Pain Management for Endometriosis
By Dr Janelle Trees, BSC (HONS), MBBS (HONS), FRACGP
Endometriosis is a disease affecting menstruating woman. It’s a condition where the lining of the uterus, the endometrium, becomes attached to other organs in the body, usually organs in the pelvis, like the fallopian tubes, ovaries, bladder and bowel. The misplaced endometrial tissue swells in response to the same hormones that stimulate the menstrual cycle, causing pain which is often severe and disabling.
It can cause infertility. But the main concern for most sufferers is pain, which can occur during periods, between periods, during sex or when going to the toilet—or all of these, sometimes. It is a common disease, affecting about 10% of women of menstrual age.
Women who have ‘endo’ can spend days every month in bed, unable to function until their pain has eased.
Suspected endometriosis is diagnosed by listening to the patient’s story carefully, a clinical (vaginal) exam and an ultrasound.
But part of the difficulty with endometriosis is that it only definitively diagnosed with an operation. A gynaecologist looking through a laparoscope (a lighted tube) inserted into the abdomen can see the endometrial tissue. The helpful thing is that it can then be lasered off or burned off with diathermy. Surgical treatment works well. Most women get years of relief.
But this surgery is not usually possible until the patient is about 30 years old. Before then, the tissue has not built up enough to be seen, but still has devastating effects.
Some unfortunate women have no visible endometriosis with the laparoscopic exam or the ultrasound, but remain in pain.
The medicines we use to treat pain of endometriosis are safe for most women to use for a limited time, e.g. during your period.
Simple over the counter medicines like paracetamol can help.
Mefanamic acid (like Ponstan) specifically blocks prostaglandins, the chemicals your body produces which make the uterus cramp. This works very well for many women with menstrual pain. It’s a non-steroidal anti-inflammatory (these medicines are called NSAIDs).
Some women have had benefit from other medicines of the same type, like Naproxen or Ibuprofen. Your doctor will help you find one that suits you. Long term, heavy use of NSAIDs can be harmful, though. Your doctor will help you keep to a safe dose.
Sometimes women need to take opioid medication (e.g. Endone) for severe pain. The main side effect of opiates, constipation, aggravates the condition. Opiates tend to knock you out, too. And they don’t always work well for this kind of pain.
The Oral Contraceptive Pill or the Levonorgestrel IUD (eg ‘Mirena’ which secretes a small dose of progesterone) are hormonal ways of avoiding menstrual pain. The OCP suppresses the body’s hormonal cycles. The Mirena usually stops menstruation altogether. These can be a great solution for some women. Others prefer to avoid hormonal treatments because of side effects. They need to find ways to manage their symptoms.
Some women have had relief with acupuncture and herbs. As an acupuncturist myself, I have seen some women with endo respond very well to Chinese Medicine, but more studies are needed to confirm its effectiveness.
Could a medicinal cannabis treatment plan help pain for women suffering from endometriosis?
We do not have any evidence that medical cannabis can stop the underlying problem of endometriosis, but cannabis has a role in chronic pain management.
Two cannabinoids—active components—extracted from the cannabis plant for use in medicinal cannabis are known as THC and CBD. CBD is known as an anti-inflammatory and often works best with some THC.
We also know from studies (and experiences) of patients with Multiple Sclerosis that medicinal cannabis can help with muscle spasm and nerve pain. Some women with endo have inflammation, muscle spasm and nerve pain.
Medicinal cannabis has been found to reduce the need for opiates in patients with chronic pain. There is also evidence that it helps relieve nausea, which some women with endometriosis suffer alongside the pain.
Your GP or Gynaecologist can work with the CBD Clinic to figure out whether medicinal cannabis can help you and which product would be suitable to try.
Everyone has their own individual body chemistry and physiology. Medical cannabis treatments and dosage need to be worked out with your doctor’s help. It takes patience, but it is an option worth exploring for women afflicted with pain as a result of this disease.