How CBD can Help Combat Endometriosis Pain
Endometriosis effects 1 in 10 women around the world (up to a staggering 176 million worldwide). It can cause huge amounts of pain for those who suffer. Due to the negative side effects of many conventional pain medications, the number of women self-treating with cannabis is increasing. CBD could possibly provide some relief to those with endometriosis, for reasons which will be explored in this article.
What is Endometriosis?
Endometriosis is a condition which effects the female reproductive system. Simply, it’s wen the tissue of the uterus (that sheds each month at your period) grows outside of the uterus itself. This tissue, called endometrium, can develop on the ovaries and fallopian tubes. However, in severe cases it can grow all throughout the abdomen.
Endometriosis itself is not life threatening, but it can cause a severe amount of pain. Just as our uterine lining sheds at our period, the tissue outside of these areas reacts to our monthly hormones. It sheds and breakdown, but as there is no clear route for it to go, it can get trapped in your body. This becomes incredibly painful and causes flaring, scaring and inflammation.
Although some people only experience the symptoms and pain mildly, for others it can be incredibly life altering. The rates of those struggling with mental health issues, such as depression and anxiety, are greatly increased amongst those suffering.
How is Endometriosis Diagnosed?
One of the major issues in treating endometriosis is the initial difficulty in getting it diagnosed. It is initially useful to understand the signs and symptoms that might lead you to seek a diagnosis. Some common symptoms women experience are:
- Bladder pain
- Consistent premenstrual symptoms
- Heavy, painful periods
- Lethargy, fatigue and trouble sleeping
- Pain during sex
- Pain in the lower back, hips and thighs
- Pain with bowel movements
- Pelvic pain
Unfortunately, the current average time it takes to receive a diagnosis is between 7 and 10 years. Tracking your cycle and symptoms can help to spread up this process slightly, but the only way to confirm it with certainty is through an explorative keyhole surgery known as a laparoscopy.
A laparoscopy is a surgery in which a camera is inserted into the pelvis through a small cut, near the navel. The doctor can use this camera to look and see if there is tissue in areas outside of the uterus itself.
What Causes Endometriosis?
Due to a lack of research, there is not a single effective treatment for endometriosis. Scientists are looking to investigate how the tissue thrives outside of the uterus, and what can be done to prevent this. The most recent theory is that the menstrual blood flows to these areas too, carrying the tissue to areas where it doesn’t belong. There is also the possibility that our environmental factors, such as hormones and toxins in food, could be causing the tissue to grow outside of where is naturally belongs.
What is understood, however, is that once the tissue begins to grow somewhere it is then able to grow and spread. Some even compare this to cancer, where cells continue to replicate in an undesired way. In order to grow the cells, use our system of veins and arteries to supply them with what they need, and remove waste products. They also grow nerve endings which increase pain perception.
What are the Current Treatments for Endometriosis?
Despite the fact endometriosis is considered a benign disease, patients can continue to experience a spread and growth of this tissue rapidly. There is research going into the possibility of cancer treatments being effective to treat endometriosis, however currently the only options available to treat the tissue itself is surgical removal. Surgery is obviously a last resort option, and it is possible for the tissue to grow back if it is not entirely removed during the process.
For those who do not want to undergo surgery, or are not suitable for it, there are other ways in which the tissue can be treated. Some doctors look to natural remedies to help restore the body’s health. Lifestyle and dietary changes can be beneficial for some, but often need to be bespoke to the individual. Exercise and physical activity can also improve the symptoms – finding a balance between working out and resting, alongside ensuring you get enough sleep, can prove helpful for some with milder symptoms.
Painkillers are often prescribed by doctors. Over the counter drugs such as ibuprofen are tried initially, with mefenamic acid often being prescribed if the pain is more severe. Doctors often try hormone therapies, such as conventional birth control pills to help regulate the pain caused by monthly cycles, although these treatments sometimes only have limited success.
What are the Side Effects for Current Endometriosis Treatments?
Taking painkillers such as ibuprofen for prolonged periods of time can lead to stomach ulcers, or inflammation to the lining of the stomach. Therefore, they are not recommended for continuous use.
Hormonal treatments can cause headaches, migraines, blood pressure changed, spotting, mood effects and weight gain. They can also change the microbiome of our gut, increasing stomach issues.
What is CBD?
Cannabidiol, commonly known as CBD is one of over one hundred chemical compounds, known as cannabinoids, that are found in the cannabis plant. They are specifically found in Cannabis sativa.
Although many people know cannabis to create a feeling of being ‘high’, this is not the case with CBD. Tetrahydrocannabinol better known as THC, is the primary psychoactive cannabinoid active in cannabis. This is the compound that creates the psychoactive effect of being ‘high’. Unlike THC, CBD does not have any psychoactive effects and does not cause the user to get ‘high’.
Although CBD does not have any psychoactive effects, it is still able to ease pain and aid relaxation. It is growing in popularity as scientific studies are beginning to prove that it can help aid symptoms of anxiety, depression and chronic pain.
Can CBD and CBD Oil help treat endometriosis?
There is growing evidence to suggest that CBD can be beneficial to some people suffering with endometriosis. The inflammation, one of the most significant causes of endometriosis pain, is lessened by the anti-inflammatory properties of CBD. There are also mild analgesic properties in CBD, which may also help reduce pain.
There have been very few studies about the effect of CBD specifically on endometriosis. We do know, however, that there is evidence to support the treatment of chronic pain through CBD and CBD oil. Moreover, there is the possibility that supporting the function of there are cannabinoid receptors that can be controlled through taking CBD that might help reduce the over-functioning of endometriosis cells, although this thesis is yet to be explored further and is only in early stages.
There are possible ways in which the cell multiplication may be helped by CBD:
- The cannabinoid CBD works with our internal endocannabinoid system to help regulate bodily processes. It is also helpful at regulating cell growth, stopping over-zealous cell multiplication. For these reasons, there has been some positive evidence that cannabis could help treat cancer, as it stops the cells from multiplying. It is possible that the same may be possible for endometriosis.
- CBD may also be able to stop the endometriotic cells from migrating or moving around the body into new organs. This may be because it blocks GPR18 receptor from activating. It is worth noting, however, that unlike CBD, THC (the psychoactive element of cannabis) may active these receptors – therefore if you are self-medicating with THC, CBD may be essential to counter this activity.
- As previously noted, in order to thrive, endometriotic cells need blood vessels and capillaries. There is the possibility that CBD can inhibit this process in cells, (as they inhibit vascularisation) in cells.
- For some patients the nerve damage can be the most painful element of endometriosis. If it is a specific kind of endometriosis, known as deep-infiltrating endometriosis, the tissue embeds itself deeper into the organs it is growing on. This can cause deeper lesions that contain a high density of nerves. CBD may be able to regulate the nerve growth by interfering with innervation (the growth of new nerves), preventing new receptors.
- There may also be a possibility that activating endocannabinoid receptors inside the body may be able to produce anti-inflammatory properties, lessening the body’s immune response to new cells and reducing pain caused by endometriosis tissue.
What CBD Products can be Used for Treating Endometriosis?
As there are a variety of ways to take CBD, it may be overwhelming working out which is the best product to use to help endometriosis symptoms.
CBD patches are a great option for those looking for a long-lasting effect, as they have a duration of 24 hours. They can also be applied close to the area of inflammation, on veinous tissue. This will ensure the CBD focuses on this area first, and then is generally released into the blood stream.
CBD vape oils are a fantastic option for those looking for the instant relief of CBD. The relief vape cartridge is specifically formulated to help with issues regarding chronic pain and is made using a range of terpenes specific to pain. A vape product quickly allows CBD to enter the system, without the wait-time for activation.
CBD capsules are an easy way to ingest CBD and are often enjoyed as part of a supplementation routine. If you are supplementing in your diet, or taking daily medication, a capsule is a great way to ensure you are consuming your CBD.
Endometriosis is a condition which effects many women, and despite growing scientific research, there is no singular cure. For those suffering, CBD may be able to help mitigate symptoms and provide anti-inflammatory effects. Moreover, there is possible evidence to suggest that CBD itself might reduce the cell growth and the prevalence of new tissue.
CBD Oil for Endometriosis Pain: Does It Help?
Endometriosis is an autoimmune disease involving the abnormal growth of cells similar to those found in the womb’s lining. According to statistics, the condition affects 1 in 10 of women of reproductive age — contributing to 176 million instances worldwide.
Researchers still don’t understand why endometrial tissue begins to grow in the uterus, spreading to the nearby pelvic organs, such as ovaries, bladder, and bowel.
The problem with endometriosis is that the errand cells start to bleed during the bleeding phase of a woman’s menstrual cycle. But unlike the normal cells, the ones triggered by endometriosis can’t pass their blood outside, causing inflammation, pain, and formation of scar tissues.
Today, we explore the benefits of using CBD oil and other types of cannabis extracts for endometriosis pain and related symptoms.
Can CBD Help with Endometriosis?
Women with endometriosis are typically prescribed pain medication, hormone therapy, or need to undergo laparoscopic surgery.
Hormonal treatments are known to cause undesirable side effects; for example, Gn-RH, a popular hormone, may trigger artificial menopause on top of causing headaches and bloating.
The efficacy of NSAIDs, such as ibuprofen, for EM-associated pain, is also questionable.
According to a review published in Deutsche Arzteblatt International, 70% of young women with endometriosis don’t respond to NSAID treatments .
That’s why alternative options, such as CBD oil, are becoming more popular for this disease.
The BMC Complementary and Alternative Medicine published a cross-sectional online survey that evaluated the efficacy of self-management strategies .
Among the most popular choices, such as hot compress, diet changes, yoga, and exercising, CBD oil scored a high place.
The study found that women who took CBD oil reported the highest pain relief scores among women who participated in the study.
Another study posted in Therapeutics and Clinical Risk Management mentioned that CBD produces anti-inflammatory effects. The author added that CBD was able to stop the release of proinflammatory cytokines in animals .
A follow-up cross-study published by Proc Natl Acad Sci USA confirmed these results, showing CBD’s immunosuppressive action through decreasing cytokine production .
Clinical Research On CBD & Endometriosis
So far, there have been no clinical trials examining the efficacy of cannabis medicine in women with endometriosis.
Two clinical trials are about to investigate the effects of phytocannabinoids on endometriosis pain and related symptoms.
In a Spanish open-label phase II trial, women with endometriosis-induced hyperalgesia will receive an oral spray with a 1:1 ratio of THC and CBD .
In another phase III double-blind placebo study, patients will be administered norethindrone acetate, a hormonal treatment, supplemented with either 10 mg or 20 mg of CBD for the management of endometriosis pain .
Gathering sufficient robust evidence to convince the medical world that cannabinoids are effective for endometriosis may take years. In the meantime, cannabis will undoubtedly play a significant role in the self-care routine of women around the world when it comes to easing their endometriosis pain.
How Does CBD Oil Work to Help with Endometriosis Pain?
The endocannabinoid system (ECS) is a vast network of endogenous cannabinoids, enzymes, and G-coupled receptors that are spread throughout the body.
These receptors (type 1 and 2) are present in the central nervous system, immune system, and peripheral organs. The main role of the ECS is to promote and maintain homeostasis in the body.
ECS modulation has been associated with therapeutic effects in several health conditions, including anxiety, insomnia, neurodegeneration, epilepsy, and chronic pain.
The CB1 receptor can be found in pain circuits; it also participates in producing pain-killing and anti-inflammatory effects. Meanwhile, the effects of CB2 receptor activity are mostly expressed in the immune system.
A 2017 study explained how THC and CBD act on these receptors. Their activity might be beneficial for women with endometriosis pain or even when their menstruation stops and other chronic pain conditions .
Several studies have implicated that CBD and other cannabis compounds can inhibit proinflammatory cytokines.
One study published in Pain journal found CB1 receptors in the rodent uterus. The research team suggested that CB1 receptors are a potential target treatment to curb hyperalgesia (sensitivity to pain) in that area .
The study also provided evidence that endocannabinoids and phytocannabinoids could be useful in alleviating endometriosis symptoms.
How to Use CBD for Endometriosis
There are several types of CBD to choose from; the three main types include full-spectrum CBD, broad-spectrum CBD, and CBD isolate.
Full-spectrum CBD contains the original phytochemical profile of the source plant, including minor cannabinoids, terpenes, flavonoids, and traces of THC. Read our Full-Spectrum CBD guide to learn more.
These compounds work synergistically to enhance the beneficial effects of the major cannabinoids and mitigate their potential side effects. This concept is known as the entourage effect.
Broad-spectrum CBD is much like its full-spectrum counterpart, save for the lack of THC. The intoxicating compound is removed from the extract after the initial extraction.
CBD isolate is exactly what it sounds like — pure cannabidiol. It occurs as whitish crystals that are then turned into a powder and mixed into different products. Isolates have no odor or flavor, and they also don’t evoke the entourage effect.
Let’s take a look at which type of CBD is more helpful in managing endometriosis pain.
Full-spectrum vs. Isolate: Which is Better for Endometriosis?
Focusing on individual cannabinoids and their mechanisms makes it easy to think that the cannabis plant has little to do with endometriosis.
Dr. Ethan Russo, a neuroscientist and passionate proponent of the entourage effect, underlines the importance of whole-plant cannabis medicine as a treatment for endometriosis and other conditions.
Russo says that there are “multiple components of cannabis that can be put together in the right preparation to treat endometriosis, both in terms of symptoms, the pain, and affecting the disease process itself. It’s rare these days that an issue like endometriosis or cancer or diabetes is going to be successfully treated with one agent.”
Conventional pharmacology tends to isolate a compound, give it a target, and observe how it deals with it — which can be very specific.
However, this pharmacology ignores the bigger picture, so it’s unlikely that one molecular mechanism will take care of the whole symptoms associated with endometriosis.
It’s worth noting that throughout human history, plants have been used medicinally. Synthetic drugs were developed later, but many of them are based directly or indirectly on plant-based chemicals.
CBD Oil for Endometriosis
CBD oil is the most popular form of CBD for endometriosis. It’s a thick hemp extract that is further diluted with a carrier oil for improved bioavailability — and bottled up with a dropper to make dosing easier.
CBD oil can be ingested in different ways. It can be taken under the tongue, where it should sit for around 60 seconds. The sublingual mechanism ensures a faster onset of effects, higher bioavailability, and better absorption. That’s because CBD enters the bloodstream directly through the tiny blood vessels in your mouth.
Other popular formats include capsules and gummies, which are better for people who dislike the taste of natural CBD oil and are looking for a precise dose in each serving.
Vaping is the fastest and most effective way to deliver CBD to your system. When you inhale CBD through a vape pen, it enters the bloodstream through the lung tissue, providing almost instantaneous effects.
CBD Cream for Endometriosis
A lot of women with endometriosis combine two forms of CBD oil — oral and topical.
When you take CBD oil, gummies, or capsules, they target EM symptoms from within, which is great for symptom control and reaching the underlying cause.
But, when you experience endometriosis flare-ups, they may require a more localized approach, such as a topical formulation.
Topical products like CBD creams, lotions, gels, and salves, are applied directly to the skin. From there, they interact with the skin’s CB2 receptors, producing a relaxing and anti-inflammatory response.
This, in turn, may contribute to effective pain control. Topicals can take between 10 and 60 minutes to start working, depending on the formulation.
CBD Dosage for Endometriosis
Most of our modern pharmaceutical medications come with standardized dosages and guidelines regarding their use.
On the other hand, CBD is a very personalized substance and can have different dosages even for people of the same height, weight, and lifestyle.
Cannabis dosages always start from low amounts and take time to gauge the effective dosage for each individual. Doctors will start you on a medication they believe will work best for you and then titrate the dose to adjust it to the severity of your symptoms and your individual body chemistry.
The goal of successful CBD dosage for endometriosis is to find the amount that gets you maximum effects with few side effects.
Can You Use Medical Marijuana for Endometriosis?
Yes, medical marijuana can be helpful in endometriosis. While CBD can effectively reduce EM pain, THC uses another important mechanism to benefit women with endometriosis.
With fewer CB1 and CB2 receptors in endometrial tissue available for endocannabinoids to bind with, the natural process of cell death (apoptosis) may be compromised, allowing for the malignant cells to multiply and spread.
Preclinical research indicates that endogenous, Phyto, or synthetic cannabinoids that target these two receptors can control the development of endometriosis.
In a 2017 study, the authors showed that drugs stimulating CB1 and CB2 receptors contributed to decreased proliferation and growth of endometrial tissue and its breakdown or what we call apoptosis .
While this may sound bad, apoptosis is a normal programmed cell death that’s part of their life cycle, and it’s disrupted in abnormal growth such as cancer or endometriosis.
This would explain why THC and potentially other molecules in cannabis would be symptomatically helpful and also target the actual pathology of endometriosis.
A recent study evaluating the effect of THC on a mouse model of endometriosis concluded that THC not only reduced pain markers but also inhibited the growth of an endometrial cyst.
Final Thoughts on CBD and Endometriosis
Animal and preclinical human studies have shown that CBD has anti-inflammatory and analgesic properties. These effects may be useful in targeting pain that is difficult to treat, such as the one triggered by endometriosis.
Since all cannabinoids and terpenes can interact with the endocannabinoid system, many of them have similar anti-inflammatory and antioxidative properties, whole-plant extracts appear to be the most effective form of cannabis treatment.
If you live in a place with a legal medical marijuana program, you can combine CBD oil with a high-THC product to optimize your treatment and use a holistic approach.
Currently, the only federally legal way to use CBD for endometriosis is by taking CBD oil and/or cream. This way, you can both support your endocannabinoid system and target localized pain.
A consultation with a doctor experienced in cannabis use should help you determine the right dosage and avoid negative interactions with any medication you might be taking.
- Armour, M., Sinclair, J., Chalmers, K.J. et al. Self-management strategies amongst Australian women with endometriosis: a national online survey. BMC Complement Altern Med 19, 17 (2019). https://doi.org/10.1186/s12906-019-2431-x (1)
- David Garcia Cinca, Hospital Clinic of Barcelona. (2019). Effect of Cannabinoid (THC / CBD 50%) on Hyperalgesia of Patients with Deep Endometriosis (EndomTHC). Available at: https://clinicaltrials.gov/ct2/show/NCT03875261 (2)
- Deimling, A.T. (2020). Cannabidiol and Management of Endometriosis Pain. Available at: https://clinicaltrials.gov/ct2/show/NCT04527003 (3)
- Dmitrieva, N., Nagabukuro, H., Resuehr, D., Zhang, G., McAllister, S. L., McGinty, K. A., Mackie, K., & Berkley, K. J. (2010). Endocannabinoid involvement in endometriosis. Pain , 151 (3), 703–710. https://doi.org/10.1016/j.pain.2010.08.037 (4)
- Bilgic, E., Guzel, E., Kose, S., Aydin, M. C., Karaismailoglu, E., Akar, I., Usubutun, A., & Korkusuz, P. (2017). Endocannabinoids modulate apoptosis in endometriosis and adenomyosis. Acta histochemical , 119 (5), 523–532. https://doi.org/10.1016/j.acthis.2017.05.005 (5)
Nina created CFAH.org following the birth of her second child. She was a science and math teacher for 6 years prior to becoming a parent — teaching in schools in White Plains, New York and later in Paterson, New Jersey.
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CBD Oil for Endometriosis Pain? Experts Warn: Buyer Beware
Can CBD oil help relieve the misery of chronic endometriosis pain? That’s the question we asked our community via Facebook, Instagram and Twitter and the response was overwhelmingly positive.
“Yes,” wrote @michelleaveryjewelry, “I have my medical license and use CBD only and a 50:50 [ratio of] CBD to the THC oil. It does help the pain. I am off narcotics.”
“It really does help,” @nycgyno answered. “I am doing research on it with some patients, and most of them are very happy with the results and the relief.”
But, not everyone agreed. Endometriosis pain is a highly individualized experience, and CBD oil is not one size fits all.
According to @therealkatedavey, “For me post-excision surgery, two years out, CBD oil really helps my bad pain days. But I had to find one that worked for me. And that’s my experience…not everything works for everyone.”
So, it’s neither silver bullet nor the old fashion “snake oil” conjured up by traveling quacks from the backs of wagons in 19 th century frontier days and foisted off on a naïve public as a cure-all—though real snake oil is used in China—plant-based preparations including marijuana do have a long and respectable history in the traditional medicines of some cultures.
Marijuana only became illegal in the U.S. with the passage of the Controlled Substances Act in 1970, though regulation rumblings had been growing since the 1920s.
Pharmaceutical-grade CBD oil, or cannabidiol oil, is derived from the cannabis plant and can be packaged in a variety of forms: gel cap, cream, oil, salve, tincture, or maybe even a transdermal or skin patch. Its effect is not the same as smoking and doesn’t produce the same cloudy euphoria and munchie giggles as the roll-your-own stuff you might have enjoyed in your college days.
Though @kadine_christie said “supposedly CBD oil shouldn’t get you high, but I hated every minute of it. It was [a] terrible feeling.” And one commenter noted, “I’m a working woman, a freelancer in the corporate world. I cannot afford to feel high.”
In many states, obtaining CBD products requires a doctor’s prescription. In others, it’s just plain illegal, though that appears to be changing rapidly.
California became the first state to legalize medical marijuana in 1996. This year, the state began to allow sales for recreational use, but the California Department of Public Health stated that, “Until the Food and Drug Administration (FDA) rules that industrial hemp-derived CBD oil and CBD products can be used as a food or California makes a determination that they are safe to use for human and animal consumption, CBD products are not an approved food, food ingredient, food additive or dietary supplement.”
The state agency explained, CBD and CBD oil are “allowable only in edible cannabis products that are produced according to the California Medicinal and Adult-Use Cannabis Regulations and Safety Act including a source, manufacturing, distribution, testing and retail supply chain that is completely separate from regular foods and beverages.”
Though there’s something about the phrase “industrial hemp” that doesn’t feel quite right, recent news reports indicate that Coca-Cola is seriously interested in adding the product to its popular line of the soft drink which traces its root recipe back to cocaine.
Could artisanal “Can”-Cola be far away?
In June, the FDA made history when it approved the use of a purified form of CBD oil to treat seizures in two “rare and severe” forms of epilepsy. Dr. Orrin Devinsky, director of NYU Langone Epilepsy Center, noted at the time, “It’s very important to highlight that the drug used in this study, cannabidiol, was…purified to 99 percent purity.”
It’s promising news for CBD fans, but Devinsky also made it clear that buyers should beware. “This is not something you can get from a dispensary today. It is a very specific pharmaceutical-grade product.”
Despite the fact that @heavers_said, “It’s my saving grace” and Vitamin Weed author Dr. Michele Ross, Ph.D. swears by the stuff, there is not a lot of authoritative clinical evidence for its effectiveness.
Lately, inboxes have been filling up with a rising tide of emails recruiting volunteers, but only a few seem to have some degree of scientific authenticity—and those results aren’t in yet.
Director of the Brain Institute of the University of Utah, Deborah Yurgelun-Todd is “testing the analgesic effects of orally-dosed Cannabidiol on subjects with non-cancer pain.”
Canada seems to be a sweet spot for legitimate clinical trials.
That’s where Ramesh Zacharias, the Medical Director of Hamilton Health Sciences Corporation in collaboration with the Michael G. DeGroote Institute for Pain Research and Care at McMaster University in Hamilton, Ontario and Dr. Antonio Vigano and Dr. Maria Fernanda Arboleda of McGill University in Montreal are doing related studies.
These studies have passed the rigorous rules of the Institutional Review Boards of the respective university.
And if you’re thinking of buying a bottle from Amazon or any other online source, remember this warning.
“Among CBD products purchased online, a wide range of CBD concentrations was found, consistent with the lack of accepted dose. Of products tested, 26 percent contained less CBD than labeled which could negate any potential clinical response. The over labeling of CBD products in this study is similar in magnitude to levels that triggered warning letters to 14 businesses in 2015-2016 from the U.S. Food and Drug Administration (e.g., Actual CBD content was negligible or less than 1 percent of the labeled content).”
That’s according to a study published online last year by the Journal of American Medical Association entitled “Labeling Accuracy of Cannabidiol Extracts Sold Online”.
And it’s nothing to fool with. “There is evidence,” according to Dr. Tomar Singer, director of reproductive endocrinology and infertility at the Lenox Hill Hospital in New York City, “that cannabis oil or cannabidiol can decrease fertility by affecting ovulation and implantation.”