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Cannabis Use, a Self-Management Strategy Among Australian Women With Endometriosis: Results From a National Online Survey

Published:November 10, 2019DOI:https://doi.org/10.1016/j.jogc.2019.08.033

      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

        • Howard F
        • Perry P
        • Carter J
        • et al.
        Pelvic pain: diagnosis and management.
        Lippincott Williams & Wilkins, Philadelphia2000
        • Ramin-Wright A
        • Schwartz ASK
        • Geraedts K
        • et al.
        Fatigue – a symptom in endometriosis.
        Hum Reprod. 2018; 33: 1459-1465
        • As-Sanie S
        • Kim J
        • Schmidt-Wilcke T
        • et al.
        Functional connectivity is associated with altered brain chemistry in women with endometriosis-associated chronic pelvic pain.
        J Pain. 2016; 17: 1-13
        • Whitaker LH
        • Reid J
        • Choa A
        • et al.
        An exploratory study into objective and reported characteristics of neuropathic pain in women with chronic pelvic pain.
        PLoS One. 2016; 11e0151950
        • Nnoaham KE
        • Hummelshoj L
        • Webster P
        • et al.
        Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries.
        Fertil Steril. 2011; 96 (366–73.e8)
        • Chalmers KJ
        • Catley MJ
        • Evans SF
        • et al.
        Clinical assessment of the impact of pelvic pain on women.
        Pain. 2017; 158: 498-504
        • Sepulcri Rde P
        • do Amaral VF
        Depressive symptoms, anxiety, and quality of life in women with pelvic endometriosis.
        Eur J Obstet Gynecol Reprod Biol. 2009; 142: 53-56
        • Pluchino N
        • Wenger JM
        • Petignat P
        • et al.
        Sexual function in endometriosis patients and their partners: effect of the disease and consequences of treatment.
        Hum Reprod Update. 2016; 22: 762-774
        • Becker CM
        • Gattrell WT
        • Gude K
        • et al.
        Reevaluating response and failure of medical treatment of endometriosis: a systematic review.
        Fertil Steril. 2017; 108: 125-136
        • Brown J
        • Farquhar C
        Endometriosis: an overview of Cochrane Reviews.
        Cochrane Database Syst Rev. 2014; CD009590
        • Sinaii N
        • Cleary SD
        • Younes N
        • et al.
        Treatment utilization for endometriosis symptoms: a cross-sectional survey study of lifetime experience.
        Fertil Steril. 2007; 87: 1277-1286
        • Fischer B
        • Rehm J
        Deaths related to the use of prescription opioids.
        CMAJ. 2009; 181: 881-882
        • Centers for Disease Control and Prevention
        CDC grand rounds: prescription drug overdoses - a U.S. epidemic.
        MMWR Morb Mortal Wkly Rep. 2012; 61: 10-13
        • Armour M
        • Sinclair J
        • Chalmers KJ
        • et al.
        Self-management strategies amongst Australian women with endometriosis: a national online survey.
        BMC Complement Altern Med. 2019; 19: 17
        • Bouaziz J
        • Bar On A
        • Seidman DS
        • et al.
        The clinical significance of endocannabinoids in endometriosis pain management.
        Cannabis Cannabinoid Res. 2017; 2: 72-80
        • Ngan T
        • Litt M
        • Eguzo K
        • et al.
        Paitent outcomes following initation of medical cannabis in women with chronic pelvic pain.
        Society of Endometriosis and Uterine Disorders (SEUD), Montréal2019
      1. Therapeutic goods order No. 93 (standard for medicinal cannabis).
        Australian Federal Government Department of Health, Canberra, Australia2017
        • Di Blasio AM
        • Vignali M
        • Gentilini D
        The endocannabinoid pathway and the female reproductive organs.
        J Mol Endocrinol. 2013; 50: R1-R9
        • Leconte M
        • Nicco C
        • Ngo C
        • et al.
        Antiproliferative effects of cannabinoid agonists on deep infiltrating endometriosis.
        Am J Pathol. 2010; 177: 2963-2970
        • Bilgic E
        • Guzel E
        • Kose S
        • et al.
        Endocannabinoids modulate apoptosis in endometriosis and adenomyosis.
        Acta Histochem. 2017; 119: 523-532
        • Maroun P
        • Cooper MJ
        • Reid GD
        • et al.
        Relevance of gastrointestinal symptoms in endometriosis.
        Aust N Z J Obstet Gynaecol. 2009; 49: 411-414
        • Baldini A
        • Von Korff M
        • Lin EH
        A review of potential adverse effects of long-term opioid therapy: a practitioner's guide.
        Prim Care Companion CNS Disord. 2012; 14 (PCC.11m01326)
        • Lagana AS
        • La Rosa VL
        • Rapisarda AMC
        • et al.
        Anxiety and depression in patients with endometriosis: impact and management challenges.
        Int J Womens Health. 2017; 9: 323-330
        • Sexton M
        • Cuttler C
        • Finnell JS
        • et al.
        A cross-sectional survey of medical cannabis users: patterns of use and perceived efficacy.
        Cannabis Cannabinoid Res. 2016; 1: 131-138
        • Lintzeris N
        • Driels J
        • Elias N
        • et al.
        Medicinal cannabis in Australia, 2016: the Cannabis as Medicine Survey (CAMS-16).
        Med J Aust. 2018; 209: 211-216
        • Scott KM
        • Bruffaerts R
        • Tsang A
        • et al.
        Depression-anxiety relationships with chronic physical conditions: results from the World Mental Health Surveys.
        J Affect Disord. 2007; 103: 113-120
        • Marjoribanks J
        • Ayeleke RO
        • Farquhar C
        • et al.
        Nonsteroidal anti-inflammatory drugs for dysmenorrhoea.
        Cochrane Database Syst Rev. 2015; CD001751
        • Els C
        • Jackson TD
        • Kunyk D
        • et al.
        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
        • Anthony J
        • Warner LA
        • Kessler RC
        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
        • Volkow ND
        • Compton WM
        • Weiss SR
        Adverse health effects of marijuana use.
        N Engl J Med. 2014; 371: 879
        • Cannabis Access Clinics
        Australian Medicinal Cannabis Pricing Analysis (Q3 2018).
        2018 (Available at:)
        • Piper BJ
        • Beals ML
        • Abess AT
        • et al.
        Chronic pain patients’ perspectives of medical cannabis.
        Pain. 2017; 158: 1373-1379
        • Belle-Isle L
        • Walsh Z
        • Callaway R
        • et al.
        Barriers to access for Canadians who use cannabis for therapeutic purposes.
        Int J Drug Policy. 2014; 25: 691-699
        • De Graaff AA
        • Dirksen CD
        • Simoens S
        • et al.
        Quality of life outcomes in women with endometriosis are highly influenced by recruitment strategies.
        Hum Reprod. 2015; 30: 1331-1341