Endometriosis and Medical Marijuana

What is Endometriosis?

Endometriosis is a disorder in which tissue that normally lines the inside of the uterus (the endometrium) grows outside of a woman’s uterus. Endometriosis most commonly involves the ovaries, fallopian tubes and the tissue lining the pelvis. Rarely, endometrial tissue may spread beyond pelvic organs as well.

With endometriosis, displaced endometrial tissue continues to act as it normally would — it thickens, breaks down and bleeds with each menstrual cycle. Because this displaced tissue has no way to exit the body, it becomes trapped. When endometriosis involves the ovaries, cysts called endometriomas may form. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions (abnormal bands of fibrous tissue that can cause pelvic tissues and organs to stick to each other). Endometriosis can cause pain, sometimes severe, especially during menstruation. Fertility problems also may develop.

Endometriosis is an autoimmune disease. A woman’s body does not recognize her own endothelial cells, which leads to a  immune response, that is oftentimes painful.

Endometriosis and Medical Marijuana

Symptoms of Endometriosis

The primary symptom of endometriosis is pelvic pain, often associated with a menstrual period. Although many women experience cramping during their menstrual period, women with endometriosis typically describe menstrual pain that’s far worse than usual. They also tend to report that the pain increases over time.

Common signs and symptoms of endometriosis may include:

  • Painful periods- Pelvic pain and cramping may begin before your period and extend several days into your period. You may also have lower back and abdominal pain.
  • Pain with intercourse- Pain during or after sex is common with endometriosis.
  • Pain with bowel movements or urination- You’re most likely to experience these symptoms during your period.
  • Excessive bleeding- occasional heavy periods (menorrhagia) or bleeding between periods (menometrorrhagia).
  • Other symptoms. You may also experience fatigue, diarrhea, constipation, bloating or nausea, especially during menstrual periods.

The severity of pain isn’t necessarily a reliable indicator of the extent of the condition. Some women with mild endometriosis have intense pain, while others with advanced endometriosis may have little pain or even no pain at all.

Causes:

Although the exact cause of endometriosis is not certain, possible explanations include:

  • Retrograde menstruation- In retrograde menstruation, menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. These displaced endometrial cells stick to the pelvic walls and surfaces of pelvic organs, where they grow and continue to thicken and bleed over the course of each menstrual cycle.
  • Transformation of peritoneal cells- In what’s known as the “induction theory,” experts propose that hormones or immune factors promote transformation of peritoneal cells (cells that line the inner side of your abdomen) into endometrial cells.
  • Embryonic cell transformation- Hormones such as estrogen may transform embryonic cells (cells in the earliest stages of development) into endometrial cell implants during puberty.
  • Surgical scar implantation-  After a surgery, such as a hysterectomy or C-section, endometrial cells may attach to a surgical incision.
  • Endometrial cells transport- The blood vessels or tissue fluid (lymphatic) system may transport endometrial cells to other parts of the body.
  • Immune system disorder- It’s possible that a problem with the immune system may make the body unable to recognize and destroy endometrial tissue that’s growing outside the uterus.

Endometriosis and Medical Marijuana

Medical marijuana has been proven to be effective for pain relief, as well as having anti-inflammatory properties. Some of the most common endometriosis symptoms, like nausea and digestion problems can also be treated with medical marijuana.

From an Inflammation and Cannabis study done at the University of South Carolina

“Marijuana is now regularly and successfully used to alleviate the nausea and vomiting many cancer patients experience as side effects to chemotherapy, combat the wasting syndrome that causes some AIDS patients to lose significant amounts of weight and muscle mass and ease chronic pain that is unresponsive to opioids, among other applications.

The university study has uncovered yet another potential application for marijuana, in the suppression of immune response to treat autoimmune diseases. The work builds on recent scientific discoveries that the environment in which humans live can actually trigger changes that occur outside of human DNA, but nevertheless can cause alterations to the function of genes controlled by DNA. These outside molecules that have the ability to alter DNA function are known collectively as the epigenome. In this study, the investigators wanted to find out if the tetrahydrocannabinol (THC) found in marijuana has the capacity to affect DNA expression through epigenetic pathways outside of the DNA itself.

The recent findings show that THC can change critical molecules of epigenome called histones, leading to suppression of inflammation. They also suggest that, because of its epigenetic influence toward inflammation suppression, marijuana use could be efficacious in the treatment of autoimmune diseases such as arthritis, lupus, colitis, multiple sclerosis and the like, in which chronic inflammation plays a central role”

From a a Study on Cannabis and Chronic Pain:

“Average reported pain relief from medical cannabis was substantial. Average pre-treatment pain on a zero to ten scale was 7.8, whereas average post-treatment pain was 2.8, giving a reported average improvement of 5 points. This translates to a 64% average relative decrease in pain. Cannabis is an extremely safe and effective medication for many patients with chronic pain. In stark contrast to opioids and other available pain medications, cannabis is relatively non-addicting and has the best safety record of any known pain medication . Adverse reactions are mild and can be avoided by titration of dosage using smokeless vaporizers.”

How to Medicate

Cannabinoid treatment  has been delivered via smoked and vaporized cannabis,  oral administration of capsules, edibles, tinctures, mouth sprays and topical application. Studies display varying degrees of intervals and dosing, ranging from the smoking of cannabis every 3-5 hours, and the oral administration of THC/CBD extracts or using topical as needed. The benefit from smoking as a route of administration is instant action and the ability of the patient to self titrate the dose needed for relief.

Vaporizing or Vaping

If you don’t like the idea of smoke there is the option to vaporize. Vaporization does not use combustion to heat the medicine. Unfortunately there is some confusion out there about vaporizers. There are now hundreds of vaporizers to choose from. There are three basic types: pen, hand-help, and tabletop. The differences are in price, portability and size. Some vaporizers claim to be able to vaporize plant matter (flowers), wax and oils. Some can only do concentrates, some only oil. The most important difference is the method used to heat the medicine. There are basically two methods (with hybrids on the way)- conduction and convection. True Vaporizing is done by convection, where air is heated, and in turn the hot air turns the medicine a to vapor which is then inhaled. Conduction Vaporizing happens when a hot element (metal plate, or bowl) touches the medicine. The medicine is placed directly in a metal or ceramic bowl or chamber that is heated which then heats the medicine and the smoke is inhaled. This is still combustion, and not truly vaporizing. This is closer to dabbing but with a much cooler heating element.

Edibles

Edibles provide ways to eat or drink your medicine. Many medicated edibles and even bottled drinks are readily available at dispensaries. Be aware that most of the edibles at dispensaries are loaded with sugar and carbs. But basically what the edibles and drinks all contain are canna butter and/or canna oil. You can purchase these or easily make them at home to add to your own baked goods, snacks or even meals (especially if you are avoiding sugar or gluten).

Tinctures

Tinctures are not new. Until cannabis was banned in 1937, tinctures were the primary type of cannabis medicines. Tinctures are essentially alcohol extractions of whole cannabis (usually the flowers and trim leaves). The best way to use tinctures is sublingually (under the tongue). Titration or dose control is easily achieved by the number of drops a patient places under the tongue where the medicine is rapidly absorbed into the arterial system and is quickly transported to the brain and body. All a patient need do with tincture is use a few drops, wait for the desired medical effects, and either use more or stop as the situation indicates. Tinctures can be flavored for better taste.

Topical’s

Topical’s are cannabis-infused oils lotions or balms, that are meant to be absorbed through the skin. They work for soreness, and inflammation and pain relief in specific areas. Topical’s can include THC, CBD and other cannabinoids. Topical’s in cream, balm or lotion form don’t cause a psychoactive response, the cannabinoids in the Topical’s only affect the CB2 receptor in the brain and THC never enters the bloodstream. In transdermal patches, THC can enter the bloodstream.

 

 

Sources: X. Yang, V. L. Hegde, R. Rao, J. Zhang, P. S. Nagarkatti, M. Nagarkatti. Histone modifications are associated with Delta(9)-tetrahydrocannabinol-mediated alterations in antigen-specific T cell responses. Journal of Biological Chemistry, 2014; DOI:

Apr. 2014 study titled “Therapeutic Benefits of Cannabis: A Patient Survey,” published in Hawaii Journal of Medicine and Public Health:

Mayo Clinic

Comments