Endometriosis Treatment and Cannabinoids

What is the endometrium? 

The endometrium is the inner lining of the uterus. It thickens during the ovulation cycle, then sheds during menstruation (AKA when a person bleeds once a month).

The endometrium itself has many functions, but the primary ones are to:

  • House and nourish an implanted embryo
  • Serve as a barrier to prevent the uterine walls from sticking to each other

When a uterus is not pregnant, the uterine walls touch. The endometrium prevents them from adhering together and scarring.

When the endometrium is gone or destroyed, the uterus becomes fibrous, forms endometrial adhesions, and grows together. This is incredibly painful and can cause countless other problems.

What is endometriosis?

Endometriosis is a condition where endometrial cells abnormally grow outside of the uterus. These growths are similar to the uterus’ inner lining, still thickening and shedding blood every month. But they are located OUTSIDE the uterus. Generally, they’re found on the ovaries, fallopian tubes, tissue around the uterus, ovaries, pelvis, bladder, and bowels. In rare cases, they sometimes grow in other areas of the body and on organs.

However, unlike menstruation, the blood and tissue shed from the cells have nowhere to go! So they get trapped in the body, creating inflammation, scarring, intense pain, and many other health-related issues.

In endometriosis, when these cells outside the uterus swell, the uterus tries to shed them. It can’t, so the area around them becomes inflamed. One inflamed area can get stuck to another inflamed area, which creates the adhesion or scarring.

Very similar to cancer cells, they grow, spread, and move to other tissues – even those where they were previously surgically removed. They create their own blood veins to supply them nutrients and remove waste products.

The lesions grow new nerve endings that increase pain perception. These nerve endings deeply imbed into different parts of the body and organs. This can cause extreme pain inside the uterus alone, so it definitely can be painful in other areas of the body not designed to handle that shedding process.

Fortunately, our bodies are pretty incredible in the self-healing department. That’s why the adhesions form in the first place! It’s the body’s way of trying to heal and reabsorb the dead, shedded cells. But the scarring is re-irritated every month. Depending where the endometrial cells are, this can eventually cause even more serious issues.

Possible symptoms of endometriosis

  • Severe menstrual cramps
  • Pelvic pain
  • Chronic or acute back pain
  • Joint and muscle pain
  • Leg pain
  • Stomach pain, nausea, diarrhea, constipation, vomiting, bloating, digestive issues
  • Loss of appetite
  • Malnourishment
  • Painful urination/bowel movements
  • Irregular cycle or heavy bleeding
  • Hot flashes
  • Vertigo
  • Migraines, headaches
  • Chronic fatigue
  • Insomnia
  • Anemia
  • Painful sexual intercourse
  • Infertility, difficulty getting pregnant
  • Hypersensitive to inflammation & toxins
  • Autoimmune issues: Endometriosis is thought to be autoimmune in nature, since those with it have higher levels of antibodies that target their own ovaries and endometrial tissue.
  • Anxiety & depression
  • Although endometriosis is considered benign, bodies unable to prevent the spread of the cells have a much higher risk for ovarian cancer
  • And more

Common Misconceptions

Pain

A common misconception is that endometriosis only affects the person during menstruation, but it can affect them at any time. 

For some, they experience pain only during menstruation. For others, it’s a daily, constant pain. Although endometriosis is considered a chronic illness and autoimmune disease, everyone’s symptoms may drastically vary.

The pain is usually worst during menstruation & ovulation but again, can be experienced at any point throughout the hormonal cycle as “flare-ups”. These flare-ups can be triggered by many factors, including food and stress.

Misdiagnosis 

Endometriosis is regularly misdiagnosed as gastrointestinal-related disorders, like IBS or Crohns. This is because endometriosis often wreaks havoc in the digestive tract.

In fact, the only way to “100% diagnose” endometriosis is through surgery. If not actively shedding, the endometrial growths usually don’t show via ultrasound. That on top of our healthcare system’s lack of research into many menstrual/womb-related conditions, many doctors unfortunately aren’t well-versed in the disease. This means it goes untreated.

With no known “cure”, Western treatment generally focuses on maintaining the symptoms and preventing it from spreading. Often the only options offered are surgery to remove the growths (which can grow back), surgery to remove the uterus (which sends you into early menopause), painkillers, and birth control/hormones. Some of these options help many people! However, many don’t; and as a whole, those options don’t pinpoint the root cause.

Cannabis and endometriosis

The endocannabinoid system (ECS) plays an important role in the healthy function of the reproductive tract. The endometrium is shown to have a significant source of cannabinoids. Anandamide levels are also high in the uterus. 

The ECS stops cell multiplication and is largely responsible for preventing abnormal cell growth/destroying abnormal cells (apoptosis). 

Studies reveal that some cannabinoid receptors can prevent cancer cells from multiplying when activated (by the ECS or THC).

Endometriosis also impairs apoptosis. Since endometrial cells act similarly to cancer cells, similar treatment with cannabinoids are proving to be effective in research. 

Endocannabinoids are involved in regulating and preventing cell-migration

Research shows CBD can stop endometrial cells from migrating by blocking the activation of the GPR18 receptor. However, THC can activate this receptor, which may increase cell migration. Everyone’s different, and only each person can feel what’s right for their body. But this possibly suggests those medicating with THC should consider counterbalancing with CBD.

Studies show THC & CBD can inhibit vascularization of endometriotic lesions.

Endometrial tissues can only grow if they create a network of blood vessels (known as vascularization) to supply them with nutrients. The research on endometriotic lesions is limited, but plenty of research supports they inhibit vascularization of cancerous lesions. So this not only cuts off the life-force being given to the lesions, but it can help the body start absorbing the nutrients being hijacked in the first place.

Nerve growth prevention and nerve pain reduction

Most lesions deal with nerve innervation, causing nerve pain. Some deal with deep-infiltrating endometriosis: a more painful form of endometriosis embedded deeper into abdominal tissue. These deeper lesions have an even higher density of nerves than other lesions.

The ECS regulates nerve growth, and the CB1 receptors are on the nerves innervating endometriotic lesions. CBD interferes with innervation by preventing activation of this receptor, thus preventing more nerve growth.

When THC activates this receptor, it can decrease pain. CBD can reduce pain by desensitizing the pain receptor TRPV1.

Studies show cannabinoids calm overactive immune systems.

Many CB2 receptors are located on our immune system’s killer cells (macrophages). When CB2 receptors are activated, they prevent macrophages from releasing inflammatory proteins (cytokines). Research shows THC activates CB2 receptors.

Infertility

A study done on rats with endometriosis showed CB1 receptors also located in rats’ blastocysts. A blastocyst is an embryo that was fertilized 5 or 6 days before. This shows the chance of normal fetal implantation in uteruses with this condition. This may help with fertility in those with endometriosis.

Endocannabinoid Deficiency

Studies show those with endometriosis live with a deficiency in CB1 production. It is one of many conditions believed to be related to endocannabinoid deficiency – along with fibromyalgia, migraines, IBD, and much more.

Inflammation

There’s so much research supporting CBD’s (and other cannabinoids) role in balancing inflammation. CBD aids inflammation reduction through inhibiting COX-2 enzymes and its interaction with the immune system. Cannabinoids also help promote homeostasis in the body. 

Fatigue and insomnia

Chronic fatigue and difficulty sleeping are very common in those with endometriosis. CBD, THC, and other cannabinoids can act as powerful sleep aids.

Nausea and vomiting

Those with endometriosis often experience gastrointestinal distress, pain, and vomiting at any point in their cycle. CBD activates 5-HT1A, which reduces the sensation of nausea. Studies show CBD influences and modulates the flow of serotonin to reduce further stimulation of the vomiting center in the brain. They also show THC can help by activating CB1 receptors. 

How can I use it for my endometriosis?

Various methods people often use for their endometriosis include:

  • Topical creams for the abdominal/back/leg muscles, which contract and squeeze in response to the uterine muscles contracting
  • Smoking and vaping for more immediate pain relief, nausea, and anxiety
  • Sublingual oil for longer lasting pain-relief and sleep
  • Suppositories for localized area of pain and cramps

Every person, their symptoms, and treatment is different. If you think you have endometriosis, consult with a trusted, licensed healthcare provider who is knowledgeable in the field.

The pain is real, and you deserve relief.

REFERENCES:

https://jme.bioscientifica.com/view/journals/jme/50/1/R1.xml

https://www.ncbi.nlm.nih.gov/pubmed/12182964

https://www.sciencedirect.com/science/article/pii/S0002944010629227

http://jpet.aspetjournals.org/content/332/2/336.long

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2972363/

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