12 November 2019:
A new study published in Journal of Obstetrics Gynaecology Canada has found one in eight Australian women with endometriosis use cannabis to alleviate pain and other symptoms, rating the plant based medicine as the most effective way to self-manage the disorder.
Researchers from NICM Health Research Institute, Western Sydney University and UNSW Sydney surveyed 484 Australian women with endometriosis between the ages of 18 and 45 to determine the types of strategies they used to self-manage symptoms.
They found more than three quarters of Australian women with endometriosis are turning to self-management strategies including breathing techniques, yoga, dietary changes, heat and cannabis. Cannabis was ranked as the most effective treatment by women.
The women said that along with reducing pain, they felt that cannabis significantly reduced symptoms of nausea and vomiting, gastrointestinal symptoms, problems with their sleep, feelings of depression and anxiety.
Women using cannabis also reported a decrease in the medication that they normally took for their endometriosis symptoms, with just over half saying they decreased their medication by 50 per cent or more. Reported side effects were mild and relatively rare.
Endometriosis is a chronic condition where tissue similar to the lining of the uterus is found outside the uterus, and commonly causes pelvic pain and fatigue, with many women reporting significant negative impact on many aspects of their life including education and work, friendships, and sexual relationships.
In Australia, around one in nine women born between 1973-78 were diagnosed with endometriosis by age 40-44. The condition may cost up to $9.7 billion in Australia per year, mostly through productivity losses.
Aside from surgery, current treatments for endometriosis include use of oral contraceptive or progestogens, and non-steroidal anti-inflammatory drugs, which do not always provide adequate pain control, or have side effects that are hard to tolerate for some women. Opioid analgesics are often prescribed for pain, however there is a risk of dependency and overdose.
Lead author on the study, NICM Health Research Institute Research Fellow and Coordinator of the Australian Medicinal Cannabis Research and Education Collaboration, Justin Sinclair said that due to the limitations of existing medical treatments for endometriosis, women are turning to self-care or lifestyle interventions for symptom relief and research is needed into the effectiveness of these self-management strategies.
"Cannabis has a long history of use in the ancient and scientific literature for various conditions such as period pain, however until now nothing has been investigated for cannabis being used for endometriosis," Mr Sinclair said.
"Past research has demonstrated that certain compounds within cannabis known as cannabinoids exert analgesic and anti-inflammatory activity. Our research sought to determine the prevalence, tolerability, and self-reported effectiveness of cannabis in women with endometriosis."
Although the study showed promising results for the use of cannabis for endometriosis symptoms, Mr Sinclair cautioned that cannabis use was not without risk, however the reported rates of adverse effects were low in their study.
"One in ten women in the study who used cannabis reported an undesirable effect such as drowsiness, rapid heartbeat, or increased anxiety," he said.
According to Chief Investigator on the study NICM Health Research Institute's Dr Mike Amour, Australian law currently requires legal medicinal cannabis use to follow specific, regulated pathways that limit prescription by this method; however, self-reported illicit use of cannabis remains relatively common in Australian women with endometriosis.
"Due to the timing of when the survey was administered, most if not all of the women in the survey would have been using illicit cannabis as access to medicinal cannabis was still in its infancy," Dr Armour said.
"This means we don't have any information about the different varieties of cannabis that women were using, or what might have been in the cannabis that was being used as it was derived from illicit sources which are not quality assured. Also, this was a self-reported survey, which can lead to over or under estimation of the positive or the negative effects.
"Further research is needed to assess the effectiveness of quality controlled medicinal cannabis and women with endometriosis."
Source: Eureka Alert
This study sought to determine the prevalence, tolerability, and self-reported effectiveness of cannabis in women with endometriosis.
A cross-sectional online survey was conducted between October and December 2017. Recruitment targeted women with endometriosis through social media postings from endometriosis advocacy groups. Women aged 18 to 45, living in Australia, and with surgically confirmed endometriosis were eligible to participate. Survey questions investigated the types of self-management used, change in symptoms or medication use, costs, and adverse events.
A total of 484 responses were included for analysis, with 76% of the women reporting the use of general self-management strategies within the last 6 months. Of those using self-management, 13% reported using cannabis for symptom management. Self-reported effectiveness in pain reduction was high (7.6 of 10), with 56% also able to reduce pharmaceutical medications by at least half. Women reported the greatest improvements in sleep and in nausea and vomiting. Adverse effects were infrequent (10%) and minor.
Australian law currently requires legal medicinal cannabis use to follow specific, regulated pathways that limit prescription by this method; however, self-reported illicit use of cannabis remains relatively common in Australian women with endometriosis. Women report good efficacy of cannabis in reducing pain and other symptoms, with few adverse effects reported. Further clinical research is warranted to determine the effectiveness of cannabis in managing endometriosis symptoms. In locations where medicinal cannabis is more accessible, there remains a paucity of evidence for its clinical efficacy with endometriosis-associated symptoms.
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. 2019 Nov 7. pii: S1701-2163(19)30808-4. doi: 10.1016/j.jogc.2019.08.033. [Epub ahead of print]