How medical cannabis may help endometriosis patients

Despite the painful, debilitating symptoms experienced by those with endometriosis, on average it still takes around seven and a half years to reach a formal diagnosis.

During this long and lengthy process, patients often cycle through traditional licensed medicines to treat the inflammation, pain, bowel concerns, sleep and mental health concerns that endometriosis causes, but these come with a long list of side effects and potential interactions. For many patients, they may offer a period of respite or relief - but for some, they don’t work at all, and unfortunately there is still not a cure for the condition. 

Often, by the time patients reach a diagnosis, they’re not only exhausted because of the effects endometriosis has had on their health over the years, they’re also exhausted from cycling through treatments that remain ineffective at meeting their needs. 

But, since 2018, medical cannabis has been a legally available option for those struggling to manage the symptoms of endometriosis with conventional approaches. But, unfortunately, awareness of these options' availability, and efficacy, is surprisingly low. 

So, we spoke to Dr David Tang, Medical Director at Releaf, and one of the UK’s leading medical cannabis doctors, about how cannabis-based options may be able to offer some comfort to patients with endometriosis to try to spread awareness of these options.

Read what he had to say below:

Q: Can you please explain what endometriosis is, and how it can affect a persons' life?

“Endometriosis is where tissue from a woman's womb finds itself distributed in other parts of their body. This tissue can be distributed anywhere in the body by the blood stream, but we most commonly see it in the abdomen and pelvis, and this can cause some really unpleasant symptoms, like chronic pain and fatigue.

In endometriosis, symptom onset happens in a cyclical fashion that’s tied into the patient’s own hormonal cycle, and depending on where the tissue is distributed, it can cause some really alarming issues like gastrointestinal bleeding, coughing up blood or having blood tinged urine.

But the main crux of the issue is, on average it takes around SEVEN YEARS to be formally diagnosed with endometriosis, and during this time, patients with endometriosis are usually really struggling to manage their symptoms.”

Q: Why does it take so long for endometriosis to be diagnosed?

“At the moment, within the NHS, treatments and medication recommendations are made on a first principle approach to treat the specific symptoms a patient is experiencing. After each treatment is tried, multiple investigations and outpatient appointments are held, and if that particular treatment is deemed unsuitable, they’ll simply try another. 

The first treatment approach taken for menstrual pain is typically anti-inflammatories or hormonal treatment, such as the combined pill or hormonal coil - and this is also often the case for patients with undiagnosed endometriosis as well. 

If, after trying multiple approaches to manage their symptoms, symptoms still persist and are troublesome, an investigation into the likelihood of endometriosis will begin. 

Patients with endometriosis are typically prescribed a combination of non-steroidal anti inflammatories (NSAIDS such as Naproxen or Mefanamic Acid) and painkillers such as amitriptyline, or those containing codeine or morphine. If their symptoms are still not treatable with medication, keyhole surgery may be considered to identify where the deposits are and remove them with heat.”

Q: And, how effective are conventional endometriosis treatments?

“While these options are effective for some, for those not responding to conventional treatments, every day is full of pain and fatigue. 

A lot of the patients I’ve seen in the medical cannabis clinic setting say, in their experience, conventional treatments have provided them with little to no benefit, and they are also often accompanied by unwanted side effects. Even after supposedly ‘curative’ keyhole surgery, unfortunately, sometimes symptoms still persist. 

This, understandably, usually has a knock on, or domino, effect on mood, sleep, and a person’s ability to get on with day to day life - or have a good quality of life.”

Q: When conventional routes have been exhausted, should patients with endometriosis explore cannabis-based options?

“Whilst the full picture of how endometriosis causes pain is not fully understood, no doubt there will be inflammatory as well as 'central' causes for the pain experienced by those with this condition. Usually, opiates work well for the 'central' causes, whereas the anti inflammatories like Mefenamic acid and Naproxen should work for the inflammatory pain caused by endometriosis.

But, the beauty of cannabis based products for medicinal use is that, because they contain an entourage of molecules, they perform the function of both classes of painkiller whilst at the same time reducing the intensity of the ebb and flow of the hormones - which drives the endometriosis process.

There is no hard scientific evidence to suggest if specific cannabinoids may be more beneficial than others for patients with endometriosis, but what we do know is that cannabinoids certainly work better in collaboration with other cannabinoids.

THC provides effective pain relief, but can come with the cost of the feeling ‘high’ - which is something the majority of patients want to avoid. CBD on the other hand isn't as strong on the pain relief front, but it does prevent the THC from intoxicating patients as much. As a prescriber of medical cannabis, part of my responsibility is finding that correct balance for each patient I see.”

Q: What kind of results have you seen in patients when they start using medical cannabis endometriosis treatments?

“Like every treatment option, results vary from person to person, but usually patients new to cannabis-treatments first notice the improvements in their pain, sleep and levels of fatigue. 

I’ve personally heard some great feedback from patients with endometriosis who have used terms like ‘transformative’ and ‘life-changing’ when describing the difference these treatments have made. But, I think the main focal point is that patients can get their lives back, they’re able to get on with being a mum, or can focus on their career or hobbies because their symptoms are far less bothersome. 

At the moment, it's believed that CBPMs don’t interact with any of the conventional treatments prescribed to patients with endometriosis, but it's important for patients with comorbidities to be made aware that interactions with other medicines can happen, and there's a higher risk of this happening if their medicines have similar side effects to CBPMs.”

Q: What are the known side effects of medical cannabis or cannabis-based treatments?

“Like any other medicine, there are known side effects to those derived from cannabis. But, CBPMs are generally well tolerated and, for many patients, offer a safe, effective alternative treatment type that targets many different aspects of endometriosis, all at the same time. 

Physically, side effects may include feeling dizzy, or being ‘muzzy’ headed, potentially having an upset stomach or loose stool, or having a fast heart beat or rapid breathing. Mentally, side effects can include overthinking or anxiety, drowsiness or impaired reflexes or experiencing more vivid perceptions and thoughts. 

In extreme cases, an angina attack or a mini stroke could occur in susceptible individuals, and overuse of too much THC (especially in patients who are new to cannabis) may provoke a 'whitey' attack. This is where the patient feels intensely dizzy and nauseated, almost like intense motion sickness, but this passes after about half an hour and is not considered a medical emergency.”

Q: Lastly, how do you evaluate whether these options are suitable for an individual with endometriosis?

“To be considered eligible for cannabis-based treatments, patients with endometriosis must have tried at least two conventional treatment options that have been unsuitable at meeting their needs. 

When someone signs up for Releaf, we use their medical records and the answers to their health questionnaire to triage their needs and see if medical cannabis may be a suitable option for them. If so, they then have a consultation with myself, or one of the other specialists that work for Releaf, to discuss this further. If we think medical cannabis may be of benefit, we can issue a prescription. 

Unfortunately, there is always, inevitably, a degree of trial and error with a patient’s first CBMP prescription - as there is with any medication. But, we do make sure this is safely monitored. 

After their initial consultation and prescription, every patient returns for a mandatory follow-up appointment, where we discuss the effectiveness of the medication in relation to the treatment goals the patient desires. 

We’ll use this time to understand the patient’s individual response to the medication and how capable they have felt, or how productive they have managed to be during the day when using these options, and from there, we’ll make any adjustments if needed.” 

Final thoughts

The effect endometriosis can have on a person’s quality of life is evident, and in the All Parliamentary Party Group (APPG) paper on Endometriosis, it’s reported 95% of patients with the condition say it negatively affects their wellbeing.

They also found 58% of patients with endometriosis had been to see their GP about their symptoms at least 10 times, and 53% have even attended A&E because their symptoms were so severe. 

While these options are still not available on prescription on the NHS, private medical cannabis clinics like Releaf can prescribe medical cannabis flower, or cannabis oil, to  patients with endometriosis if their condition, and symptoms, cannot be managed with traditional approaches. 

To explore the endometriosis care options available at Releaf, assess your eligibility for medical cannabis today.