Medical Cannabis for Gynecologic Pain Conditions: A Systematic Review
Objective: The endocannabinoid system is involved in pain perception and inflammation. Cannabis contains delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), which are cannabinoids that bind to endocannabinoid system receptors. A fatty acid amide called palmitoylethanolamide (PEA) enhances endogenous cannabinoids. Given that use of medical cannabis is increasing, we sought to characterize patterns of cannabis use for gynecologic pain and its effectiveness as an analgesic.
Data sources: We searched PubMed, EMBASE, Scopus, Cochrane, and ClinicalTrials.gov using terms for “woman,” “cannabis,” and “pain” or “pelvic pain” or “endometriosis” or “bladder pain” or “cancer.” The search was restricted to English-language articles published between January 1990 and April 2021 and excluded animal studies.
Methods of study selection: The initial search yielded 5,189 articles with 3,822 unique citations. Studies were included if they evaluated nonpregnant adult women who used cannabinoids for gynecologic pain conditions (eg, chronic pelvic pain, vulvodynia, endometriosis, interstitial cystitis, malignancy). Study types included were randomized controlled trials (RCTs), cohort studies, and cross-sectional studies. Covidence systematic review software was used.
Tabulation, integration, and results: Fifty-nine studies were considered for full review, and 16 met inclusion criteria. Prevalence of cannabis use ranged from 13% to 27%. Most women ingested or inhaled cannabis and used cannabis multiple times per week, with dosages of THC and CBD up to 70 mg and 2,000 mg, respectively. Sixty-one to 95.5% reported pain relief. All six prospective cohort studies and one RCT of PEA-combination medications reported significant pain relief, and the average decrease in pain after 3 months of treatment was 3.35±1.39 on the 10-point visual analog scale. However, one fatty acid amide enzyme inhibitor RCT did not show pain reduction.
Conclusion: Survey data showed that most women reported that cannabis improved pain from numerous gynecologic conditions. Cohort studies and an RCT using PEA-combination medications reported pain reduction. However, interpretation of the studies is limited due to varying cannabis formulations, delivery methods, and dosages that preclude a definitive statement about cannabis for gynecologic pain relief.
Systematic review registration: PROSPERO, CRD42021248057.
Copyright © 2022 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.
Conflict of interest statement
Financial Disclosure Jenell S. Coleman holds investments in a cannabis exchange-traded fund. The other authors did not report any potential conflicts of interest.
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CBD for Interstitial Cystitis – Does it Help?
Interstitial Cystitis (IC) is a condition that causes long-term pelvic pain. If you have ever had a urinary tract infection (UTI), you understand the distress this bladder condition causes. It tends to affect people in their 30s and 40s and is much more common in women than men.
Still, unlike UTI, which antibiotics can cure, Interstitial Cystitis does not have a cure, and it can have a significant impact on your daily life, physical and emotional health, and relationships. Fortunately, various treatments can help relieve the symptoms.
Things that can help relieve the pain of these symptoms include lifestyle changes. The traditional therapies include dietary modifications, avoiding certain foods or drinks, reducing stress, pelvic floor therapy, and cannabis.
Cannabis is one of the most practical ways to deal with a chronic condition like IC, and it has been used medicinally for centuries. Cannabis-based products, such as CBD oils and CBD lubricants, have positive effects, can help to decrease inflammation, and potentially alleviate pelvic pain.
Does CBD Lube Work For Interstitial Cystitis?
In our body, we can find multiple cannabinoid receptors that endocannabinoids can bind to, including the lower urinary tract; this means that CBD lubricants are helpful treatments for bladder conditions such as Interstitial Cystitis.
In fact, CBD has effects on people diagnosed with many different illnesses and is proven to do more than relieve pain. Still, it also helps improve sleep quality, which potentially reduces the pain throughout the day and in the mornings also helps with inflammations. CBD’s therapeutic effects are numerous, which is why it would work for all the pains and symptoms that Interstitial Cystitis causes.
Unfortunately, the use of CBD for Interstitial Cystitis is only supported by anecdotal evidence. Some hopeful findings say that cannabinoid receptors are present in the lower urinary tract, which means the bladder walls line up with cannabinoid receptors. So, if systemic cannabinoids affect the lower urinary tract, they may become clinically useful.
CBD Dosage For Interstitial Cystitis
To know how much CBD to take for Interstitial Cystitis, there have been studies where the subjects are given between 150mg CBD, 300mg CBD up to 600mg CBD. Results said that the 300mg dose of CBD reduces pelvic pain significantly.
Sexologist and author Dr. Sadie Allison, and CBD scientist John Renko, B.S.E. created GoLove’s CBD lubricant specifically to enhance wellness and sexual health. As a result, it can help relax pelvic floor muscles and reduce any discomfort and inflammation that Interstitial Cystitis may cause. In case you want to learn more about this, you can read our article about the best lube for Interstitial Cystitis .
GoLove CBD Lubricant comes in several sizes, 40ml with 200mg of CBD and 5ml with 25mg of CBD, and these concentrations are high enough to be effective and safe. Besides, anyone can use it as GoLove is water-based, hypoallergenic, latex-safe, and pH-balanced.
Cannabis and chronic bladder pain
If you’ve ever had a urinary tract infection, or UTI, then you understand the pain of interstitial cystitis (IC), a bladder condition marked by urinary urgency, frequency and pelvic pain. But unlike a UTI, which can be cured with antibiotics, interstitial cystitis has no cure, and the millions of (mainly) women who suffer from it are, for the most part, left to deal with the condition on their own.
I know this because I’m one of those women, and my journey with IC, also known as painful bladder syndrome, has been a textbook case of mystery and misdiagnosis.
It started over a decade ago with a urinary tract infection that just wouldn’t go away. For nearly a year, I was in and out of walk-in-clinics and off-and-on antibiotics, but no matter how many prescriptions I downed, the pain, urgency and frequency always returned.
Mysteriously, every time my urine was tested for bacteria – the tell-tale sign of a UTI – it came back clean. Meanwhile, I was getting out of bed to pee constantly, sometimes 20 times a night.
Sometimes I go months without symptoms, and sometimes I find myself in a ‘flare’ that ends in the emergency room, with internal bleeding and swollen kidneys, but still no infection. Why?
No one’s really sure – not my family doctor, not my urologist, and not my rheumatologist, physiatrist, naturopath, physiotherapist, or the numerous other experts I’ve consulted for this, and potentially related conditions. That’s just how it is.
Interstitial cystitis is a diagnosis of exclusion, meaning it’s only given after other potential causes – like a UTI, bladder cancer, kidney stones, endometriosis or a sexually transmitted infection – have been ruled out. There’s only one ‘clincher’, the presence of either glomerulations (superficial hemorrhages) or of Hunner’s ulcers (distinctive patches of inflammation) on the bladder wall. I have Hunner’s ulcers, but more than 90 per cent of diagnosed IC patients don’t express either of these so-called classic IC signs.
It’s also possible that IC is not one condition, but a related set of symptoms with a variety of causes. Researchers aren’t even sure what kind of condition it is, but they have a few guesses: the top contenders are that it’s a neurological condition, an autoimmune attack or a reaction to toxic substances or bacteria that haven’t been identified yet, or aren’t picked up by current tests.
What I do know is this: I’m not uncommon. The Interstitial Cystitis Association reports that three to eight million American women and one to four million American men may have IC. They don’t provide Canadian stats, we can guess that the numbers are similar here, affecting up to six per cent of women and almost one per cent of men.
Often IC patients experience other conditions concurrently, most commonly fibromyalgia, irritable bowel syndrome, allergies and food intolerances, celiac disease, chronic fatigue, lupus, pelvic floor dysfunction, vulvodynia and endometriosis.
Without knowing the exact cause of the condition, it’s hard for doctors to know how to treat it, and every patient responds uniquely to different methods. Classic therapies include dietary modifications, pelvic floor physiotherapy, bladder retraining, antihistamines, antidepressants, antispasmodics and analgesics. Some patients may opt to receive medications directly into the bladder via catheter.
For me, the best treatments so far have been strict dietary modifications and cannabis. The last was a bit of a surprise. I’ve always liked cannabis, and although getting high on weekends was a pleasant distraction from my pain, I never saw it as a practical way to deal with a chronic condition, mainly because I didn’t want to be high every day. It wasn’t until I started taking a regular dose of non-intoxicating CBD oil, which I’d been prescribed for another condition, that I experienced a wonderful side effect – my first extended remission from IC. That prescription helped so much, I switched careers – now I spend my days exploring why cannabis so many conditions, and sharing those stories here.
There are clinical explanations for my positive experience with cannabis, and researchers are just starting to tease them out. One promising finding shows that like other organs, the bladder walls are lined with cannabinoid receptors, the “locks” that allow cannabinoids, or the “keys” to turn.
Cannabis extracts have been shown to help multiple sclerosis patients suffering from incontinence, while more recent studies suggest that the endocannabinoid system – composed of the bodily receptors that process cannabinoids – “is implicated in many gastrointestinal and urinary physiological and pathophysiological processes, including epithelial cell growth, inflammation, analgesia, and motor function.”
The same study goes on to say that modulating the endocannabinoid system might help patients with a range of gastrointestinal and bladder conditions. Its authors write that any drug that can inhibit endocannabinoid system degradation or raise the body’s levels of endocannabinoids -which CBD does – “are promising candidates for gastrointestinal and urinary diseases.”
Early research is promising, but there isn’t enough yet to form a full picture. I’d like to better understand why cannabis seems to reduce my flares, but for now, I know it’s helping, and that’s enough.
Personal anecdotes are no match for peer-reviewed studies, but the fact is there’s still a lot we don’t know about IC. In that respect, it’s not that different from the many painful conditions – largely suffered by women – we know little about, such as fibromyalgia, or endometriosis.
I look forward to increasing research that can explain why I experience pain, and why cannabis helps it. But until that day, I get a certain philosophical satisfaction from the fact that a drug we don’t know that much about seems to help so many conditions we don’t know much about either, including IC.