Columbia have legalized medical marijuana to date; 11 states and D.C. also permit marijuana for recreational use, with another 16 states having decriminalized the possession of small amounts of the drug.

“Prescribing” CBD and Cannabis

Marijuana remains illegal at the federal level, so the act of prescribing it is still illegal, even in states that have legalized it. Physicians and some APPs can, however, write a recommendation for and discuss the benefits of the plant if the patient suffers from a qualifying condition covered by their local law (usually severe conditions like cancer, HIV/AIDS, glaucoma, or multiple sclerosis).

Because the Drug Enforcement Agency classifies cannabis as a schedule 1 drug — with more restrictions than even fentanyl or methadone — officially, there are “no currently accepted medical use and high potential for addiction.” It requires a rigorous approval process to study, so to-date there’s little peer-reviewed research. That leaves providers hesitant to recommend a drug that’s hasn’t been rigorously studied and whose contents and dosage aren’t regulated by the FDA.

Meanwhile, interest in cannabidiol, or CBD, has skyrocketed in recent years. While CBD is an essential component of marijuana, it doesn’t contain tetrahydrocannabinol (THC) and therefore doesn’t cause a “high.” A full 14 percent of American adults say they use CBD, according to an August 2019 Gallup poll, most often for pain (40 percent), anxiety (20 percent), and insomnia (11 percent).

Only one CBD-derived drug, which treats seizures in children, has been approved by the Food & Drug Administration (FDA). All 50 states have legalized CBD in some form, and retailers have added it to pretty much any product you can imagine — from cheeseburgers to toothpicks to mouth wash.

How can cannabis and CBD affect endometriosis?

Cannabis mimics endocannabinoids, natural molecules that act on the endocannabinoid system (ECS), which maintains homeostasis in the body. ECS receptors, in turn, are found throughout the human body. The ECS participates in a wide variety of processes, including pain, stress, sleep, metabolism, immune function and reproduction.

While research is lacking, Dr. Armour says there’s another reason to believe cannabis could have a particularly powerful effect on endometriosis pain. Both the uterus and ovaries have highly expressed cannabinoid receptors, he explains. Some researchers even think cannabis could slow the growth of endometrial tissue.

“The endocannabinoid system has been found recently to interact with specific mechanisms associated with pain,” explains Dr. Armour. “It also appears to play an important role in cellular proliferation and apoptosis, which may explain why cannabis is being used by women with endometriosis. However, little has been done clinically to investigate this currently.”

What the research says

While there’s little research into cannabis for pain, one recently published paper found it may can effectively reduce pelvic pain and opioid use. In Dr. Armour’s study, on average, respondents rated the effectiveness of cannabis a 7.6 out of 10, with 55 percent reporting they were able to reduce the need for pharmaceuticals by at least half. Women reported the greatest improvements in sleep and nausea/vomiting, with only 10 percent saying they experienced adverse side effects, like anxiety, drowsiness, and rapid heart rate.

CBD, meanwhile, appears to have analgesic, anti-inflammatory, and immunomodulatory properties — but “the jury is out at the moment as to whether it can provide as much potential pain relief in endometriosis as THC does,” says Dr. Armour.

What should you tell patients with endometriosis about using CBD or cannabis?

For now, researchers agree that there’s not enough research to make a conclusion about the benefits or risks of cannabis. People who are at risk of developing addiction or schizophrenia should avoid it altogether, while patients with lung disease should avoid smoking it since it causes airway inflammation, wheezing and chest tightness.

Understanding the risks

For patients interested in using cannabis, “talking with a physician who understands the ECS and has experience in prescribing cannabis is an important first step,” says Dr. Armour. “Like all medications, it still comes with certain risks.”

CBD, on the other hand, may seem less risky to recommend, as it doesn’t have the psychoactive effect of THC and no known risk of abuse or dependence, notes Dr. Armour. But there still are dangers.

Because CBD isn’t regulated by the FDA, it’s impossible to confirm the exact ingredients or concentration in any given supplement. The FDA has found some CBD products contain contaminants like pesticides and heavy metals.

What’s more, CBD can raise levels of certain medications. “[It’s] been shown in preclinical and case studies to change the way certain medications are metabolized. It appears to be of more concern than THC in this particular regard,” notes Dr. Armour. Providers should ask patients taking CBD about any other medications they’re on and closely monitor for adverse side effects, he adds.

Safer alternatives

Dr. Armour also calls out the other, nonpharmacological treatments that can address endometriosis symptoms. Some women find relief from heat packs, hot baths, and hot water bottles. Research suggests that acupuncture twice a week for several months may reduce pelvic pain, although it’s unclear whether the effect lasts after patients complete treatment. And a low-FODMAP diet may help improve any IBS-like symptoms. Just remind patients that this eating plan is for short periods of time.

References:

What Is the Low FODMAP Diet?, Academy of Nutrition and Dietetics.

More Women are Self-Treating Endometriosis with Cannabis and CBD — But is it Safe? For the estimated 11 percent of American women between 15 and 44 living with endometriosis, symptoms like severe

Unexpected Ways to Ease Endometriosis Pain

Take Pain Relievers in Advance

Some painkillers work best if you take them before your pain is severe. Ask your doctor if non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen are an option for you. You can take them up to 24 hours before you expect menstrual pain to start. They block your body from making chemicals that cause inflammation. You can take NSAIDs regularly until your period or ovulation ends. Check the label so you don’t overdo it.

Do Physical Therapy

PT isn’t just for rehabbing sports injuries or after an accident. Endometriosis can affect the way your pelvis and abdomen work, which can cause more pain. A pelvic or women’s health physical therapist can come up with a plan to help get those areas working right again.

Get Up and Moving

It’s understandable if you feel like lying on the couch when you’re hurting. But regular exercise can help you feel better. It doesn’t have to be extreme. Walking, stretching, and doing breathing exercises can all help ease your endometriosis pain.

Go Gluten-Free?

Some women who switch to a gluten-free diet feel less endometriosis pain. But it doesn’t work for everyone. Try cutting wheat from your diet for a few months to see how you feel. Instead of regular pasta, eat rice noodles or corn pasta. Replace wheat-based foods with rice, buckwheat, and lentils. After a month or two, you can try wheat again. If pain and bloating get worse, go back to a gluten-free diet. Talk to your doctor before you do.

Do Pelvic Floor Exercises

Endometriosis affects your pelvic floor muscles, and when they don’t work right, you can have even more pain. Pelvic floor exercises can strengthen the muscles and help you feel better.

Keep It in Perspective

It can be tough to face an ongoing disease, and some ways of handling it are healthier than others. It’s better to focus on the problem and what you can do about it rather than your emotions and how those feelings make you want to act. For example, when you’re in pain, think about what you can do to feel better instead of how bad it makes you feel. This can reduce stress and depression and help your body feel better.

Could CBD Oil Help?

Cannabidiol (CBD) is one of two keyВ molecules in marijuana. The other one, THC, gets you high, while CBD doesn’t. Research suggests CBD can help with pain and inflammation. While there isn’t much research on CBD and endometriosis specifically, some women say taking CBD oil helps ease their pain. If you want to try it, be sure to check with your doctor about getting CBD oil from a safe and legal source.

Try TENS

Transcutaneous electrical nerve stimulation (TENS) is a therapy that uses mild electric currents to treat pain. The currents hit your nerves and stop them from sending pain signals to your brain. Ask your doctor if TENS therapy would be a good addition to your treatment plan.

Relax With a Massage

A spa day might be just what the doctor ordered. A back or abdomen massage can help ease your menstrual pain, both right after the massage and even more in the weeks after. Massages can help you beat stress, too.

Tap Into Acupuncture

This traditional Chinese medicine practice uses very thin needles to stimulate nerves and muscles. It is thought to release natural painkillers in your body, and research shows that acupuncture can help curb endometriosis pain.

Sprinkle on Cinnamon

This spice could counter inflammation and may lower a hormone in your body that causes discomfort during your period. It’s not clear if it works for endometriosis pain, but in an Italian study, about a teaspoon helped some women with their menstrual pain. If you like the taste, it’s a safe and natural option to try on food or in a drink.

Botox Perk?

Botulinum toxin (Botox) isn’t just for smoothing wrinkles on your face. Because it relaxes the muscles that it’s injected into, doctors use it to treat things like cerebral palsy, migraine, bladder problems, and eye twitching. A small study also found that it lessened pelvic pain and spasms for women with endometriosis. Though this sounds promising, more research is needed before it can become an approved treatment.

Don’t Skip Your Morning Coffee

A few studies have looked at a possible link between drinking coffee or caffeine and endometriosis. There doesn’t seem to be a link between the two, so if your daily routine includes a cup of joe, there’s no need to change that. It might even play a role in lowering your chances of getting endometrial cancer.

Take a Nap

Many women with endometriosis feel tired a lot. Try to keep a consistent sleep schedule and listen to your body. If you need a nap, take one. One study found that a short mid-afternoon nap in the days right before your period can boost your mood and make you more alert.

Talk to a Counselor

The physical pain of endometriosis can also affect your emotions as you adjust to life with the condition. Make time to take care of your mental health. Meet with a wise friend, counselor, or psychologist to get support. It helps to talk through what it looks like to live with an ongoing disease.

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Endometriosis.org: “Painkillers,” “Five things that pelvic health physical therapy can do to improve your endometriosis-related pain,” “Dietary modification to alleviate endometriosis symptoms.”

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Minerva Chirurgica: “Gluten-free diet: a new strategy for management of painful endometriosis related symptoms?”

Einstein: “Patients with endometriosis using positive coping strategies have less depression, stress and pelvic pain

Patients with endometriosis using positive coping strategies have less depression, stress and pelvic painPatients with endometriosis using positive coping strategies have less depression, stress and pelvic pain.”

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Endometriosis Foundation of America: “CBD Oil for Endometriosis Pain? Experts Warn: Buyer Beware.”

Cleveland Clinic: “Transcutaneous Electrical Nerve Stimulation (TENS).”

European Journal of Obstetrics, Gynecology and Reproductive Biology: “Effectiveness of complementary pain treatment for women with deep endometriosis through Transcutaneous Electrical Nerve Stimulation (TENS): randomized controlled trial.”

Iranian Journal of Nursing and Midwifery Research: “The effects of massage therapy on dysmenorrhea caused by endometriosis.”

Autonomic Neuroscience: “Physiological responses to touch massage in healthy volunteers.”

Mayo Clinic: “Acupuncture,” “Botox injections.”

PLOS ONE: “Effects of acupuncture for the treatment of endometriosis-related pain: A systematic review and meta-analysis.”

Pharmaceutical Biology: “Anti-inflammatory activities of essential oils and their constituents from different provenances of indigenous cinnamon (Cinnamomum osmophloeum) leaves.”

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Patients with endometriosis using positive coping strategies have less depression, stress and pelvic pain Journal of Clinical and Diagnostic Research: “Comparative Effect of Cinnamon and Ibuprofen for Treatment of Primary Dysmenorrhea: A Randomized Double-Blind Clinical Trial.”

Neurology: “Botulinum Toxin Treatment of Chronic Pelvic Pain in Women with Endometriosis.”

European Journal of Nutrition: “Coffee and caffeine intake and risk of endometriosis: a meta-analysis.”

Nutrients: “Caffeinated Coffee, Decaffeinated Coffee and Endometrial Cancer Risk: A Prospective Cohort Study among US Postmenopausal Women.”

Human Reproduction: “Fatigue – a symptom in endometriosis.”

Sleep and Biological Rhythms: “Napping during the late‐luteal phase improves sleepiness, alertness, mood and cognitive performance in women with and without premenstrual symptoms.”

International Journal of Women’s Health: “Anxiety and depression in patients with endometriosis: impact and management challenges.”

Reviewed by Traci C. Johnson, MD on October 12, 2019

This tool does not provide medical advice. See additional information.

THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for general informational purposes only and does not address individual circumstances. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Never ignore professional medical advice in seeking treatment because of something you have read on the WebMD Site. If you think you may have a medical emergency, immediately call your doctor or dial 911.

You may be surprised by these ways to ease your endometriosis pain.