When researching my book, I became really excited about the potential cannabis (and CBD specifically) holds for the endometriosis population. Not only can it help with pain, but also hormone levels, inflammation, oxidative stress, and potentially even the formation of new endometriosis lesions or regression of current ones.

Far out, man ;)

And that was when I was researching two years ago. Since then, there have been a few more tubular studies released about CBD and endometriosis, so I thought I’d write a fun blog on the topic to get us high-ly educated on it.

Cannabis: Hijacking the Endocannabinoid System

The cannabis plant (i.e. weed, ganja, Mary Jane, you get the picture) contains over 100 different phytocannabinoids—teeny tiny molecules that resemble teeny tiny molecules our own body makes, called endocannabinoids. Smoke it or make it in the body, phytocannabinoids and endocannabinoids are so molecularly similar they attach seamlessly to receptors in our endocannabinoid system.

Never heard of the endocannabinoid system? You’re not alone, it was only recently discovered! This is actually kind of nuts, considering how much it helps regulate our body’s essentials such as emotional processing, sleep, metabolism, pain, inflammation, immune system regulation, memory, and even eating.

Like the endocrine system, our endocannabinoid system is woven throughout our brains and bodies, packed with receptors eagerly waiting for cannabinoid molecules to come along. The two main receptors are CB1 and CB2, they’re quite different, and important to know when talking function.

The CB1 receptor is highly concentrated in the brain, and it surpasses the number of many other types of receptors found in the brain. In very short and simple speak, they help regulate neurotransmitters' direction. This is how they regulate different bodily systems: the activity of hunger, temperature, or alertness is adjusted via immediate feedback. This is also where the psycho-active cannabinoid THC fits in, hijacking the CB1 receptor and altering our mental state (slow alertness and munchies, anyone).

CB2 receptors are different, mainly found in immune tissues and even on immune cells that help control immune functioning, inflammation, oxidative stress, and pain. Unlike CB1 receptors, CB2 receptors do not cause a high. In this way, you can have positive cannabinoid benefits without the brain fog.

Endocannabinoid Deficiency and Chronic Disease

According to researchers, chronic stress and inflammation can result in "Clinical Endocannabinoid Deficiency," which may deeply contribute to the underlying cause of various illnesses such as migraines, autoimmune diseases, IBS, and other treatment-resistant syndromes, such as endometriosis. This deficiency occurs when the body is unable to produce enough endocannabinoids on its own, and why some people have found relief from using CBD or THC products because it helps the endocannabinoid system function normally again. This may be why therapeutic levels of CBD are being shown as promising agents in endometriosis-related issues. [11-12]

In fact, new research supports the idea that the endocannabinoid system may directly influence numerous facets of endo, from the creation of pain to disease pathology (inflammation, proliferation, and cell survival). This means that helping to reduce the size and recurrence of lesions. Win-win! [1]

Marijuana and/or CBD Oil for Endometriosis Pain:

One thing researchers agree upon across the board is how cannabinoids can influence pain—why THC and CBD are great considerations if you’re an endo-warrior with warrior pain levels.

THC can influence pain perception and help relax muscle spasms, two factors contributing to deadly “endo flairs.” And they’re actually really good at doing this. A 2022 study examining cannabis use amongst endometriosis patients found that pain relief was one of the biggest reasons for use. When it came to flairs, the method of inhalation was often preferred (i.e. smoking) since the resulting pain decrease was almost instantaneous. It was also noted that smoking’s effect on the brain and musculature (both relying on CB1 receptors) might also be important for patients who suffer from pelvic floor muscle spasms, since the THC-associated muscle relaxant can help reduce pain. [2]

But CBD is also a top contender for pain relief. Although CBD doesn’t offer such a fast response, it should absolutely be considered as a longer-term pain treatment option. The way CBD works is to actually help reduce inflammatory factors, oxidative stress, mast cells, prostaglandins, and more. All these factors are associated with creating the crippling pain endometriosis is known for. In fact, CBD is so good at lowering chronic pain new research recommends it as an “excellent alternative to an opioid in chronic pain,” offering all the benefits without addiction scares. [3-5]

CBD and Endometriosis Regression:

While high levels of inflammation play a significant role in the progression of endometriosis (what I refer to as “endo-ing” in my book), low inflammation supports endometriosis regression. This is why CBD, known for its anti-inflammatory properties, may offer potential therapeutic benefits in supporting the stabilization or regression of endometriosis. While research is thus far limited to Petri dishes and animal models, the results are exciting.

In a recent rat model, researchers found that CBD increased antioxidant capabilities and lowered oxidative stress, thereby lowering chronic inflammation. And, by lowering inflammation, endo lesions shrank. The CBD also reduced mast cell degranulation (a potent cause of inflammation and pain in endometriosis) and reduced neuro-sensitizing mediators, reducing the heightened sensitization and pain associated with endo. [1]

In another rat model, rats given CBD had not only had significant reductions in endo lesion size, but they also had reduced levels of the inflammatory immune cells responsible for the creation of new lesions (i.e. an antiangiogenic effect). This means the CBD not only supported lesion regression but also supported fewer lesions from being newly established.[6]

One reason why may be because CB1 and CB2 receptors are found on many of the exact inflammatory immune factors associated with endometriosis establishment and progression (such as TNF-α, IL-6, and IL-8 in monocytes and macrophages). By hijacking the conversation within these pro-inflammatory and trouble-causing cells, CBD may be a BIG help in reducing endometriosis-associated inflammation. Pretty freaking cool. [7]

**Note: Currently, research like this is near impossible to be done on humans without better imaging technology. No one wants a laparoscopy surgery to measure their endo lesions, get stitched up, take CBD, and get cut open again to see if the lesions shrank. Until we have tech that can better track what lesions are doing without surgery, studies like this will likely be kept to rodents, Petri-dishes, sad monkeys, and women with endometriomas that can be imaged.

Endometriosis and CBD: Stress, Anxiety, and Sleep

As I lay out in a chapter in my book, stress is a potent contributor to endometriosis. And more than a symptom! It turns out cortisol and adrenaline (the two main stress hormones) actually fuel endometriosis growth and progression. It’s why learning to beat back stress is more than just a good habit, but actually important for disease mitigation.

The problem is that the majority of us with endo are stressed AF. I know I was. I was so stressed, for so long, that if someone asked if I was stressed, I would say “nope” and believe it! I honestly didn’t know any other way so it seemed, so … normal.

It turns out I wasn’t alone — nearly 2/3 of women with endometriosis report so much chronic anxiety we indeed view it as a personality trait (compared to 8.3 percent of women without endo). This was soooo me. Unfortunately, a chronic stress mindset like this may directly fuel the body's endo-ing. [8]

Luckily, CBD has some encouraging results when it comes to relaxing the ‘ol stressed-out-and-anxiety-riddled brain. A brain that overthinks, stresses, worries, and cannot turn off even to sleep.

According to a 2021 review, there have been 7 double-blind placebo-controlled clinical trials of CBD for stress. That’s not a drop in pond! And, all the studies proved that CBD so effectively reduces stress that it’s even comparable to pharmaceuticals. [9]

All this lessening of anxiety may help with sleep. In a 2019 study, nearly 80% of participants with anxiety that took CBD for three months found their anxiety reduced quickly within the first month and then stayed low for the duration of the study. So too, did sleep improve for nearly 60% of participants. [10]

As a side note, while CBD appears to lower stress, THC may have the opposite effect on susceptible individuals. Although THC can help lower acute stress (why some people smoke when they’re anxious), over time, constant use may actually increase your overall stress and anxiety. So if you’re smoking a lot and not feeling your mental best, you may want to consider a THC hiatus and try CBD instead.

Limitations of CBD Research and endometriosis

It’s important to note that we need a lot more research on endometriosis and CBD before making any big claims about it. Still, the current research is promising! Combined with the patient feedback I’ve heard, there is quite a BIG and very supportive community of those that have benefitted from it (speaking from a practitioner who knows quite a few sufferers that utilize THC or CBD religiously to aid their endo journeys).

That being said, if you’re interested in using cannabinoids, make sure to reach out to your doctor to discuss if it’s right for you. Understand that while CBD is known through the research and medical community to be generally well tolerated with few side effects, the same cannot be said about THC (known for its side effects and has the potential to be addictive for some).

What mg CBD Oil for Endometriosis?

As federal and state limits on this type of “drug” have minimized, THC has become easier to access. In most states, you can get a prescription for medical marijuana from a helpful doctor, whereas some states legally allow anyone to access it as long as you’re over 18. There are also many varieties of cannabis available, from the original smoking type to edibles, which are helpful if you want to dial in a specific THC dosage you’re comfortable with since there are low-THC options available for those who would like to skip the “high.”

CBD is much easier to access, with companies shipping worldwide. I know on Kaua`i, we have a few quality brands grown right here on the island, such as `Aina Organic CBD. I’m a huge fan of supporting small, local companies and reached out to get you a 20% discount if you’re interested in trying this company. Use promo code healendo20 [please note, I’m not an affiliate, just a fan].

Another popular brand is Charlotte’s Web, which has a cult-like following after being shown to help an epileptic little girl named Charlotte. It’s a cool story if you have time to watch :)

Quality: As a friendly reminder, look for organic! Non-organic means chemicals sprayed on the plants you’re smoking or swallowing, and there are plenty of organic brands available that you shouldn’t have trouble locating any.

Quantity: THC and CBD have no official dosage guidelines since cannabis isn’t a regulated drug. This means you will be talking to a doc and listening to your body to find the dosage that best supports you and your needs. Remember, more isn’t always better! It’s more about finding the best amount to support your symptoms.

Generally, it’s accepted that 25-75mg/dose/day is helpful for anxiety, while 30-50mg/day seems helpful for pain. Play around with dosages and remember sometimes it takes time and patience for results to appear. Give it 1-3 months and see how you feel. If you feel better, great! If you don’t feel any different, maybe CBD isn’t for you—so perhaps there is no need to keep such an expensive supplement on hand since, yah, CBD gets pricey.

If you deal with chronic endo pain, anxiety, sleep disturbances, inflammation, and oxidative stress, and haven’t tried hijacking the ESC, it may be time to try it!

Have you tried CBD or other cannabinoids with endometriosis? Leave a comment below on your experience so other sufferers who come across this blog can hear from you!

Disclaimer: This blog post is for educational purposes only. I am not a doctor and do not diagnose, treat, or cure disease. I recommend contacting a knowledgeable practitioner who can help you figure out the best variety to try for your specific situation.

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6) Okten, S. B., Cetin, C., Tok, O. E., Guler, E. M., Taha, S. H., Ozcan, P., & Ficicioglu, C. (2023). Cannabidiol as a potential novel treatment for endometriosis by its anti-inflammatory, antioxidative and antiangiogenic effects in an experimental rat model. Reproductive biomedicine online, 46(5), 865–875. https://doi.org/10.1016/j.rbmo.2023.01.018

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