Can CBD Help With Endometriosis Pain?

  • Endometriosis (EM), a condition where endometrial tissues grow outside the uterus, is often treated with painkillers. However, A study from Deutsche Ärzteblatt International mentioned that 70% of young women with EM are resistant to non-steroid anti-inflammatory drugs (NSAIDs) (1).
  • An animal study from Pain mentioned that modulating the endocannabinoid system might reduce endometrium-induced hyperalgesia (excess sensitivity to pain) (2).
  • A 2019 study found that cannabidiol (CBD) displayed the highest pain relief scores among women who self-managed their EM pain using alternative strategies (3).
  • A study posted by Therapeutics and Clinical Risk Management mentioned that CBD has anti-inflammatory and analgesic properties that might be useful for difficult-to-treat pain (4)
  • Still, more studies are needed to confirm CBD’s efficacy in alleviating EM pain. Women with this condition must seek medical advice from a licensed physician before taking CBD.

Why Women Are Turning to CBD for Endometriosis Pain

Endometriosis (EM) is a condition caused by endometrial tissue growth outside of the uterus. This condition often causes severe menstrual pain and cramping.

Treatment options include hormone therapy, pain medication, or laparoscopic surgery. Hormone therapies, such as contraceptives (birth control), gonadotropin-releasing hormone (Gn-RH), and progestin therapy, may cause undesirable side effects.

For example, Gn-RH may cause artificial menopause (5).  Contraceptives and progestin therapies may cause headaches and bloating (6)

Also, studies have debated the efficacy of non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, on EM-associated pain (7)

A review published by Deutsche Ärzteblatt International mentioned that 70% of young women with EM do not respond to NSAID treatments (8)

These factors are why women with EM are turning to alternative options to improve quality of life.

The BMC Complementary and Alternative Medicine posted a cross-sectional online survey that measured the efficacy of self-management strategies. The strategies women used for EM pain were exercising, yoga, diet changes, hot compress, and CBD oil.

The study found that CBD oil produced the highest pain relief scores among women who participated in the survey (9)

This anecdotal evidence from the survey may be explained by studies supporting CBD’s therapeutic benefits.

A study posted by Therapeutics and Clinical Risk Management mentioned that CBD has anti-inflammatory and analgesic properties. The author added that CBD was able to inhibit proinflammatory cytokines on animal subjects (10)

Cytokines are cell-signaling proteins that trigger systemic inflammation in the body (11).  

This hypothesis was supported by an animal cross-study posted by Proc Natl Acad Sci USA. Study results showed that CBD’s immunosuppressive action decreased cytokine production, resulting in reduced inflammation in knockout mice (12).

Although positive results have been observed from anecdotal and animal studies, more research is needed to determine CBD’s clinical value as an endometriosis treatment.

How CBD Oil Works to Help With Endometriosis Pain

The endocannabinoid system (ECS) is a complex system composed of endogenous cannabinoids and G-coupled receptors. The human body is filled with these receptors (13)

The endocannabinoid receptors, cannabinoid 1 (CB1) and cannabinoid 2 (CB2), are present in the central nervous system, immune system, and peripheral organs. The ECS’s function is to promote and maintain body homeostasis (14).

Modulating the ECS has therapeutic benefits in several health problems, such as chronic pain (15), anxiety, insomnia (16), neurodegenerative diseases (17), and epilepsy (18)

CB1, the more abundant receptor, can be found in pain circuits. CB1 receptors also participate in producing analgesic and anti-inflammatory effects (19). Meanwhile, CB2 receptors are mostly expressed in the intestines and the immune system.

A 2017 study explained how cannabinoid receptor agonists might stimulate CB1 receptors and CB2 receptors. This activity might be beneficial in treating EM pain and other chronic pain conditions (20)

Phytocannabinoids, such as CBD, tetrahydrocannabinol (THC), and cannabigerol (CBG), have an affinity to CB1 receptors (21)

Several studies suggested CBD’s ECS modulation might inhibit proinflammatory cytokines (22)

It has also been observed that CBD might act as an agonist for endocannabinoid receptors, therefore modulating the ECS (23)

A study from Pain journal mentioned that CB1 could be found in rodent uterus. The authors added that CB1 receptors in the uterus are a potential target treatment to reduce endo-induced hyperalgesia (sensitivity to pain) (24)

The authors mentioned that studies in EM rat models provided evidence that endocannabinoids and cannabinoids could be useful in reducing endometriosis symptoms (25).

Although rats models have significant ECS differences with EM in human models, a study recognized that there might also be lateral aspects (26)

The Pros and Cons of CBD Oil for Endometriosis Pain

The Pros

  • A study has acknowledged that CBD might influence receptors to suppress proinflammatory cytokine production (27).
  • A study mentioned that CBD has anti-inflammatory and analgesic properties (28)
  • A study found that CBD oil had the highest pain relief scores among women who self-managed their EM pain using alternative strategies (29).
  • Studies acknowledged that CBD has an excellent safety profile and is well-tolerated (30).  

The Cons

  • There is a lack of clinical studies on how CBD may affect endometriosis pain in humans. Most existing studies are done on animal subjects.
  • The CBD industry lacks regulation. Customers must thoroughly research before buying any CBD product
  • CBD may cause adverse effects, such as loss of appetite, dry mouth, diarrhea, and sleepiness (31).
  • CBD may cause liver injury when used in extremely high doses (32).

How CBD Oil Compares to Alternative Treatments for Endometriosis Pain

There is no cure for EM. The main goals of therapies are pain management and improving quality of life (33)

There are several alternative medicines available for managing EM pain. 

Xuefu Zhuyu decoction (XZD) is an herb used in treating EM pain in China. Clinical studies have shown that XZD has therapeutic benefits in relieving dysmenorrhea, promoting fertility, and shrinking ectopic lesions (34)

Another herb, Qu Yi Kang (QYK), has been shown to alleviate dysmenorrhea symptoms and reduce endometrial lesions (35).

Green Tea Epigallocatechin-3-Gallate (EGCG) is a compound extracted from green tea leaves. ECG might enhance apoptosis and inhibit lesion growth in rat models (36)

Ginsenoside Rg3 is found in Panax plants. An animal study has shown that ginsenoside Rg3 reduced lesions in EM rat models (37)

These herbs are some of the several alternative medicines for treating EM pain. Mostly, these herbs are geared toward pain management

These herbal medications like XZD, QYK, EGCG, and ginsenoside Rg3 have been clinically studied due to their popularity as EM treatments in China.

Studies have shown that CBD might also reduce pain and inflammation (38). Like ECGC, CBD might also enhance apoptosis and suppress cytokine production (39)

However, CBD’s efficacy on EM pain is not yet supported by clinical trials. 

How to Choose the Best CBD Oil for Endometriosis Pain

Women with EM may opt for full-spectrum CBD or broad-spectrum CBD

Full-spectrum CBD oil contains all the cannabinoids found in the hemp plants, such as CBD, 0.3% tetrahydrocannabinol (THC), cannabigerol (CBG),  and cannabinol (CBN). 

Broad-spectrum CBD contains all the same cannabinoids except for THC

Both full-spectrum and broad-spectrum create the “entourage effect.” This term is named after the cannabis synergy, wherein an individual takes in the supposed health benefits of all the cannabinoids in one dose. 

The entourage effect has been demonstrated by an animal study published by Frontiers in Plant Science. The author mentioned that cannabis extracts with predominant CBD concentrations might deliver better analgesic results than pure THC or CBD (40)

Women who have an intolerance to other cannabinoids may opt for CBD isolate (90% pure CBD).  

CBD Dosage for Endometriosis Pain

There is a lack of clinical studies on the appropriate CBD dosage for EM pain. 

However, a study from the British Journal of Pharmacology recommended that individuals start with less than 1 to 5 mg per kilogram a day. This dose can gradually increase once the system gets used to taking CBD (41)

Another study also mentioned that pure CBD produced a dose-response curve. The author observed that a smaller dose was effective until the peak is reached. Afterwhich, additional dosings no longer induce any response (42).  

This dose-response curve was demonstrated by a cross-study posted in the Brazilian Journal of Psychiatry. The authors showed that 300mg pure CBD produced better results compared to 150mg and 600mg (43).

When taking CBD for EM pain, women must remember to be cautious. An extremely high CBD dose has been shown to cause liver damage (44).

How to Take CBD Oil for Endometriosis Pain

When taking CBD oil for EM pain, an individual may want quick pain relief. Therefore, the recommended administration is through inhalation of CBD vapors (45)

A study mentioned that the lungs are very efficient in absorbing cannabinoids. Plasma concentrations can be delivered into the bloodstream in 10 minutes or less (46).

However, vaping may also cause adverse effects, such as allergic reactions, shortness of breath, and chest pains (47).

Oral CBD deliveries are available in the form of capsules, softgels, and gummies. This method is recommended to be taken with or without a meal. 

CBD tinctures may be taken through sublingual delivery. This method can be done by using an applicator to drop CBD tinctures under the tongue. 

Compared to vaping, oral and sublingual delivery may take longer to be absorbed into the body, but these methods allow for optimal absorption (48).

Some CBD companies have designed CBD suppositories for painful periods. However, there are no studies on how CBD suppositories might help in relieving EM pain.

CBD isolate is often sold in powder form. Women may mix this in a carrier oil, like virgin coconut oil, olive oil, or hempseed oil. CBD crystalline isolate may be dissolved under the tongue.

Meanwhile, transdermal CBD is not recommended for EM pain. 

FAQ

What is Endometriosis?

The endometrium is a tissue lining inside the uterus. During each menstrual cycle, the endometrium thickens and bleeds. 

In some women, endometrial cells can be found outside the uterus, particularly in the fallopian tubes, ovaries, and pelvic lining. 

During the monthly cycle, the endometrial tissues thicken and bleed, irritating the surrounding tissues and organs. The blood clot buildup eventually becomes scar tissue and causes organs to stick to each other. 

Symptoms of endometriosis include (49):

  • Severe menstrual cramps
  • Dysmenorrhea
  • Chronic pelvic pain
  • Pain during urination and bowel movements.
  • Lower back or abdominal pain
  • Pain with intercourse
  • Infertility

The exact cause of EM is unknown, but experts believe that EM can be caused by heredity, c-section and hysterectomy procedures, and immune system disorders. 

Effective treatments are available, but the surgery produces the best result. Laparoscopic surgery can remove the lesions, adhesions, and scar tissue.

The laparoscopic procedure may also restore fertility. A study mentioned that the postoperative fertility rate was 43% (50).

However, the study also mentioned that the recurrence of EM after laparoscopic surgery is 20% after five years (51).

What is Deep Infiltrating Endometriosis?

Deep Infiltrating Endometriosis (DIE) is when scar tissues caused by endometrial lesions have infiltrated 5 millimeters into the tissues of pelvic organs (52)

DIE is considered stages 3 and 4 of endometriosis. Stages 1 and 2 involve minimal lesions and superficial implants on surrounding organs, while stages 3 and 4 are when cysts are formed in the ovaries (53)

The late stages also mean that surrounding organs have deep implants and dense adhesions (54).

Treatments for DIE often involve surgery, NSAIDs, and hormonal therapies. DIE can lead to infertility and multiple cyst growths if left untreated (55)

How is CBD Oil Different from Medical Marijuana?

CBD is a cannabinoid extracted from Cannabis sativa plants. Manufacturers use an extraction method to produce a concentrated version without the psychoactive effects one may get from cannabis products or medical marijuana

Depending on the cannabis strains used by the dispensary, medical marijuana can contain up to 17-28% THC (56). Federal law prohibits CBD oil from carrying more than 0.3% THC.

Hemp derivatives, such as CBD oil, hemp oil, and hemp seed oil, are legal in the United States. 

Unlike medical cannabis or medical marijuana, CBD oil is legal in all 50 US states and territories. Medical and recreational cannabis use is only allowed in 11 US states.

Although CBD is legal, it remains highly unregulated. Some questionable CBD brands are not held accountable for falsely advertising their products as high-quality. 

Customers can quickly identify legitimate CBD brands by checking the company’s transparency. High-quality CBD brands often post the certificate of analysis (COA) on their website. 

The COA is a third-party lab result from ISO-certified laboratories. With the COA, consumers know exactly how much cannabinoids are contained in the product. 

The COA also tests for heavy metals, fungicides, pesticides, and other contaminants. The COA ensures that the product is safe for use on humans or pets.

Conclusion

Animal studies have shown that CBD has anti-inflammatory and analgesic properties (57). These findings suggest that CBD might be useful in alleviating difficult-to-treat pain.

Also, CBD oil has reduced EM pain among women who tried self-management strategies (58)

Researchers also mentioned that studies in EM rat models provided evidence that modulating the ECS might reduce endometriosis symptoms (59)

More studies are needed to confirm CBD’s efficacy in alleviating EM pain. Therefore, women suffering from the condition must seek medical advice from a licensed physician before taking CBD.


  1. Halis, G., Mechsner, S., & Ebert, A. D. (2010). The diagnosis and treatment of deep infiltrating endometriosis. Deutsches Arzteblatt international, 107(25), 446–456. https://doi.org/10.3238/arztebl.2010.0446
  2. Dmitrieva, N., Nagabukuro, H., Resuehr, D., Zhang, G., McAllister, S. L., McGinty, K. A., Mackie, K., & Berkley, K. J. (2010). Endocannabinoid involvement in endometriosis. Pain, 151(3), 703–710. https://doi.org/10.1016/j.pain.2010.08.037
  3. Armour, M., Sinclair, J., Chalmers, K. J., & Smith, C. A. (2019). Self-management strategies amongst Australian women with endometriosis: a national online survey. BMC complementary and alternative medicine, 19(1), 17. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30646891/
  4. Russo E. B. (2008). Cannabinoids in the management of difficult to treat pain. Therapeutics and clinical risk management, 4(1), 245–259. https://doi.org/10.2147/tcrm.s1928
  5. The Mayo Clinic. Endometriosis Treatment Overview. Retrieved from https://www.mayoclinic.org/diseases-conditions/endometriosis/diagnosis-treatment/drc-20354661
  6. The Mayo Clinic. Progestin Overview. Retrieved from https://www.mayoclinic.org/drugs-supplements/progestin-oral-route-parenteral-route-vaginal-route/side-effects/drg-20069443
  7. Dmitrieva, N., Nagabukuro, H., Resuehr, D., Zhang, G., McAllister, S. L., McGinty, K. A., Mackie, K., & Berkley, K. J. (2010). Endocannabinoid involvement in endometriosis. Pain, 151(3), 703–710. https://doi.org/10.1016/j.pain.2010.08.037
  8. Halis, G., (2010). Op cit.
  9. Armour, M., (2019). 
  10. Russo E. B. (2008). Op cit.
  11. Parameswaran, N., & Patial, S. (2010). Tumor necrosis factor-α signaling in macrophages. Critical reviews in eukaryotic gene expression, 20(2), 87–103. https://doi.org/10.1615/critreveukargeneexpr.v20.i2.10
  12. Carrier EJ, Auchampach JA, Hillard CJ. Inhibition of an equilibrative nucleoside transporter by cannabidiol: a mechanism of cannabinoid immunosuppression. Proc Natl Acad Sci U S A. 2006;103(20):7895-7900. doi:10.1073/pnas.0511232103
  13. Lu, H. C., & Mackie, K. (2016). An Introduction to the Endogenous Cannabinoid System. Biological psychiatry, 79(7), 516–525. https://doi.org/10.1016/j.biopsych.2015.07.028
  14. Ibid
  15. Mlost, J., Wąsik, A., & Starowicz, K. (2019). Role of endocannabinoid system in dopamine signalling within the reward circuits affected by chronic pain. Pharmacological research, 143, 40–47. https://doi.org/10.1016/j.phrs.2019.02.029
  16. Shannon, S., Lewis, N., Lee, H., & Hughes, S. (2019). Cannabidiol in Anxiety and Sleep: A Large Case Series. The Permanente journal, 23, 18–041. https://doi.org/10.7812/TPP/18-041
  17. Khan, M. I., Sobocińska, A. A., Czarnecka, A. M., Król, M., Botta, B., & Szczylik, C. (2016). The Therapeutic Aspects of the Endocannabinoid System (ECS) for Cancer and their Development: From Nature to Laboratory. Current pharmaceutical design, 22(12), 1756–1766. https://doi.org/10.2174/1381612822666151211094901
  18. Silvestro, S., Mammana, S., Cavalli, E., Bramanti, P., & Mazzon, E. (2019). Use of Cannabidiol in the Treatment of Epilepsy: Efficacy and Security in Clinical Trials. Molecules (Basel, Switzerland), 24(8), 1459. https://doi.org/10.3390/molecules24081459
  19. Bouaziz, J., Bar On, A., Seidman, D. S., & Soriano, D. (2017). The Clinical Significance of Endocannabinoids in Endometriosis Pain Management. Cannabis and cannabinoid research, 2(1), 72–80. https://doi.org/10.1089/can.2016.0035
  20. Ibid
  21. Russo E, Guy GW. A tale of two cannabinoids: the therapeutic rationale for combining tetrahydrocannabinol and cannabidiol. Med Hypotheses. 2006;66(2):234-246. doi:10.1016/j.mehy.2005.08.026
  22. James M. Nichols and Barbara L.F. Kaplan.Cannabis and Cannabinoid Research.Mar 2020.12-31.https://doi.org/10.1089/can.2018.0073
  23. Russo E, (2006). Op cit.
  24. Dmitrieva, N., Nagabukuro, H., Resuehr, D., Zhang, G., McAllister, S. L., McGinty, K. A., Mackie, K., & Berkley, K. J. (2010). Endocannabinoid involvement in endometriosis. Pain, 151(3), 703–710. https://doi.org/10.1016/j.pain.2010.08.037
  25. Ibid.
  26. Stratton, P., & Berkley, K. J. (2011). Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications. Human reproduction update, 17(3), 327–346. https://doi.org/10.1093/humupd/dmq050
  27. Russo E. B. (2008). Op cit.
  28. Ibid
  29. Armour, M., (2019). Op cit.
  30. Iffland, K., & Grotenhermen, F. (2017). An Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies. Cannabis and cannabinoid research, 2(1), 139–154. https://doi.org/10.1089/can.2016.0034
  31. Bauer, B. (2018, Dec 20). What are the benefits of CBD — and is it safe to use? Retrieved from https://www.mayoclinic.org/healthy-lifestyle/consumer-health/expert-answers/is-cbd-safe-and-effective/faq-20446700
  32. FDA. What You Need to Know (And What We’re Working to Find Out) About Products Containing Cannabis or Cannabis-derived Compounds, Including CBD. Retrieved from https://www.fda.gov/consumers/consumer-updates/what-you-need-know-and-what-were-working-find-out-about-products-containing-cannabis-or-cannabis
  33. The Mayo Clinic. Endometriosis Diagnosis and Treatments. Retrieved from https://www.mayoclinic.org/diseases-conditions/endometriosis/diagnosis-treatment/drc-20354661
  34. Kong, S., Zhang, Y. H., Liu, C. F., Tsui, I., Guo, Y., Ai, B. B., & Han, F. J. (2014). The complementary and alternative medicine for endometriosis: a review of utilization and mechanism. Evidence-based complementary and alternative medicine : eCAM, 2014, 146383. https://doi.org/10.1155/2014/146383
  35. Ibid
  36. Wang CC, Xu H, Man GC, et al. Prodrug of green tea epigallocatechin-3-gallate (Pro-EGCG) as a potent anti-angiogenesis agent for endometriosis in mice. Angiogenesis. 2013;16(1):59-69. doi:10.1007/s10456-012-9299-4
  37. Kong, S., Zhang., (2014). Op cit.
  38. Nagarkatti, P., Pandey, R., Rieder, S. A., Hegde, V. L., & Nagarkatti, M. (2009). Cannabinoids as novel anti-inflammatory drugs. Future medicinal chemistry, 1(7), 1333–1349. https://doi.org/10.4155/fmc.09.93
  39. Ibid
  40. Russo E. B. (2019). The Case for the Entourage Effect and Conventional Breeding of Clinical Cannabis: No “Strain,” No Gain. Frontiers in plant science, 9, 1969. https://doi.org/10.3389/fpls.2018.01969
  41. Millar SA, Stone NL, Bellman ZD, Yates AS, England TJ, O’Sullivan SE. A systematic review of cannabidiol dosing in clinical populations. Br J Clin Pharmacol. 2019;85(9):1888-1900. doi:10.1111/bcp.14038
  42. Russo E. B. (2019). Op cit.
  43. Linares IM, Zuardi AW, Pereira LC, et al. Cannabidiol presents an inverted U-shaped dose-response curve in a simulated public speaking test. Braz J Psychiatry. 2019;41(1):9-14. doi:10.1590/1516-4446-2017-0015
  44. Ewing, L. E., Skinner, C. M., Quick, C. M., Kennon-McGill, S., McGill, M. R., Walker, L. A., ElSohly, M. A., Gurley, B. J., & Koturbash, I. (2019). Hepatotoxicity of a Cannabidiol-Rich Cannabis Extract in the Mouse Model. Molecules (Basel, Switzerland), 24(9), 1694. https://doi.org/10.3390/molecules24091694
  45. Devinsky, O., Cilio, M. R., Cross, H., Fernandez-Ruiz, J., French, J., Hill, C., Katz, R., Di Marzo, V., Jutras-Aswad, D., Notcutt, W. G., Martinez-Orgado, J., Robson, P. J., Rohrback, B. G., Thiele, E., Whalley, B., & Friedman, D. (2014). Cannabidiol: pharmacology and potential therapeutic role in epilepsy and other neuropsychiatric disorders. Epilepsia, 55(6), 791–802. https://doi.org/10.1111/epi.12631
  46. Ibid
  47. Shmerling, R.H., Can Vaping Damage Your Lungs? (2019)., Retrieved from https://www.health.harvard.edu/blog/can-vaping-damage-your-lungs-what-we-do-and-dont-know-2019090417734
  48. Millar, S. A.,(2019)., Op cit.
  49. The Mayo Clinic. Endometriosis Symptoms and Causes. Retrieved from https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656
  50. Redwine DB, Wright JT. Laparoscopic treatment of complete obliteration of the cul-de-sac associated with endometriosis: long-term follow-up of en bloc resection. Fertil Steril. 2001;76(2):358-365. doi:10.1016/s0015-0282(01)01913-6
  51. Ibid
  52. Halis, G., Mechsner, S., & Ebert, A. D. (2010). The diagnosis and treatment of deep infiltrating endometriosis. Deutsches Arzteblatt international, 107(25), 446–456. https://doi.org/10.3238/arztebl.2010.0446
  53. Endometriosis Foundation of America. Endometriosis Stages: Understanding the Different Stages of Endometriosis. Retrieved from https://www.endofound.org/endometriosis-stages
  54. Ibid
  55. Halis, G.,(2010). Op cit.
  56. Stuyt E. (2018). The Problem with the Current High Potency THC Marijuana from the Perspective of an Addiction Psychiatrist. Missouri medicine, 115(6), 482–486.
  57. Russo E. B. (2008). Op cit.
  58. Armour, M., (2019). Op cit.
  59. Dmitrieva, N., (2010). Op cit.  
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