Endometriosis

Endometriosis is an estrogen-dependent, inflammatory condition in which endometrial-like tissue is found outside the uterus, within the pelvic cavity typically, though ectopic endometrial implants may also occur outside the pelvic cavity. The bladder, bowel, pelvic wall, and retroperitoneal structures are often involved in endometriosis, with adhesions forming between structures. Endometriosis is one of the main causes of chronic pelvic pain in females, is estrogen-dependent, develops after menarche, and, in some women, can extend into the post-menopausal phase of life also. It has no specific biomarkers and no specific symptom that can solely be attributed to the disease, making diagnosis difficult. There is no current cure. Treatment options include pharmaceuticals (e.g., analgesics, hormone therapy, antidepressants) and surgery, though significant proportion of women will experience a recurrence 5 years after surgery or medical treatment. Some treatments can adversely affect fertility and many have undesirable side effects. There is a need for other treatment options for many women. The etiopathogenesis of endometriosis is multifactorial and includes chronic inflammation, cellular proliferation, angiogenesis, hormonal imbalance, changes to the gut and uterine microbiome, and more. Pain processes involved include nociceptive, inflammatory nociceptive, and neuropathic pain, and centralization of pain is also involved. The ECS is involved in regulation of many of the processes that are involved in endometriosis at the cellular level, and the ECS is involved in regulation of pain and associated symptoms including anxiety, depression, and poor sleep. There is evidence of an association between ECS dysregulation and endometriosis, though this is not necessarily causal. The ECS may potentially be a useful pharmacological target for endometriosis treatments including pain management and treatment of other comorbidities, as well as addressing the underpinning pathomechansisms. Preclinical evidence suggests that components of medicinal cannabis (MC), cannabidiol and tetrahydrocannabinol, show some promise in combatting this disease, and some synthetic cannabinoids also show promise. Human evidence for the use of MC in endometriosis is largely from cross-sectional studies, though there is support from one retrospective cohort study and two systematic reviews. There have been no prospective observational studies or randomized controlled trials published to date. Existing research indicates that women with endometriosis are using MC to treat pain and other symptoms of endometriosis and that MC is efficacious for alleviating pelvic pain, improving sleep, reducing anxiety and depression, and reducing nausea and vomiting. Palmitoylethanolamide in combination with polydatin or alpha-lipoic acid may also be promising. Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Similar content being viewed by others

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(2025). Endometriosis. In: Medicinal Cannabis in Women’s Health. Springer, Cham. https://doi.org/10.1007/978-3-032-01737-6_5 Download citation DOI: https://doi.org/10.1007/978-3-032-01737-6_5 Published: Publisher Name: Springer, Cham Print ISBN: 978-3-032-01736-9 Online ISBN: 978-3-032-01737-6 eBook Packages: MedicineMedicine (R0)