Women's health
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
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: [email protected]
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
Women's health
Cannabis legalisation not linked to adverse birth outcomes – study
Researchers studied the relationship between the liberalisation of cannabis laws and key indicators of child health
Legalisation of cannabis in the US is not linked to any significant adverse outcomes for child health, according to a recent study.
New data shows that changes in legal status of cannabis in US states is not associated with increases in adverse clinical birth outcomes.
Researchers at Purdue University studied the relationship between the liberalisation of state-level cannabis laws and two key indicators of child health – birthweight and gestational age.
Their findings were published in the journal Population Research and Policy Review.
While the authors reported a trend which indicated a reduction in average birthweight and gestational age for some groups of women following the relaxation of cannabis penalties, they acknowledged that these changes were not linked to any “increases in clinically meaningful birth indicators associated with adverse child health.”
The findings are similar to those reported in a 2021 study which found “no statistically significant effect of medical cannabis laws on the proportion of newborn hospitalisations”.
The authors concluded: “Our findings indicate that cannabis policy liberalisation may be contributing to lower average birth weights and reduced average gestational age, but not in a manner that has increased low birthweight (<2500 g) infants or preterm (<37 weeks) births.
“These results indicate that while cannabis policies have not led to increases in adverse clinical birth outcomes overall, these trends are worth monitoring to ensure that increases in clinically relevant child health outcomes do not emerge as the nationwide trend toward liberalised cannabis policy persists. “
They added: “Although our study does not show substantial changes in adverse birth outcomes, policymakers should be attentive to opportunities to strengthen child health by considering policies that minimise consumption, particularly heavier forms of consumption, by prospective parents.”
While the evidence base around the effects of cannabis use during pregnancy on perinatal is growing, studies assessing the potential impacts of cannabis exposure are mixed.
Some observational data has identified a link between exposure and low birth weight and/or an increased risk of preterm birth. However others have failed to substantiate these claims once adjusting for other factors, such as tobacco smoking.
The majority of the existing studies have been done on recreational cannabis, accessed through the illicit market, which tends to contain higher levels of THC than that in medicinal cannabis.
There have been very limited, if any, studies exploring the effect of prescribed cannabis on perinatal health, as advice from clinicians is that women should refrain from using cannabis medicinally or otherwise whilst pregnant or breastfeeding.
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Women's health
Medical cannabis and endometriosis – “I can live a normal life”
Thirty-two-year-old Megan has lived with the symptoms of endometriosis since her teens.
Megan, an Australian medical cannabis patient living with endometriosis, shares how the plant has helped in managing her symptoms.
Thirty-two-year-old Megan has lived with the symptoms of endometriosis since her teens. At times she’s experienced such intense pain that she struggled to leave her house.
“I honestly believe I would have ended up suicidal within the next few months if I didn’t pursue and get approved for medicinal cannabis when I did,” she said.
During Endometriosis Awareness Month in March, Cannabis Health interviewed several patients across the globe who live with the often-debilitating symptoms of the inflammatory condition.
Endometriosis is present in about one in 10 women and non-binary people aged between 25 to 40 in the United Kingdom – but can affect people at any age.
Cells similar to those lining the womb grow elsewhere in the body, such as the bladder, ovaries, colon and rectum, and react to changing hormones in the menstrual cycle.
They grow thicker in the middle of the cycle and then break away and start to bleed before being slowly reabsorbed by the body. This process can cause inflammation, pain and new scar tissue.
Megan, who lives in Australia, explained that she was only officially diagnosed with endometriosis in February this year.
Lengthy diagnosis is common as the condition can mirror others and is widely misunderstood among many doctors – the average time from onset of symptoms is seven and a half years.
“I’ve always had painful periods – I just always thought they were meant to be painful,” Megan told Cannabis Health.
“I didn’t question it until early 2018 my periods stopped for about three months and when they returned it was like everything was turned up and the pain was excruciating.”
In early 2019 Megan was told she had adenomyosis, a condition in which the inner lining of the uterus breaks through the muscle wall of the uterus.
Symptoms can include lower abdominal pressure, menstrual cramps, bloating and heavy periods.
Her GP at the time suggested that she may have endometriosis as well, but it was not confirmed until surgeons performed a laparoscopy – keyhole surgery of the abdomen or pelvis.
Managing pain
People who have endometriosis often suffer from painful periods, painful sex, pain in the lower abdomen, pain on passing a stool and urinating, or lower back pain.
This can then lead to difficulty sleeping, an inability to focus on daily tasks, and in some cases a mental health decline.
Over the years Megan has tried NSAIDs, codeine and oxycodone in an attempt to manage the pain.
“I’m somewhat unlucky that I don’t respond to a lot of painkillers… so I was always ‘pushing through’ the pain and essentially burning myself with heat packs,” she said.
Meanwhile, she was using cannabis recreationally, but it took a comment from her partner to realise that it was also helping to dull the symptoms of her two conditions.
“I was mid-flare about 12 months ago and we’d run out of cannabis. It was a long weekend in my city so all the dealers we knew were sold out,” she recalled.
“I was curled up in bed with my heat packs and my partner said then I should see if I can get into trials for medicinal cannabis or a prescription for it.
“He’d picked up that it was the only thing that would help my pain and being reliant on black market wasn’t ideal long term.”
She was initially nervous to make an appointment at a clinic, because she did not think she would get approved.
“Everyone downplays endo so much, I was worried I’d get the same kind of dismissal about my symptoms and pain that so many doctors had done in the past,” she said.
She finally applied for a prescription last summer, and because she was able to show all the painkillers she had tried that had not worked, the process to approval was fairly quick.
Among the methods she uses to take cannabis are ingesting CBD and THC oils, and cannabis flower to vape.
“The CBD oil helps with overall symptoms – definitely reduces anxiety and nausea and has a huge impact on reducing pain,” said Megan.
“THC oil I’ll use more on days when the pain is worse than my normal levels, or when I get a random flare up some days, it helps to take THC oil and flower together to get through it.”
Stigma
Despite how much it helps her, Megan has experienced some negative comments due to her use of cannabis, particularly before she was given a prescription.
“I think a lot of people still just view it as this evil illegal drug and don’t understand that it’s such a powerful and useful plant and tool in treating people’s illnesses,” she explained.
However, after getting a prescription she said her friends and family had been “surprisingly supportive”.
She continued: “I’m not sure if it’s because it’s issued via a prescription that makes people more approving of it, or if it’s just because they can see the effect it’s had on me since starting it. Maybe a combination of both.”
Getting a prescription for cannabis made a huge difference to her wellbeing.
“With cannabis I can live a pretty normal life,” she added.
But in the long term, Megan is worried for women who have endometriosis, and the dismissive nature of some doctors when it comes to the benefits of cannabis for pain.
“I’m scared for the next generation of endo warriors who are going to be pushed onto these incredibly strong medications,” she said.
“I really struggle to comprehend how some doctors will be happy for their patients to be on really strong pharmaceuticals every day to manage their pain, but can still be so anti-cannabis.”
Alongside the cannabis, the laparoscopy – during which surgeons removed some of the offending cells – also helped to significantly ease the pain of the endometriosis.
She stressed that it is vital that more surgeons are trained in expert excision surgery as a more permanent solution for patients.
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