Endometriosis, sometimes referred to as endo, is a painful medical condition that affects women and people born with a uterus physically, emotionally, and financially. Learn more about this often-misunderstood condition, including what symptoms to look out for, how to cope, and available medical treatments. Plus, find out about the role of CBD in endometriosis treatment.

Introduction to Endometriosis: What is it and Who is Affected?

Endometriosis is a condition that results when a type of tissue that normally lines the inside of the uterus (called the endometrium) starts to grow in parts of the body where it shouldn’t. This most often includes the ovaries, fallopian tubes, bladder, and the outside of the uterus into the body including the diaphragm, lungs, and even in the brain.

This endometrium-like tissue responds to reproductive hormones the way it does in the uterus, meaning that it grows and thickens as if it were preparing for a pregnancy. In the uterus, when pregnancy doesn’t occur, a change in hormone levels stimulates the uterus to shed its lining, which flows out of the body through the cervix and vagina along with menstrual blood. 

The problem with endometrium-like tissue growing outside the uterus is that it behaves the same way and tries to break down and shed, except it has nowhere to go. This tissue gets trapped and can lead to inflammation and scarring in the pelvic area, which can cause severe and chronic pelvic pain.

The cause of endometriosis is not known, but researchers estimate that at least 11% of American women of reproductive age have undiagnosed endometriosis. 

Symptoms and Diagnosis of Endometriosis

Endometriosis is surprisingly difficult to diagnose for two main reasons. Firstly, it can manifest as any combination of symptoms that overlap with other reproductive health conditions such as adenomyosis and ovarian cysts. Secondly, a definitive diagnosis is only possible with an invasive procedure that confirms the presence of endometrium-like tissue outside the uterus.

The symptoms of endometriosis include:

• Mild to severe pain in the pelvis or lower back, that lasts beyond menstruation
• Very painful period cramps
• Very heavy menstrual flow or periods that last longer than 7 days
• Pain during or up to 48 hours after sexual intercourse
• Pain during bowel movements or urination
• Infertility
• Gastrointestinal issues such as constipation, diarrhea, and bloating
• Bleeding or spotting between periods

If you experience one or more of these symptoms and inform your doctor, they may suggest performing a pelvic ultrasound to try to detect irregularities in the reproductive tract. Another imaging test that your doctor may perform is magnetic resonance imaging (MRI) to get a better look at abnormal tissue.

These imaging tests are used as a non-invasive option to determine whether laparoscopy is warranted. A laparoscopy is a procedure in which a camera is inserted through a cut in the abdomen to look for endometriosis and a tissue sample is removed from the affected area for examination under a microscope. A laparoscopy is the only way to confirm a diagnosis of endometriosis. 

Once diagnosed, endometriosis is classified into one of four stages (minimal, mild, moderate, severe) based on the number, size, depth, and location of endometrium-like tissue growths.

Understanding the Causes and Risk Factors of Endometriosis

The cause of endometriosis is unknown and it can happen in any female who has begun menstruating, but the condition is most common in middle-aged women (30 to 50). Other risk factors include never having had any children, having a shorter-than-normal menstrual cycle, a family history of endometriosis, or suffering from a health problem that blocks menstrual blood from flowing from your body. 

Read more: 7 Signs of Endometriosis: Understanding the Symptoms

Living With Endometriosis: Tips for Managing Pain and Maintaining Quality of Life

Understanding what can trigger flare-ups of endometriosis pain allows you to prepare for different possibilities and minimize the impact of this painful condition on your quality of life. The following factors can trigger endometriosis pain:

• Hormonal imbalances
• Menstruation
• Stress
• Sedentary lifestyle
• Diet

By taking steps to address each of these possible triggers, you can improve your quality of life while living with endometriosis. If your pain has gotten to an unbearable level that is preventing you from living a normal life, it’s time to explore medical treatment options.  

 Medical Treatments for Endometriosis: Surgery, Hormonal Therapy, and More

There is no cure for endometriosis, but the good news is that the symptoms can be managed. Options for treating endometriosis include:

• Painkillers 
• Hormonal contraceptives or other hormonal therapies
• Surgery

A more aggressive approach to treating endometriosis is to cut it out with surgery. Although a laparoscopic procedure can remove scar tissue, lesions, and adhesions caused by endometriosis, there is always a risk of the tissue growing again. 

Read more: How to Be an Endometriosis Ally and Understanding Endometriosis Pain Triggers

Complementary and Alternative Therapies: CBD for Endometriosis

If you suffer from endometriosis and are willing to try just about anything in hopes of getting some pain relief, you’re not alone. There are a variety of complementary and alternative medicine (CAM) therapies that people use to help with endometriosis. These are nonpharmacologic interventions to treat pain and mood disturbances that come with endometriosis.

CAM therapies for endometriosis include Chinese herbal medicine, acupuncture, microwave physiotherapy, and even psychological interventions. Some herbal therapies have been shown to decrease the size of endometrial lesions (Kong et al., 2014).

Cannabidiol (CBD) has shown promise as a natural source of pain relief. CBD in oil form is popular for topical use, but CBD oil for endometriosis doesn’t make sense since it is an internal health problem.

An alternative therapy we at AIMA are excited about is CBD suppositories for endometriosis. Endometriosis is associated with an imbalance in the endocannabinoid system (ECS), receptors for which are known to be located within the reproductive tract. 

Preclinical studies have indicated that phytocannabinoids may be an effective form of pain relief for endometriosis (Nahler, 2020).  CBD suppositories for endometriosis are inserted directly into the vagina, where CBD can act locally on the cannabinoid receptors in the reproductive tract. Stay tuned for more exciting developments in alternative pain relief and research into reproductive health.

Editor: Lanna Last & Thomas Sauls

Scientifically Reviewed By: Mali Meibod