{"paper_id":"51a660a2-96fb-46bb-8e0d-eb6ca7f2e378","body_text":"ABSTRACT\nIntroduction\nEndometriosis is a chronic inflammatory condition that affects around 1 in 7 women of reproductive age. Current medical treatments tend to be sub-optimal to manage the range of symptoms, with low levels of patient satisfaction. Cross-sectional and retrospective data suggests that people with endometriosis are consuming cannabis to help manage their symptoms.\nAreas covered\nThis review discusses the evidence for consumption of medicinal cannabis to help manage endometriosis symptoms, including potential mechanisms of action from both animal models and human studies, usage in the community, the current evidence from clinical trials and observational studies, and the safety and potential drug interactions.\nExpert opinion\nWhile there is a lack of high-quality clinical trial evidence, significant self-reported evidence from cross-sectional surveys and retrospective observational data suggests that those consuming medicinal cannabis report reductions in endometriosis symptoms such as pelvic pain, dysmenorrhea and gastrointestinal symptoms, and improve mental health and sleep. Given the low levels of satisfaction with current treatment options, consideration should be given to trialing medicinal cannabis as part of the interdisciplinary management of endometriosis in those who express interest and who do not demonstrate any significant contraindications.\nArticle highlights\nLess than 25% of women with endometriosis report satisfaction with current conventional treatments with high discontinuation rates due to ineffectiveness and side effects.\nDysregulation of the endocannabinoid system in endometriosis, including reduced CB₁ receptors and elevated endocannabinoid levels, provides biological plausibility for therapeutic intervention through TRPV1 modulation and PPARγ activation.\nCannabis consumption is associated with self-reported reductions in pain, gastrointestinal symptoms and nausea, and improvements in sleep quality and mental health.\nCannabis consumption is associated with reductions in potentially addictive medications such as opioids and benzodiazepines; however these reductions should be done under the guidance of a physician.\nDespite promising preclinical data and substantial observational evidence, robust randomized controlled trial data in humans remains lacking, preventing recommendation of more widespread adoption as a treatment.\nDeclaration of interest\nM Armour is the principal investigator on several clinical trials on medicinal cannabis and endometriosis; declares grant funding from OzMedicannGroup (OMG), Cannim and Canopy Growth; declares clinical trial products from Australian Natural Therapeutics Group (ANTG); declares consulting fees from Nectar brands, Evolv Health, AIMA and Helius Therapeutics. J Sinclair is employed by ANTG; is a current member of the scientific advisory board for United in Compassion (pro bono); is a board member of the Australian Medicinal Cannabis Association (pro bono). T Farooqi is leading a clinical trial on medicinal cannabis and the gut microbiome in endometriosis and declares clinical trial products from ANTG. C Seaman runs a consultancy for medicinal cannabis. O Holtzman is the vice president of the Australian & New Zealand College of Cannabinoid Practitioners. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.\nReviewer disclosures\nPeer reviewers on this manuscript have no relevant financial or other relationships to disclose.","source_license":"public-domain-us","license_restricted":false}