In a recent study published in the Journal of Clinical Medicine, researchers reviewed available literature on cannabis as a self-management strategy in the treatment of pain arising due to endometriosis. They further investigated the mechanisms by which cannabis interacts with the endocannabinoid system (ECS) and the interactions of gut microbiota and ECS in treating the condition. Their findings reveal that cannabis-derived endocannabinoids have a protective effect on the gut, decrease gut inflammation, and improve its permeability. This, in turn, suppresses bloating, the most common endometriosis symptom. Cannabinoids or cbd capsules further inherently suppress pain receptors and serve as a natural painkiller. CBD capsules online results highlight gut microbiota and the ECS as future clinical trial targets in the fight against endometriosis.

Endometriosis and the benefits of cannabis

Endometriosis is a disease in sexually mature women (between the first period and until menopause) characterized by uterus lining-like tissue growing outside the confines of the uterus. It is a common condition, estimated to affect 10% of all women, with symptoms including severe pelvic pain and outcomes including difficulties conceiving.

In addition to its direct outcomes, endometriosis-related chronic pelvic pain (CPP) has been associated with several comorbidities including irritable bowel syndrome (IBS), psoriasis, rheumatoid arthritis, mental health issues (depression and anxiety), and chronic fatigue syndrome. The annual economic loss due to the disease is estimated at between USD 1,459 and USD 20,239 per woman, highlighting the socioeconomic burden of the disease alone, not accounting for its treatment.

Research has identified progesterone as a common characteristic of endometriosis patients, suggesting hormone imbalances that subsequently trigger inflammation due to the local infiltration of immune cells. These cells establish new cells, which have been found to activate pathways associated with invasion, proliferation, metastasis, and angiogenesis. Since most hormone resistances arise due to imbalances within the gut microbial system, resulting in changes in expression levels of estrogen-metabolizing enzymes, recent studies have focused on the associations between the gut microbiome and the disease.

Current treatment for endometriosis involves a combination of surgical intervention and hormone treatment. Anti-neuropathics, including gabapentin, pregabalin, and amitriptyline, are used to reduce pain and allow for normal daily functioning. Unfortunately, these interventions are medically suboptimal given the reduced access of women in developing and underdeveloped countries to surgery and the much-reduced efficacy of anti-neuropathics in suppressing pain in endometriosis patients. Research has presented that endometriosis patients are four times more likely to overuse painkillers, thereby developing dependency and abuse conditions.

Metabolites from the Cannabis genus received extensive attention during the 1990s, resulting in the discovery of the endocannabinoid system (ECS), a complex signaling system composed of G-protein-coupled cannabinoid receptors, ion channel transient receptor potential vanilloid 1, and a cohort of enzymes responsible for endocannabinoid synthesis and catabolism. Cannabidiol (CBD) and tetrahydrocannabinol (THC), the two main active ingredients derived from cannabis consumption, have intrinsic pain suppression abilities and have been used in other medical research.

Given its relative inexpensiveness and ease of access, cannabis consumption has become a popular self-medication against endometriosis pain despite sufficient research into the pathways and mechanisms through which it may affect the ECG, thereby positively- or negatively altering endometriosis outcomes.

Study findings

The present study is a descriptive review of current scientific knowledge on endometriosis, focusing on the impacts of endocannabinoids on disease outcomes and the associations between ECS, gut microbiota, and endometriosis. While publication screening methodologies have not been reported, the list of citations suggests that over 140 scientific papers were perused during the synthesis of this work.

Research has identified that the ECS is primarily involved in pain modulation and inflammation suppression. Endocannabinoids or exogenous cannabinoids have been shown to activate the CB1 and CB2 receptors, critical components of the G-protein-coupled system, thereby suppressing nociceptive processing and inducing analgesia

ECS is further hypothesized to play a central role in endometriosis pathology, with some researchers referring to the disease as an “endocannabinoid deficiency.” Strong correlations have been observed between circulating endocannabinoid levels in the plasma and the severity of endometriosis, with lower levels of endocannabinoids associated with increased pain. However, other studies have suggested that endometriosis and the ECS may have complex associations with the onset of the former initiating a feedback loop in the latter. This indicates that the role of ECS in endometriosis may extend beyond inflammation- and pain suppression and warrants further research into the mechanisms underlining these interactions.

Can external cannabis consumption help?

The role of cannabis or cbd capsules derivatives in endometriosis, especially concerning their pain suppression capabilities, has spurred examinations of cannabis use as a potential natural alternative to current anti-neuropathic therapies. An ongoing clinical trial is testing the efficacy of CBD isolate oil and vaporized THC in pain modulation for women admitted to hospitals and clinics reporting severe endometrial pain. Murine in vivo models have paved the way for these types of trials, given the positive effects of CBD against not only endometrial pain but also their observed growth retarding effects on the surface area of endometriotic implants