Endometriosis affects around 1 in 7 women by the age of 44 in Australia. Endometriosis-related chronic pelvic pain includes a variety of pain symptoms including dysmenorrhea (period pain), dyspareunia (pain during sexual intercourse), fatigue, dyschezia (pain on bowel motions), and dysuria (pain on urination). Endometriosis impacts women’s health and wellbeing, including social activities, mental and emotional health, work and finances,and sexual relationships,and has been shown to reduce the physical quality of life similar to that of cancer patients.Endometriosis places significant economic and social burden on patients, their families, and society as a whole.The economic burden of endometriosis is similar to or higher than other chronic disease burdens, such as heart disease and diabetes. The cost of illness burden in Australia is $30,000 per woman per year, or $9.7B in total, with the majority of costs being due to lost productivity, and pain severity being the most significant modifiable factor. Current pain management strategies have shortcomings and significant addictive potential. Opioid analgesics are not recommended for persistent pain due to both a lack of efficacy and safety concerns, however they are commonly prescribed for endometriosis.
The Endocannabinoid System (ECS) is a relatively recent scientific discovery, being uncovered largely in the 1990s from research into the Cannabis genus. The ECS is composed of three major components: G-protein-coupled cannabinoid receptors (both CB1 and CB2), endocannabinoids (endogenously produced cannabinoids) and the enzymes involved in synthesis and catabolism of the endocannabinoids. This presentation will cover the role of the ECS in endometriosis including its extensive involvement throughout the female reproductive tissues, its dysregulation in women with endometriosis including increased levels of anandamide (AEA) and 2-arachidonoylglycerol (2-AG), and a reduction in CB1 receptors and how medicinal cannabis may slow lesion progression due to its effects on angiogenesis, apoptosis, nerve innervation, cell migration, and endometrial hyperproliferation. Finally, how medicinal cannabis's complex nature makes clinical trial design more difficult and potential strategies to manage this.