Endometriosis + Medicinal Cannabis: Frequently Asked Questions

Answering your questions about medicinal cannabis treatment options for endometriosis in Australia.

by

Polln - Emily O.

August 2022

table of contents

6

min read

There are currently over 830,000 people living with endometriosis in Australia.1 Symptoms of endometriosis can be extremely painful and debilitating for those who live with the condition, often causing them to miss out on social, work or other engagements. Without a cure, these symptoms often need to be managed through medical or surgical interventions.

In this article, we’re answering your questions about how medicinal cannabis (also known as ‘medical marijuana’) may be able to help treat the symptoms of endometriosis in some patients – especially severe or chronic pain caused by inflammation and other associated symptoms like poor mental health, sleep issues, gastrointestinal issues and nausea and vomiting.

What is endometriosis?

Endometriosis is a progressive, chronic condition whereby some of the cells similar to those that line the uterus / womb – known as the endometrium – grow elsewhere in the body, especially in the pelvis. These cells respond to messages from the ovaries, despite not being in the uterus, leading to endometriosis tissue bleeding every month when a person has their period. 

This can be extremely painful, affect fertility and prevent those who have the condition from participating fully in their lives. Over time, the condition can cause inflammation and scarring and even cause adhesions, whereby organs stick together in certain places.

About 1 in 9 menstruating people in Australia1 develop endometriosis by the time they are in their 40s, causing tens of thousands of hospitalisations every year. There is no known cure for endometriosis, but some symptoms can be managed through a variety of interventions.

Can medicinal cannabis help treat endometriosis?

Medical cannabis is commonly prescribed to treat some of the symptoms associated with endometriosis and is known to be an effective treatment for many patients. 

A 2017 Australian survey of 484 participants2 aged 18–45 and suffering from endometriosis found that one in ten participants used cannabis to treat their symptoms, citing good efficacy in reducing pain and other symptoms with few adverse effects. Pain reduction, as well as improvements in sleep, nausea and vomiting were the main reasons cited for self medicating with cannabis, with 56% of participants using cannabis having been able to reduce pharmaceutical medications by at least half.

In a separate 2021 study of 252 participants with endometriosis3 cannabis was found to be effective for pelvic pain, gastrointestinal issues and mood, with effectiveness differing based on method of ingestion (such as inhalation or other oral methods). 

Each of us has an endocannabinoid system (ECS) and cannabinoid receptors all over the body, mainly in our central and peripheral nervous systems, immune system and organs. These receptors have also been found in the endometrium and gut linings. Research4 has shown that the endocannabinoid system plays a part in endometriosis, making cannabis treatments (which interact with the endocannabinoid system in numerous ways) valuable treatments to explore when looking at endometriosis. 

The two main cannabinoids found in the cannabis plant are THC and CBD, both of which interact with the cannabinoid receptors found in our body and ECS to produce varying effects. Both THC and CBD can have benefits in the treatment of endometriosis. 

Cannabis is known to have anti-inflammatory properties and studies have shown it is beneficial in treating chronic pain,5 anxiety6 and depression.7 Inflammation, chronic pain and associated comorbidities like mental health issues, anxiety and depression are all symptoms experienced by many living with endometriosis, so cannabis is a viable treatment option for these symptoms. 

Like any medication, medical cannabis will work differently for everyone. Depending on the severity of your condition, the type of treatment prescribed and the individual way it interacts with your body, you may or may not find medical cannabis to be an effective treatment for your endometriosis symptoms.

What type of medical cannabis is best for treating endometriosis symptoms?

Medical cannabis treatments prescribed in Australia can generally be classified as being high THC, high CBD or a combination of THC and CBD, whereby effects will vary depending on the ratio of THC to CBD.

Depending on your medical history and the symptoms you’re experiencing, your doctor may prescribe you a cannabis treatment from one or more of these categories in the format of an oil, flower, or other delivery format. The most common medical cannabis treatment prescribed for endometriosis is a CBD oil taken orally.

CBD and CBD oils are known to have anti-inflammatory and mild analgesic properties, which makes them effective at reducing the pain that many endometriosis patients experience, given inflammation is one of the main reasons patients with endometriosis experience pain.

In Australia, chronic pain patients make up around 60–70% of medicinal cannabis prescriptions.8 So while there is limited research about endometriosis and CBD specifically, we know that many patients in Australia benefit from taking medicinal cannabis treatments like CBD and CBD oil for pain (there is some discussion around the efficacy of varying ratios of THC to CBD in treating endometriosis symptoms in this aforementioned study3).

THC is known for its analgesic and psychotropic properties and is also known to have positive effects in treating many types of pain. In a study which looked at endometriosis in mice,9 THC was found to have analgesic and antispasmodic properties while also inhibiting the development of endometrial cysts. More studies are yet to be done on the effectiveness of THC in inhibiting endometrial cyst development in humans, but these findings are promising. 

Scientists and those in the medicinal cannabis industries believe that using the whole plant – including a range of cannabinoids like THC and CBD, terpenes and other compounds – offers greater health benefits than using specific cannabinoids in isolation. This is known as the ‘entourage effect.’

Are there any side effects associated with using medical cannabis to treat endometriosis?

Like any medication, whether it’s natural or pharmacological, medical cannabis treatments can cause unwanted side effects in some patients.

CBD has a narrow side effect profile, whereas THC can cause more side effects in certain patients. Some patients may experience things like fatigue, dry mouth, lightheadedness or nausea when starting medical cannabis treatment, or other effects which will vary from person to person. With the support of a prescribing practitioner, patients will often be able to resolve these side effects through correct dosing and titration. When taken in conjunction with THC, CBD can help mitigate the negative side effects associated with THC, especially rare symptoms of anxiety (thanks to the entourage effect!). 

Currently, Australian law states that it is illegal to drive with any amount of THC in your system, even if you have a valid prescription and regardless of whether you are impaired or not. This is something patients should consider if they are thinking about accessing medical cannabis treatments for endometriosis.

How does medical cannabis compare with more conventional endometriosis treatments?

Patients with endometriosis often have to manage their symptoms through a combination of lifestyle adjustments, natural medicines, pharmaceutical medicines and surgical interventions. This can look like taking herbal or other supplements, taking nonsteroidal anti-inflammatory drugs (NSAID) like Ibuprofen and Voltaren or adopting other pain relieving or lifestyle adjustments, such as dietary changes.

However, a large number of endometriosis patients require stronger painkillers, oral or intrauterine contraceptive methods, progesterone hormonal interventions and laparoscopy surgeries to remove endometriosis lesions. A laparoscopy is the only form of treatment that changes the physiology of your body (addressing the root cause), whereas all other forms of treatment support in reducing symptoms. 

Each of these interventions comes with a range of side effects that many patients find intolerable, which may lead to them seeking out other alternative treatments to help manage symptoms, such as medicinal cannabis. Here are some of the side effects patients with endometriosis report experiencing from conventional treatments:

  • Gastric side effects caused by NSAIDs, including inflammation of the lining of the stomach and stomach ulcers from prolonged use.
  • Contraceptive pill side effects, including: headaches, migraines, irregular bleeding, increased blood pressure, nausea, weight gain, mood changes, changes to gut microbiome and nutritional deficiencies.
  • Progesterone method side effects such as thyroid health issues.
  • Laparoscopy side effects including recurring endometriosis symptoms, scarring and other post-surgical complications.

Many patients who use medicinal cannabis to manage the symptoms of endometriosis, especially chronic pain, report experiencing fewer side effects than those seen with their conventional treatments.10

How can I get a prescription for medical cannabis to help treat my endometriosis?

To be eligible for a medical cannabis prescription, the TGA states that a patient must:

  1. Have a chronic condition lasting three months or more 
  2. Have tried other treatments to manage the symptoms of this condition
  3. Have found those treatments to be unsuccessful in treating the condition or to have produced unwanted side effects

If you’re one of the 830,000+ Australians living with endometriosis and you’ve tried one or more of the conventional treatments listed above, or any other treatment, you are likely to be eligible to access medicinal cannabis to help manage your endometriosis symptoms. 

The first thing to do is to talk to your doctor about wanting to try medicinal cannabis. If you’re unsure whether your current doctor can help you access medicinal cannabis, you can book a consultation with one of our Polln Practitioners who specialise in these treatments to discuss whether they might be right for you. 

Why should I get a prescription for medical cannabis instead of just buying CBD oil or cannabis products online or illegally to treat my endometriosis?

Research has shown11 that a significant number of Australians living with endometriosis use cannabis illegally to manage their symptoms. While this demonstrates just how beneficial many patients find cannabis to be in managing their symptoms, it also shows us that many are finding the Australian medical cannabis industry to be too inaccessible, expensive or difficult to navigate and are instead opting for illegal cannabis products purchased online or via the black market. 

Because recreational cannabis is unregulated in Australia, there’s a big risk that your therapeutic goals will not be met by the product you buy without a prescription. This is because the active ingredients in unregulated products have varied concentrations, may differ from what you’ve been told they are, or in some cases may not be present at all. 

When taking cannabis to treat a specific medical condition like endometriosis, it’s important to know exactly which cannabinoids are present within your cannabis, and at what quantity and ratio. Getting a prescription for medicinal cannabis from a licensed healthcare professional is the best way to ensure you’re getting quality, regulated medicine containing the active ingredients you need to treat your condition.

You can read more about buying illegal vs. legal cannabis here.

Treating endometriosis with Polln

While the pathways to access medicinal cannabis haven’t always been clear, things are definitely changing.

At Polln, our biggest mission is to make alternative treatments like medical cannabis more accessible to patients living with debilitating chronic conditions, including endometriosis. If you’re unsure whether your current doctor can help you access medicinal cannabis, you can book a consultation with one of our Polln Practitioners who specialise in these treatments to discuss whether they might be right for you. 

Help end endo

Consider making a donation to help end endo at https://endoaustralia.org.au/

References
  1. Endometriosis Australia. Endo Facts. 2018.
  2.  Sinclair J, Smith CA, Abbott J, Chalmers KJ, Pate DW, Armour M. Cannabis Use, a Self-Management Strategy Among Australian Women With Endometriosis: Results From a National Online Survey. J Obstet Gynaecol Can. 2020 Mar;42(3):256-261. doi: 10.1016/j.jogc.2019.08.033. Epub 2019 Nov 10. PMID: 31722852.
  3.  Sinclair J, Collett L, Abbott J, Pate DW, Sarris J, et al. Effects of cannabis ingestion on endometriosis-associated pelvic pain and related symptoms. 2021. PLOS ONE 16(10): e0258940. https://doi.org/10.1371/journal.pone.0258940
  4.  Bouaziz J, Bar On A, Seidman DS, Soriano D. The Clinical Significance of Endocannabinoids in Endometriosis Pain Management. Cannabis Cannabinoid Res. 2017 Apr 1;2(1):72-80. doi: 10.1089/can.2016.0035. PMID: 28861506; PMCID: PMC5436335.
  5.  Therapeutic Goods Administration (TGA), Guidance for the use of medicinal cannabis in the treatment of chronic non-cancer pain in Australia. Version 1, December 2017.
  6.  Shannon S, Lewis N, Lee H, Hughes S. Cannabidiol in Anxiety and Sleep: A Large Case Series. Perm J. 2019;23:18-041. doi: 10.7812/TPP/18-041. PMID: 30624194; PMCID: PMC6326553.
  7.  Turna J, Simpson W, Patterson B, Lucas P, Van Ameringen M. Cannabis use behaviors and prevalence of anxiety and depressive symptoms in a cohort of Canadian medicinal cannabis users. J Psychiatr Res. 2019 Apr;111:134-139. doi: 10.1016/j.jpsychires.2019.01.024. Epub 2019 Jan 31. PMID: 30738930.
  8.  Henderson L, Kotsirilos V, Cairns A, Ramachandran A, Peck C, McGregor I. Medicinal cannabis in the treatment of chronic pain. Australian Journal of General Practice, Volume 50, Issue 10, October 2021, doi: 10.31128/AJGP-04-21-5939 
  9.  Escudero-Lara A, Argerich J, Cabañero D, Maldonado R. Disease-modifying effects of natural Δ9-tetrahydrocannabinol in endometriosis-associated pain. 2020, eLife 9:e50356
  10.  Sinclair J, Smith CA, Abbott J, Chalmers KJ, Pate DW, Armour M. Cannabis Use, a Self-Management Strategy Among Australian Women With Endometriosis: Results From a National Online Survey. J Obstet Gynaecol Can. 2020 Mar;42(3):256-261. doi: 10.1016/j.jogc.2019.08.033. Epub 2019 Nov 10. PMID: 31722852.
  11.  "1 In 10 Women With Endometriosis Report Using Cannabis To Ease Their Pain". The Conversation, 2019, https://theconversation.com/1-in-10-women-with-endometriosis-report-using-cannabis-to-ease-their-pain-126516. Accessed 16 Aug 2022.

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