Endometriosis is a condition in which tissue similar to the lining inside the uterus (called “the endometrium”), is found outside the uterus. Left untreated endometriosis induces a chronic inflammatory reaction that may result in scar tissue. It afflicts 11% of women worldwide during their reproductive years of 15 to 49. Previous studies have indicated that the endocannabinoid system may participate in the progress of endometriosis.

The symptoms of endometriosis include painful periods, painful ovulation, pain during or after sexual intercourse, heavy bleeding, chronic pelvic pain, and fatigue. Not all women experience these symptoms but if left untreated can lead to infertility.

Gender bias by both women and health care providers, due to a “normalization” of symptoms, results in a significant delay from when a woman first experiences symptoms until she eventually is diagnosed and treated.


Treatment Options for Endometriosis

Treatment includes pain killers such as nonsteroid anti-inflammatory drugs, selective serotonin reuptake inhibitors (SSRIs), heating pad, birth control pills, and opiates. Often after a pregnancy the condition is improved but not cured. Doctors in the 60’s and 70’s recommended hysterectomies. A laparoscopy can facilitate the lysis of tissue outside the uterus.

A national online survey of Australian women with endometriosis showed several self-management strategies. The most common were heat, rest, and meditation or breathing exercises. Cannabis, heat, hemp/CBD oil, and dietary changes were the most highly rated in terms of self-reported effectiveness in pain reduction. Physical interventions such as yoga/Pilates, stretching, and exercise were rated as being less effective. Adverse events were common, especially with using alcohol (53.8%) and exercise (34.2%).

Women are at higher risk for endometriosis if they have a mother, sister, or daughter with endometriosis, or started their periods at an early age (before age 11). Other risk factors are short monthly cycles (less than 27 days), heavy menstrual periods that last more than 7 days, or are infertile. Pregnancy, or breastfeeding may lower the risk.

Endometriosis and Endocannabinoid Dysfunction

Endometrial cells, like cancer cells, tenaciously refuse to die and migrate to other parts of the human organism. When functioning optimally, the endocannabinoid system (ECS), the body’s innate regulating system, should be able to cause natural cell death and prevent unwanted cell proliferation. However, in the case of endometriosis, for some unknown reason the cells are left to run riot.

Ethan Russo, MD, who originally coined the phrase clinical endocannabinoid deficiency, suggest that a dysfunction of the cannabinoid receptors (CB1 and CB2) may be the explanation. Russo noted a study in 2017 that showed endometriosis lesions compared to controls, were decreased in both the CB1 and CB2 receptors. It explains why THC [tetrahydrocannabinol] and potentially other components of cannabis would be symptomatically helpful, and also affect the actual pathological process of endometriosis.

Whole Plant Cannabis Not Isolates

Dr Russo maintains there are “multiple components of cannabis that can be put together in the right preparation to treat the symptoms, and the disease process itself of endometriosis. In a previous article by CannaAngel in Cannabis Corner discussed the effectiveness of N-Palmitoylethanolamine (PEA) a close relative of anandamide, for the treatment of chronic pelvic pain.

Choosing the correct cannabis oil for pain is a trial-and-error experience. Previous use, tolerance, and access make titrating doses difficult. Effectiveness is related to the various modes of administering cannabis. Inhalation lasts for two hours. Oral ingestion of tinctures, capsules, or gummies have different effects and sometimes take up to two hours to work. Gummies are usually isolates. Russo recommends whole plant cannabis. There may be instances when vaginal suppositories are more effective during menstruation, while switching back to capsules, gummies, or inhaling when menses is complete.

Access to high dose cannabis (1:1 ration of CBD:THC) can be obtained from these two companies vetted by CannaAngel. For suppositories try Synergy Wellness. For high dose tinctures to put in food try Firebird Touch Therapy. Remember in suppository mode THC is not psychoactive because it does not get metabolized by the gut. For other references, See this excellent video, or visit The Endo Monologues.

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