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The silent epidemic of women’s pelvic pain – is medical cannabis the answer?

There is a growing understanding of how cannabis medicines could help in the management of pelvic pain

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Female pelvic pain can range from chronic low level to agonising pain, felt by women that arises from the pelvic area.

Could cannabis be the answer to the silent epidemic of women’s pelvic and bladder pain? Dr Sally Ghazaleh, pain consultant at London’s Whittington Hospital and female health expert at Integro Clinics thinks it might be.

Claire Singer was in her teens when she began to develop pain when she passed urine or had sexual intercourse. She describes experiencing a constant unpleasant feeling of pressure in her bladder, even after emptying it. 

“I was spending half my life with a hot water bottle between my legs,” says Claire.

“Even though my mum and I went to countless doctors, they simply kept giving me antibiotics that had no effect or asked me to pee on a stick to look for an infection, that always came back negative I kept being told that I had interstitial cystitis and that as I grew older it would go away – but it didn’t.

She adds: “The fact that I was dismissed as making a big fuss by every doctor I saw, made me frustrated and depressed. The extreme feeling of nausea the pain produced, left me totally debilitated. I had to carry a bottle of soda water with me at all times to help with the sensation.” 

It was not until her mid-30s that Claire saw a gynaecologist who diagnosed painful bladder syndrome and pelvic floor myofascial pain.

The fact that she finally had been listened to and had a diagnosis marked the start of her journey to understanding and being able to cope with her pain.  

But what is pelvic pain? And given that thousands of women suffer from it, why is it such a silent epidemic?

Female pelvic pain is a cover-all term that can range from chronic low level, to agonising pain, felt by women that arises from the pelvic area.

It can be responsible not only for chronic suffering but also for notable disability. It can have a massive impact upon the individual’s ability to engage in pain free sexual intercourse and can cause great psychological suffering and depression. 

If resulting from nerve pain it may appear idiopathic or it can relate to a specific condition such as vulvodynia, painful bladder syndrome, myofascial pain resulting from muscle spasms in the pelvic floor, which can refer pain through the stomach, back and to trigger points, which can be excruciating – and endometriosis.

“In my cannabis clinic, I have seen women who have suffered from chronic pelvic pain continuously over the years,” explains Dr Ghazaleh.

Dr Sally Ghazaleh, pain consultant and women’s health expert at Integro

“They have tried multiple medications and undergone different specialist treatments to reduce the pain, all to no avail.  In fact, not only were some of the traditional approaches ineffective but the drugs they were prescribed such as opioids and anti-neuropathic medicines had very unpleasant side effects.”

She continues:”It is a fact that women experience more intense and long- lasting pain complaints than men, even for conditions occurring with similar frequency in the two sexes.

“Lack of knowledge by GP’s and perhaps being met with skepticism, feeling rejected, ignored, lack of comprehension and stigma towards women’s health contributes to women’s pain. Symptoms are frequently not diagnosed or go untreated for a long time.

“This results in women left suffering not only with chronic pain but also the huge psychological impact of this on them and their family.” 

Pelvic Pain mechanisms are complex, interconnected and can be divided into three main categories of pain: the nociceptive, the inflammatory, and the neuropathic pain.

The current pain management strategies for pelvic pain focus mainly on medical treatments such as hormonal therapy, pain medicines or non-steroidal anti-inflammatory drugs (NSAIDs) and/or or surgical re-sectioning. 

But the growing understanding of how new drugs such as cannabis medicines can help in this field is exciting, with the endocannabinoid system (ECS) featuring increasingly as an important factor in pain mechanisms.

Dr Ghazaleh continues: “As a last hope to reduce their pain they gave medical cannabis a try and many found that it could help them live a normal life after years of suffering.

“Patients stated that as well as reducing pain, they felt that medical cannabis considerably decreased gastrointestinal symptoms, sleep problems, feelings of depression and anxiety. Most importantly an appreciable number reported they were able to reduce some of their traditional medication.”

The ECS includes signalling molecules (anandamide and 2-AG) and cannabinoid receptors (CB1 and CB2) Endogenous cannabinoids and cannabinoid receptors exist at various levels in the pain pathways, from peripheral sensory nerve endings to spinal cord and supra-spinal centres.

Significantly, CB1 receptors are highly expressed in the uterus, as well as in multiple non-reproductive tissues.

The CB2 receptors are preferentially expressed abundantly in the immune system, intestines and in other tissues such as the lungs, uterus, pancreas, and skin.

The interactions between the ECS and pain associated mechanisms in pelvic pain patients occur at several levels: changes in central and peripheral neural system, involvement of neuropathic and inflammatory pain, psychological interaction with the pain experience, hormonal variability of the pain, and the expression of cannabinoid receptors, enzymes and ligands.

Targeting endocannabinoid modulation to treat pain is probably more than just treating the pain, it is also targeting the psychological impact it has on the patient, hence why it can be very effective.

“One pain mechanism will prevail over the others, which could be due to differences in the pathogens or disease entities,” says Dr Ghazaleh.

Dr Anthony Ordman

“This should be considered when developing strategies in personalised medicine, which could certainly involve the use of medical cannabis to produce a better outcome.”

Claire had started to self-medicate at the age of 17, using recreational cannabis, which she found reduced her pain and eased the nausea.

She moved to using medicinal cannabis when she became a patient of pain consultant, Dr Anthony Ordman at Integro Clinics.

Dr Ordman is one of the UK’ s most experienced and knowledgeable pain consultants. He worked with Claire to discover the correct prescription; oil during the day and a flower vape in the evening to help with her pain 

“Cannabis medicines give my pain a softness and blurs its’ sharp edges making it much more tolerable and easier to deal with,” she says.

“I also find it much easier to sleep, meaning my stress levels are significantly lower, which in turn reduces the amount of pain I feel. Through self-care, awareness and cannabis medicines I can now lead a much higher quality life.”

Dr Ghazaleh adds: “It goes without saying, that although I have seen positive results using medical cannabis for women’s pelvic conditions additional research is urgently required to assess the effectiveness of quality controlled medicinal cannabis in this area.

“We are only just starting to understand the full workings of the human ECS and what a greater understanding of terpenes and the molecular potential of cannabis medicines can bring us.”

If you have had a similar experience to Claire and are interested in speaking to Dr Sally Ghazaleh or Dr Anthony Ordman, please contact Integro Clinics  or email:  Contact@integroclinics.com

Integro Medical Clinics Ltd always recommend remaining under the care and treatment of your GP and specialist for your condition, while using cannabis-based medicines, and the Integro clinical team would always prefer to work in collaboration with them.

Dr Sally Ghazaleh will be taking part in a groundbreaking webinar series, exploring women’s health and cannabis medicines. The second webinar on Tuesday 3 August, will discuss the experiences of mothers and their children who require cannabis medicines to manage their conditions.

The event is free, you can register here

 

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How cannabis can offer an alternative for menopause symptoms

Experts at Integro Clinics explore how cannabis medicines can offer an effective alternative to HRT

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Experts at Integro Clinics explore how cannabis medicines can offer an effective alternative to HRT treatment for menopause symptom control.

It is now widely accepted that Hormone Replacement Therapy (HRT) can be very useful in treating menopause symptoms. However, it is not suitable for all women – some who may not feel comfortable using it or have a medical contraindication such as a family history of cancer.

There is an alternative out there that can be used in conjunction with HRT treatment, to complement it, or used entirely on its own – cannabis medicines.

At Integro Clinics our female pain expert, Dr Sally Ghazaleh and Neuropsychiatrist, Dr Mayur Bodani have seen encouraging results from patients using medical cannabis in the form of an ingestible oil (CBD mixed with THC) and by vaping prescribed cannabis flower.

The specific symptom cannabis-based medicines (CBM’s) can address in menopause include insomnia, anxiety, depression, headaches, low libido, and brain fog. If you have profoundly disturbed sleep, it can have a massive impact on your quality of life, mental well-being & ability to cope.

At Integro Clinics we have witnessed that once the patient achieves a better and more consistent regular quality of sleep, with the help of CBM’s, everything starts to pick up. Anxiety can decrease, the desire to take physical exercise and mental clarity are increased, which can lead to a lift in depression and a more positive mindset.

If you are interested in finding out in more detail how CBM’s can help you with your menopause symptoms, do not miss the opportunity to register for free for a webinar on Tuesday 30 November.  Hosted by Integro Clinics, Cannabis Health and Cannabis Patient Advocacy and Support Services (CPASS), it will look to break down the stigma that women face when it comes to menopause and medical cannabis.

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Menopause: An event image advertising a panel discussion around women's cannabis and menopause

To register for a free ticket for the webinar, please click here

On the panel

Integro Clinics Dr Sally Ghazaleh and Dr Mayur Bodani will join other experts in the field including specialist sexual health nurse Sarah Higgins. There will also be an opportunity to take questions from the audience.

Menopause: Dr Sally Ghazaleh

Dr Sally Ghazaleh

Dr Sally Ghazaleh is a pain management consultant and prescriber of cannabis-based medicines at Integro Clinics, where she is the resident female pain expert. Dr Ghazaleh specialises in managing patients with lower back pain, neck pain, neuropathic pain, abdominal pain, cancer pain, complex regional pain syndrome, post-stroke pain and fibromyalgia. She has a particular interest in bladder and abdominal pain in women, and women’s health in general & menopause. She is fluent in Arabic, English and Hungarian.

Menopause: Dr Mayur Bodan

Dr Mayur Bodani

Dr Mayur Bodani, a neuropsychiatrist at Integro Clinics qualified in both General Medicine (to hospital medicine standard) and neuropsychiatry. He has over 25 years of experience in the field and prescribes cannabis medicines at Integro Clinics for mental health-related conditions.

Gone are the days where women are just supposed to put up and get on with it – there are new medicines out there such as medical cannabis, that can address and help menopause symptoms.

If you would like further information or to speak to Dr Sally Ghazaleh or Dr Mayur Bodani or any of the team at Integro please contact us at:

Website: www.integroclinics.com
Email: Contact@integroclinics.com
Twitter: @clinicsintegro

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Sex, pain and stigma: Could CBD lubricant be the answer?

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Women's health

The gender gap in medical cannabis – why are less women accessing treatment?

Women reveal how workplace stigma and healthcare inequality have affected their decision to access cannabis.

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illustration of women

With two thirds of medical cannabis patients in Project Twenty21 identifying as male, what is holding younger women back from accessing what could be a life-changing treatment?

There’s a whole year of Claire’s life which she can’t remember. 

Diagnosed with fibromyalgia while sitting her exams in high school, she was prescribed a dose of 1,800mg of gabapentin a day. 

“I took my tablets in the morning and by 12 o’clock that afternoon I couldn’t tell you what I had for breakfast, that’s how strong they were,” says the 28-year-old.

“I don’t remember any of it. I failed all my exams. I even had a boyfriend that I don’t really know anything about.”

Claire’s battle with chronic pain began at the age of 13, when she fell off of a horse and broke her hip. The break wasn’t picked up until she underwent an operation three years later and the pain never fully subsided.  

Claire has been experiencing chronic pain since the age of 13.

At the same time she was struggling with excruciatingly painful cramping – not just during her period – but was frequently dismissed by male doctors as having anxiety, or blamed for “eating too much dairy” or “just trying to get out of school”. 

“I told my GP that I was struggling and asked if he could write me a note so I could get some support at school. When I got the letter from him he had written that I should try going to bed a bit earlier,” Claire adds.

“That’s just one of the stories I can tell you about being a young woman experiencing chronic pain.” 

In 2015, after finally being listened to by a female GP, Claire underwent a laparoscopy [a surgical procedure required to diagnose the condition] and was told she had endometriosis. 

By this point she had scarring all over her bladder, kidneys and bowel and the disease had progressed to such a point that she was told she may not be able to have children. 

Claire says: “It makes you think, had they listened to me sooner could they have prevented that? I think the fact that I was also suffering from chronic pain and a hip injury, made them less likely to believe me, they felt that there was too much going on.”

The medical gender gap

According to a 2017 government survey, women reported a higher prevalence of chronic pain than men and studies have also shown that women supposedly experience more severe and frequent levels of pain, for a longer duration than men and are more likely to report migraines, musculoskeletal pain, and pain from osteoarthritis, rheumatoid arthritis and fibromyalgia. 

Despite this, many like Claire do not feel they are taken seriously by doctors and research now shows that women are more likely to have their pain discounted as “emotional” or “psychogenic”.

“I remember how suicidal I felt, how pointless everything seemed,” she says of that period of her life.

“After I failed my exams I thought I’m never going to get a degree, I’ll never get a job. What is the point?

“I never experienced anxiety or depression until the chronic pain got out of control, but [doctors] were always trying to conflate that relationship.”

Claire did manage to go to university, but struggled to manage the workload and social life with her condition, eventually having to resit a year.

“I couldn’t go out so my social life was affected,” she says. 

“It was really difficult just to be normal, I had to choose between uni work, sleep or friends, and sometimes I never had the option to do any of it.”

In her third year, with a prescription amounting to 480 tablets a month, a friend encouraged her to look into medical cannabis. 

“At this point I was still very anti-drugs,” Claire admits.

“I’m a prim, piano-playing nerd and always have been, but I was struggling, I was in a lot of pain and I didn’t really want to be around anymore.”

Claire was able to climb the hill behind her house for the first time thanks to her prescription

With the help of cannabis Claire was able to come off all of her other painkillers. She completed a masters in psychology, set up her own business and now works supporting young people struggling with mental health issues. 

Since January, Claire has had a legal prescription through Project Twenty21, which helps to subsidise the cost of prescriptions while aiming to build the UK’s largest evidence base for the safety and efficacy of medical cannabis.

Despite the fact it is this which has made all of her achievements possible, she is still wary of stigma when it comes to her professional career.

“I was really lucky [my manager] was open minded, but I am also very reserved about who I tell,” Claire says.

“If I was going for a new job I wouldn’t feel comfortable telling them straight away, because you don’t know what people’s perceptions of it are.”

This stigma could be holding other women back from accessing cannabis treatment.

According to data from Drug Science’s Project Twenty21, two thirds of patients enrolled in the programme identify as male, with only 29.3 per cent of those in the younger patient group (aged 18-25) women. But the number of female patients steadily increases with age and in the over 75s group, 63 per cent of patients identify as women.

This is at odds with the fact that women are thought to make up the majority of CBD consumers, with more than one study reporting that they are more likely to use the supplement than men and a survey from the Brightfield Group of 2,400 participants found that 58 per cent of CBD users were women.

So, why doesn’t this translate to those accessing a medical cannabis prescription?

Stigma in the workplace

Claire believes that it could be the fact that women are statistically more likely to hold jobs in health, social care and education where the risks of being associated with cannabis may be greater, even to the point it could cost them their job. 

According to Government figures published in March 2021, 78 per cent of jobs in the health and social work sector and 71 per cent of jobs in education were held by women. Women are also more likely than men to work as employees and less likely to be self-employed.

“I work with vulnerable young people every day,” says Claire.

“My biggest fear was one of my students finding out and damaging my reputation and I think that’s a big barrier for a lot of young women.”

Laura works in education and runs the blog and Instagram account The Endo Monologues, where she documents her journey with endometriosis and adenomyosis. But even though she is a legal medical cannabis patient, only a select number of colleagues know about  her prescription.

“My employer is not aware of my prescription and as it stands and I don’t think that I will be able to disclose this until the understanding and viewpoint on using medical cannabis changes,” she told Cannabis Health. 

“Working in an environment that tout’s cannabis as being a negative thing plays a huge part of this as I feel it would be seen as contradictory on their part to be accepting of someone who uses it even if that is for legal medical reasons.

“I think it would trigger lots of discussions where I would have to defend myself, which is ridiculous as it’s my body, it’s having a significant impact on my health and wellbeing and it’s allowing me to work. I would love to be able to have conversations to educate people on it at my work but until the overall public opinion of cannabis changes, that won’t happen.”

She continues: “Using medical cannabis turns me into a pain-free functioning human being, so on my employer’s part I think they’re happy in the fact that I can work and not be restricted by my conditions. As far as they’re concerned, they think I’m using conventional medication to allow that and I’m happy to let them think that.”

Laura admits that she had reservations about accessing a prescription due to what she describes as the “prejudice in her profession” and feels other women may be in the same position.

“Ultimately, I had to do what’s right for my health,” she says.

“From my standpoint my work doesn’t need to know, as it’s no different to taking any other legal long-term medication and it doesn’t impact my work performance. My only concern was and still is, that I could be penalised for not declaring it and potentially lose my job due to the attached prejudice.”

She adds: “Women have so much to fight against in the workplace already that adding cannabis to the equation is another battle to fight. It might be that you don’t need to declare it to your employer like me but for individuals who do, the ongoing prejudice is another barrier to overcome. We already have it ingrained by society that we must choose between a career and a family and can’t have both, cannabis adds another bias against us which is so incredibly wrong.”

Seeking validation

It could be that after years of being misdiagnosed and generally feeling unsupported by the medical system, women are less likely to seek out other healthcare professionals and may even experience trauma in medical settings.

Katie* 25, who suffered severe endometriosis symptoms from the age of 11 until her diagnosis two years ago, was consistently told “this is just what periods are like”. 

She now experiences severe anxiety in medical situations after more than a decade of not being believed. 

“I have had both incredible experiences with health professionals and experiences that I could call traumatising,” she says.

“I’m usually quite a confident person but in medical situations I am so terrified I can’t speak. I believed them after years of being told that I had a psychosomatic disorder, when actually I had endometriosis and a spinal condition.”

Katie has also now been able to access a medical cannabis prescription, through Project Twenty21. She says she finally felt validated after her initial appointment with the prescribing pain consultant.

“I can understand why people with chronic conditions may feel defeated and may not want to seek out another health professional,” she says.

“I was so scared my mum had to sit with me in case I froze. But it was one of the most pleasant experiences I’ve ever had with a medical professional. I felt listened to and validated.”

With millions of patients facing even longer delays to their diagnosis journey, as waiting lists swell in the wake of Covid-19, many who are suffering could be benefiting from medical cannabis.

“There is an endometriosis crisis in this country at the moment, particularly as a result of Covid-19 – I know people who are on waiting lists of up to five years for surgery,” says Katie.

“I think medical cannabis could be the answer to that, but there is so much stigma to overcome.”

Katie sees the gender gap which we know is present in the medical system, reflected in the emerging medical cannabis space, where she says support groups feel “male dominated”.

“There is a gender gap in medicine, but you can also see it in the medical cannabis space,” she says.

“We need to hear from more women, particularly those with endometriosis and reproductive conditions. People who were assigned female at birth are facing double the stigma, as a woman who uses cannabis but also a woman in pain, we have to battle with that old trope of the ‘hysterical woman’.”

Katie adds: “Cannabis is not a magic wand, it hasn’t cured everything but it has given me a quality of life and allowed me to function as a human being. I want to see women talking about how it helps them.”

A sentiment which Claire echoes.

“I want to advocate for this medication, it really has changed my life and that’s why I don’t mind talking about it,” she says.

“The more people who say ‘I can do this and still do my job and so do millions of other people around the world’, that’s what’s going to change things.”

Find out more about Project Twenty21 here

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*Some names have been changed

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