Abstract
Objective
This study sought to determine the prevalence, tolerability, and self-reported effectiveness
of cannabis in women with endometriosis.
Methods
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.
Results
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.
Conclusion
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.
Résumé
Objectif
Les auteurs de cette étude cherchaient à déterminer la prévalence, la tolérabilité
et l'efficacité autodéclarée du cannabis chez les femmes atteintes d'endométriose.
Méthodolgie
Une enquête transversale en ligne a été menée entre octobre et décembre 2017. La méthode
de recrutement consistait à cibler des femmes atteintes d'endométriose par les publications
de groupes de sensibilisation à l'endométriose sur les médias sociaux. Les femmes
de 18 à 45 ans vivant en Australie et atteintes d'une endométriose confirmée chirurgicalement
étaient admissibles à participer à l'enquête. Les questions de l'enquête visaient
à examiner les types d'autogestion de la maladie employés, les changements dans les
symptômes ou la prise de médicaments, les coûts et les événements indésirables.
Résultats
Au total, les auteurs ont tenu compte de 484 réponses aux fins d'analyse; 76 % des
femmes ont rapporté avoir utilisé des stratégies d'autogestion de leurs symptômes
au cours des 6 derniers mois. Parmi les femmes ayant recours à l'autogestion, 13 %
ont mentionné utiliser le cannabis pour soulager leurs symptômes. Le taux d'efficacité
autodéclarée du cannabis pour réduire la douleur s'est avéré élevé (7,6 sur 10) et
56 % des femmes ont affirmé avoir réduit leur traitement médicamenteux d'au moins
la moitié. Les participantes ont rapporté que les plus importantes améliorations s’étaient
produites sur le plan du sommeil et de la nausée et des vomissements. Les effets indésirables
se sont avérés peu fréquents (10 %) et mineurs.
Conclusion
À l'heure actuelle, la loi australienne exige que la consommation légale de cannabis
médicinal soit régie par des protocoles précis et réglementés, dans le but d'en limiter
la prescription. Toutefois, la consommation illicite autodéclarée de cannabis demeure
relativement fréquente chez les Australiennes atteintes d'endométriose. Les participantes
déclarent que le cannabis est efficace pour réduire la douleur et les autres symptômes,
en plus de n'occasionner que peu d'effets indésirables. Il y a lieu de mener des recherches
cliniques supplémentaires afin de déterminer l'efficacité du cannabis dans le traitement
des symptômes de l'endométriose. On constate un manque de données probantes relativement
à l'efficacité clinique du cannabis médicinal pour traiter les symptômes liés à l'endométriose
dans les milieux où cette option est accessible.
Key Words
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REFERENCES
- Pelvic pain: diagnosis and management.Lippincott Williams & Wilkins, Philadelphia2000
- Fatigue – a symptom in endometriosis.Hum Reprod. 2018; 33: 1459-1465
- Functional connectivity is associated with altered brain chemistry in women with endometriosis-associated chronic pelvic pain.J Pain. 2016; 17: 1-13
- An exploratory study into objective and reported characteristics of neuropathic pain in women with chronic pelvic pain.PLoS One. 2016; 11e0151950
- Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries.Fertil Steril. 2011; 96 (366–73.e8)
- Clinical assessment of the impact of pelvic pain on women.Pain. 2017; 158: 498-504
- Depressive symptoms, anxiety, and quality of life in women with pelvic endometriosis.Eur J Obstet Gynecol Reprod Biol. 2009; 142: 53-56
- Sexual function in endometriosis patients and their partners: effect of the disease and consequences of treatment.Hum Reprod Update. 2016; 22: 762-774
- Reevaluating response and failure of medical treatment of endometriosis: a systematic review.Fertil Steril. 2017; 108: 125-136
- Endometriosis: an overview of Cochrane Reviews.Cochrane Database Syst Rev. 2014; CD009590
- Treatment utilization for endometriosis symptoms: a cross-sectional survey study of lifetime experience.Fertil Steril. 2007; 87: 1277-1286
- Deaths related to the use of prescription opioids.CMAJ. 2009; 181: 881-882
- CDC grand rounds: prescription drug overdoses - a U.S. epidemic.MMWR Morb Mortal Wkly Rep. 2012; 61: 10-13
- Self-management strategies amongst Australian women with endometriosis: a national online survey.BMC Complement Altern Med. 2019; 19: 17
- The clinical significance of endocannabinoids in endometriosis pain management.Cannabis Cannabinoid Res. 2017; 2: 72-80
- Paitent outcomes following initation of medical cannabis in women with chronic pelvic pain.Society of Endometriosis and Uterine Disorders (SEUD), Montréal2019
- Therapeutic goods order No. 93 (standard for medicinal cannabis).Australian Federal Government Department of Health, Canberra, Australia2017
- The endocannabinoid pathway and the female reproductive organs.J Mol Endocrinol. 2013; 50: R1-R9
- Antiproliferative effects of cannabinoid agonists on deep infiltrating endometriosis.Am J Pathol. 2010; 177: 2963-2970
- Endocannabinoids modulate apoptosis in endometriosis and adenomyosis.Acta Histochem. 2017; 119: 523-532
- Relevance of gastrointestinal symptoms in endometriosis.Aust N Z J Obstet Gynaecol. 2009; 49: 411-414
- A review of potential adverse effects of long-term opioid therapy: a practitioner's guide.Prim Care Companion CNS Disord. 2012; 14 (PCC.11m01326)
- Anxiety and depression in patients with endometriosis: impact and management challenges.Int J Womens Health. 2017; 9: 323-330
- A cross-sectional survey of medical cannabis users: patterns of use and perceived efficacy.Cannabis Cannabinoid Res. 2016; 1: 131-138
- Medicinal cannabis in Australia, 2016: the Cannabis as Medicine Survey (CAMS-16).Med J Aust. 2018; 209: 211-216
- Depression-anxiety relationships with chronic physical conditions: results from the World Mental Health Surveys.J Affect Disord. 2007; 103: 113-120
- Nonsteroidal anti-inflammatory drugs for dysmenorrhoea.Cochrane Database Syst Rev. 2015; CD001751
- Adverse events associated with medium- and long-term use of opioids for chronic non-cancer pain: an overview of Cochrane Reviews.Cochrane Database Syst Rev. 2017; CD012509
- Comparative epidemiology of dependence on tobacco, alcohol, controlled substances, and inhalants: basic findings from the National Comorbidity Survey.Exp Clin Psychopharmacol. 1994; 2: 244-268
- Adverse health effects of marijuana use.N Engl J Med. 2014; 371: 879
- Australian Medicinal Cannabis Pricing Analysis (Q3 2018).2018 (Available at:)
- Chronic pain patients’ perspectives of medical cannabis.Pain. 2017; 158: 1373-1379
- Barriers to access for Canadians who use cannabis for therapeutic purposes.Int J Drug Policy. 2014; 25: 691-699
- Quality of life outcomes in women with endometriosis are highly influenced by recruitment strategies.Hum Reprod. 2015; 30: 1331-1341
Article info
Publication history
Published online: November 10, 2019
Footnotes
Competing interests: See Acknowledgements.
Each author has indicated that they meet the journal's requirements for authorship.
Identification
Copyright
© 2019 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
