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Endometriosis and Adenomyosis – Cannabis Research

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Overview - Endometriosis and Adenomyosis

Description of Endometriosis and Adenomyosis

Endometriosis is a proliferation of interior endometrial cells outside the uterus. Displaced cells continue to respond to hormonal changes and behave as they would inside the uterus. However, without an easy exit, they remain, causing growth and adhesions. This can be extremely painful or asymptomatic in some. Growths and adhesions may spread throughout the pelvic cavity, forming attachments on the ovaries, bowels, or other surrounding tissue.


The exact causes of endometriosis remain unclear. Among other theories, researchers hypothesize that its cause may lie with exposure to environmental toxins (e.g., dioxin) or in retrograde menstruation, where menstrual blood flows backward instead of out of the vagina.


Orthodox treatments include pain management, hormonal or nonhormonal supplementation, and surgery.


Endometriosis is different from adenomyosis, which occurs when the lining grows into the uterus's muscle, causing abnormal thickness.

Disease Classification

Condition: Endometriosis
Disease Family: Gynecological Condition
Organ System: Endocrine System
ICD-10 Chapter: Diseases of the Genitourinary System
ICD-10 Code: N80

Endometriosis and Adenomyosis Symptoms:

Chronic lower abdominal pain, painful intercourse, dysmenorrhea (e.g. pain with menses, spotting, heavy bleeding, cramps), pain when urinating, pain with bowel movement, increased pain with movement or pressure, infertility, bloating, nausea, constipation.

Also known as:

ENDO

Drug Interactions

THC Interaction with Pharmaceutical Drugs

  • Tetrahydrocannabinol (THC) can enhance the effects of drugs that cause sedation and depress the central nervous system, such as benzodiazepines, barbiturates, and alcohol. 
  • THC is metabolized by an inhibitor of several enzymatic liver pathways referred to as cytochrome P450 (aka CYP450). There are more than 50 enzymes belonging to this enzyme family, several of which are responsible for the breakdown of common drugs such as antidepressants (e.g., amitriptyline, doxepin, fluvoxamine), antipsychotics (haloperidol, clozapine, Stelazine), beta-blockers (e.g., propranolol), bronchodilators (e.g., theophylline), or blood thinners (e.g., warfarin). Thus, patients taking these medication classes may find that THC increases the concentration and effects of these drugs and the impact duration.
  • Clinical observation (not yet confirmed by clinical trials) suggests no likely interactions with other pharmaceuticals at a total daily dose of up to 20mg THC.

If you are interested in the interaction potential of specific pharmaceuticals with THC, consider visiting these free drug interaction checkers: Drugs.com or DrugBank Online.

CBD Interaction with Pharmaceutical Drugs

  • Cannabidiol (CBD) may alter the action of metabolic enzymes (specific drug-transport mechanisms) and alter interactions with other drugs, some of which may produce therapeutic or adverse effects. For instance, CBD interacts with the enzyme cytochrome P450 3A4 and cytochrome P450 2C19, increasing the bioavailability of anti-epileptic drugs such as clobazam (a benzodiazepine). This makes it possible to achieve the same results at significantly lower dosages, reducing treatment costs and risks of adverse effects. 
  • Groups of drugs affected include anti-epileptics, psychiatric drugs, and drugs affecting metabolic enzymes.
  • Clinical observations (not yet confirmed by clinical trials) suggest no likely interactions with other pharmaceuticals at a total daily dose of up to 100mg CBD.

If you are interested in the interaction potential of specific pharmaceuticals with CBD, consider visiting these free drug interaction checkers: Drugs.com or DrugBank Online.

THC/CBD Interaction with Pharmaceutical Drugs

In general, when using cannabinoid-based therapeutics that contain both THC and CBD consider the ratio between them and weigh the relevant information displayed in the individual THC and CBD Drug Interaction windows accordingly.

If you are interested in the interaction potential of specific pharmaceuticals with both primary cannabinoids and THC/CBD, consider visiting these free drug interaction checkers: Drugs.com or DrugBank Online.

Concerns about Cannabis and Cancer-related Immunotherapies:
Some recent clinical observational studies have suggested that the co-administration of cannabinoid-based therapeutics and immunotherapy or immune checkpoint inhibitors in the treatment of certain types of cancer has been associated with worse overall survival rates (T. Taha et al., 2019; A. Biedny et al., 2020; G. Bar-Sela et al., 2020).

However, other studies have suggested that the co-commitment use of immune checkpoint inhibitors and cannabis-induced no such deleterious effects. More specifically, one trial was conducted on animals resulting in data suggesting that cannabis did not negatively affect the properties of immune checkpoint inhibitors (B. Waissengrin et al., 2023). The same authors compared the previous study results with findings from a cohort of 201 patients with metastatic non-small cell lung cancer who received treatment with monotherapy pembrolizumab as a first-line treatment and adjunct cannabis to treat mainly pain and loss of appetite. Their time to tumor progression was 6.1 versus 5.6 months, and overall survival differed between 54.9 versus 23.6 months in cannabis-naïve patients and cannabis-using patients, respectively. However, while numerically different, the authors write that these differences were not statistically significant, leading them to suggest that “These data provide reassurance regarding the absence of a deleterious effect of cannabis in this clinical setting.”

Dosing Considerations

THC Dosage Considerations

  • THC micro dose:  0.1 mg to 0.4 mg
  • THC low dose:  0.5 mg to 5 mg
  • THC medium dose:  6 mg to 20 mg
  • THC high dose:  21 mg to 50+ mg

CBD Dosage Considerations

  • CBD low dose:  0.4 mg to 19 mg
  • CBD medium dose: 20 mg to 99 mg
  • CBD high dose:  100 mg to 800+ mg (upper limits tested ~1,500mg)
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Disclaimer
Information on this site is provided for informational purposes only and is not meant to substitute for the advice provided by your own licensed physician or other medical professional. You should not use the information contained herein for diagnosing or treating a health problem or disease. If using a product, you should read carefully all product packaging. If you have or suspect that you have a medical problem, promptly contact your health care provider.

Information on this site is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over-the-counter medication is also available. Consult your physician, nutritionally oriented health care practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.