Endometriosis – an indication for cannabinoids ?

Received : June 25, 2020 Published : July 18, 2020 Endometriosis is associated with imbalances of the endocannabinoid system (ECS) which correlate with symptoms: Whereas cannabinoid receptors CB1 and CB2 are downregulated, plasma levels of endocannabinoids (AEA, 2-AG and PEA) are elevated. In addition, levels of matrix metalloproteinases (MMPs) which are important for a wide range of pathological processes including spreading of cells and inflammation are also high in ectopic endometrium. Cannabinoids including cannabidiol (CBD) are known to interact wit the ECS. Among other mechanisms, they decrease MMP production and therefore invasiveness of cells. As endometrial cells have a hyperproliferative phenotype and pro-angiogenic properties, it may be argued that the decrease of MMPs by CBD could also reduce endometriosis. At present, only population-based surveys suggest that cannabinoids reduce pain and other symptoms in women affected by endometriosis. Whereas a majority of women who have used cannabis confirm its efficacy, it is not without risks. Of the two main active compounds, d9-tetrahydrocannabinol (THC) and cannabidiol (CBD), CBD has the advantage of not being psychotomimetic, therefore not causing the typical “high”. It is not a “scheduled drug”, does not interfere with workplace testing or police controls when driving, and is well tolerated also when taken as long-term treatment. Pure CBD is devoid of potential impurities which are frequently found in “street cannabis”. This could be a safe and novel approach for the treatment of endometriosis.