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Marijuana Use for Treatment of Endometriosis Pain: A Systematic Review

Nicole Ennis
Florida State University

Co-Authors: Savannah Calleson1, Katie Kloss1
1Florida State University

Endometriosis is a common, chronic inflammatory condition in women due to the presence of endometrial-like tissue found outside the uterus. Endometriosis can cause a myriad of symptoms such as chronic pelvic pain, fatigue, dyspnea, dyspareunia, dyschezia, and dysuria. The chronic health implications for women with endometriosis can lead to a decreased quality of life. Management of endometrial pain can include pain medications, oral contraceptives, laparoscopy, and even hysterectomy. The objective of this study was to determine what evidence exists for the use and effectiveness of medical marijuana (cannabis) for endometriosis related pain.

The literature for this review was collected from the following databases: PubMed, Web of Science, Cochrane Central Register of Controlled Trials, MEDLINE, and Embase. Cohort studies, case-control studies, cross-sectional surveys, and systematic reviews from 1996 to August 2022 assessing any relationship between marijuana/cannabis use and endometriosis were eligible for inclusion. Duplicate articles, non-accessible full text articles, and articles not published in English were excluded. Retrieved articles were independently reviewed by two reviewers and any discrepancies were resolved by consensus by a third reviewer.

A total of 522 references were identified and retrieved. Following screening, eight articles were included for review: four cross-sectional surveys, two systematic reviews, one retrospective cohort study, and one review of literature. Total participants who used cannabis for endometriosis symptom management was N= 1817 across five studies. All included studies were from high-income countries where marijuana is legalized medicinally or recreationally. Overall, results showed that cannabis consumption for symptom relief was common among women with endometriosis and some women even reported use of cannabis reduced their use of analgesics.

We found no randomized controlled trials on the use of marijuana for endometriosis related pain indicating an important gap for future research given the recent findings that dysfunction in the endocannabinoid system (ECS) may play a role in endometriosis related pain. This study was limited by the lack of literature specifically analyzing the relationship between endometriosis and therapeutic marijuana use. Although, endometriosis is very common, it can often go undiagnosed which may attribute to the lack of literature.

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