Endometriosis & Medical Cannabis

We typically don’t like to talk about menstrual cycles or anything related to a women's time of the month. It makes people uncomfortable and squirm in their seats. Despite our hang ups, 5-15% of women of reproductive age deal with the devastating and debilitating impact of endometriosis. That’s over 175 million women worldwide, many of whom struggle alone. 

I’ve suffered with severe cramps for as long as I can remember. I mentioned them to doctors over the years, but the blank stare along with "cramps are normal" was the typical response I was met with. Eventually my pain progressed from during my period to the days leading up to it, to starting with ovulation, to throughout the entire month. The pain during my period became so severe that I have to plan my schedule around it. I schedule every month knowing I will be incapacitated for at least two days.  Eventually, I started experiencing what I could best describe as sudden and severe cramping episodes. We're talking 0-60mph, 9/10 pain. The episodes come on in an instant and last for 10-15 minutes at a time. I found myself pulling off the road while driving, dropping to the floor in the fetal position while going about my day, and waking up from a dead sleep due to the quick onset incapacitating pain. It took a few doctors, lots of probing & testing, and an invasive surgery to confirm that the source of my debilitating symptoms was endometriosis. 

What is Endometriosis? 

Endometriosis is a painful chronic health condition in which the tissue that normally lines a woman’s uterus, called the endometrium, grows outside of the uterus. This tissue implants throughout the pelvic cavity, sometimes spreading into other regions of the body. These endometrial implants respond to the hormones of the menstrual cycles as it normally would - thickening and breaking down with each cycle. As the blood cannot exit the body it becomes trapped, which can lead to the development of scar tissue and adhesions. These adhesions stick to organs and the pelvic cavity, often twisting, displacing, and fusing body structures together. The implants and adhesions can cause severe debilitating pain, cramping, nausea, and related symptoms during all phases of a woman’s menstrual cycle. 

Symptoms

Dysmenorrhea (painful periods)
Low back and abdominal pain
Pain with sex
Pain with bowel movements or urination
Excessive bleeding and bleeding in between periods
Infertility
Fatigue
Diarrhea, constipation, bloating, nausea

In addition to physical symptoms, the psychological impact of endometriosis can be especially difficult to cope with. On top of the general chronic pain, many women experience painful intercourse and infertility, factors that further compound anxiety, depression, and stress.

Conventional Treatment Options

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Current medical treatments include hormonal therapies, painkillers, nonsteroidal anti-inflammatory (NSAIDs), and/or surgical resection; a surgery only performed by a small number of qualified physicians and not typically covered under insurance. Most treatment options include uncomfortable side effects, risks, and ineffective symptom management. 

Medical Cannabis

While the understanding of the causes of endometriosis are largely unclear, research into the endocannbinoid system (ECS) is showing promise as an area of consideration. Studies indicate that women with endometriosis have lower concentrations of CB1 receptors in endometrial tissue, suggesting that an “endocannabinoid deficiency” is implicated in disease development and the experience of pain. Cannabinoids targeting the ECS receptors may offer both pain management and possible intervention for disease growths due to the antiproilferative and antifibrotic effects of cannabis. 

Patients often report relief from pain, nausea, cramping, diarrhea and GI upset, and fatigue when using medical cannabis for endometriosis. It's also helpful for relieving related anxiety, depression, and sleep difficulties. One of the most profound experiences I've had on my cannabis journey is the amelioration of my nighttime cramping episodes. With the use of a nightly cannabis capsule I've been able to reduce these episodes by roughly 95%. The impact that has had on my sleep quality, day to day pain, and overall wellbeing is indescribable.

Finding the Perfect Medical Cannabis Product for Endometriosis

CBD:THC Ratio

There is no clear answer for the perfect CBD:THC ratio for addressing endometriosis related pain. In my own experience,  a 1:1 ratio (or close to it) works well for endometriosis related nerve pain and cramping, while high THC concentrates work well for the generalized pain, nausea, fatigue, and mood related symptoms. High CBD medications also work well in times that symptoms aren’t as severe, or during the day when the euphoric effects of THC are best avoided. Self experimentation is always required for finding the best cannabis medicine for one's needs, but a somewhat balanced ratio of CBD:THC is a great place to start. 

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Delivery Method

Like the perfect ratio, the best delivery method also depends on patient needs, preferences, and other medical conditions. Patients should consider time of onset, duration, and psychoactivity level when choosing the proper delivery method. Many patients utilize a combination of methods for the most comprehensive relief. You can learn more about choosing the right delivery method here

 

Inhalation: Provides quick onset relief, allows patients to titrate doses as needed, great for breakthrough symptoms. 

Oral/Edibles: Particularly effective due to the full body & long lasting effects.  Both CBD and THC are appropriate choices. Many women find that CBD oil taken daily can decrease overall pain and inflammation levels throughout the menstrual cycle. 

Topical: Provides localized relief without psychoactivity, great for cramps and pelvic pain. Many patients prefer this method for daytime use due to the lack of psychoactivity. 

Transdermal: Transdermal patches deliver a steady consistent dose of cannabis medicines throughout the day. While they can be costly, the convenience and strength can be great for severe flare days or when other medication routes are not an option. 

Suppositories: Relatively new to the cannabis scene, some women prefer cannabis suppositories or "weed tampons." While these oil based suppositories can provide signifiant relief, they tend to be expensive and require high doses. They are a good option for those wishing to avoid the psychoactive affects, but duration may vary. Women with pain during sexual intercourse may find suppositories particularly helpful. 

My Favorite Florida Cannabis Products for Endometriosis

1. Surterra's 1:1  (nerve pain, cramping)
2. Surterra's Serene 5:1  (daytime use, pain, fatigue) 
3. Trulieve Truclear - 9lb Hammer & Banana Kush (flares, severe pain) 
4. Trulieve Grand Daddy Purple  (pain, nausea, appetite) 
5. DIY Cannabis Topical (pain, cramping)

Other Lifestyle Factors

Medical cannabis is not a magic bullet. Incorporating it into a larger self-care & treatment plan will allow the most therapeutic benefit. Many patients find that cannabis brings such relief that it gives them the motivation and kick start to incorporate other lifestyle changes that can help improve symptoms and overall health. A non-inflammatory diet, proper sleep, exercise, and managing stress are all important factors for managing symptoms. Complimentary treatments like epsom salt baths, castor oil packs, heating pads, Cognitive Behavioral Therapy, deep breathing techniques, and pelvic floor physical therapy can also be beneficial. 

Authored by: Kristina Risola, MA, CRC, CHWC
Director of Operations

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References: 
Bouaziz, J., On, A. B., Seidman, D. S., & Soriano, D. (2017). The Clinical Significance of Endocannabinoids in Endometriosis Pain Management. Cannabis and Cannabinoid Research, 2(1), 72-80. doi:10.1089/can.2016.0035
IVKER, R. (2018). CANNABIS FOR CHRONIC PAIN: A proven prescription for using marijuana to relieve your pain and... heal your life. S.l.: SIMON & SCHUSTER.