New research points to potential of cannabinoids in gynaecological conditions

A growing body of scientific research suggests that cannabinoids can be a helpful tool in the management of a myriad of women’s health-related symptoms. We speak to some of those at the forefront of this emerging field of medicine. 

The former British Monarch, Queen Victoria, is thought to have relied on cannabis tinctures to manage her monthly menstrual cramps. Her personal physician, Sir Russell Reynolds, reportedly a firm believer in the medicinal benefits of the plant. Now, after decades of strict regulation significantly restricting research into its therapeutic properties, the science may be catching up. 

A recent quasi-experimental study found CBD suppositories ‘significantly reduced frequency and severity of menstrual-related symptoms’, as well as their impact on daily functioning. Those who used them also had less need for conventional pain management such as paracetamol and other analgesics.

The findings are significant, says co-author Dr Staci Gruber, director of the Cognitive and Clinical Neuroimaging Core and Marijuana Investigations for Neuroscientific Discovery (MIND) programme and Women’s Health Initiative at McLean Hospital’s Brain Imaging Center, particularly in an area where there has been little innovation.

“It’s really important, especially when we consider this relative to the usual treatment,” Gruber, whose lab has been researching cannabinoids for several years, tells Femtech World.

“We know that there is tremendous potential [for cannabinoids] in pain and inflammation, which make up the Venn diagram of discomfort.”

Gruber, who cites the earliest paper to reference cannabis use in menstrual symptoms as dating back to around 1889, adds: “It’s important to recognise that people have been using cannabis as a medicine for thousands of years…. Gynaecological pain covers a lot of different conditions and disorders, and this is a vastly understudied population. We should be exploring and exploiting some of these compounds to try to understand how to give individuals who are suffering more relief.”

Real-world evidence is increasingly reporting the benefits of cannabis products for a myriad of gynaecological conditions, as well as those health issues which predominantly affect women. A recent analysis of YouGov data on US women aged 21 and older aimed to understand why women are turning to cannabis. Improving sleep quality was a top reason why women would try cannabis (16%), followed by alleviating physical pain and aiding relaxation (12%). 

Observational studies from Australia, New Zealand and Canada have also highlighted a high prevalence of medicinal cannabis use among patients with complex chronic conditions such as among endometriosis.  A recent survey of over 900 patients in Europe, found that over three quarters reported trying self-management strategies in the past six months to better cope with symptoms, with cannabis found to be the ‘most effective’. 

The role of the endocannabinoid system

There is still more research needed to better understand the effects of cannabinoids in these conditions and the mechanisms of action. However, according to Dr Gruber, who is preparing to launch a new study investigating cannabinoids in individuals with endometriosis and adenomyosis, what we do know is that the endocannabinoid system (ECS) plays a ‘major role’.

Despite not being discovered until the early 90s, the ECS plays an important role in the body, responsible for maintaining ‘homeostasis’ or balance and regulating bodily functions such as temperature, mood, pain and inflammatory responses. 

The ECS is made up of receptors throughout the body, known as CB1 and CB2, which interact with cannabinoids, such as CBD and THC. The human body also produces its own endogenous cannabinoids, the main ones being Anandamide and 2-arachidonoylglyerol (2-AG).

Some studies have suggested that the ECS could play a role in the pathology of conditions such as endometriosis, due to the high volume of these receptors in the womb and other reproductive organs.

“The endocannabinoid system is responsible for keeping so many things in balance… [it] plays a significant role in the menstrual cycle,” Gruber explains.

“We have endogenous cannabinoids, cannabinoid receptors and degradative enzymes throughout the hypothalamic pituitary ovarian axis, the fallopian tubes and in the uterus.

“We also have menstrual cycle-dependent endocannabinoid gene expression that’s been observed and is impacted by different gynaecological issues.”

She continues: “The really compelling thing for me was that the cannabinoid receptor expression is changed in individuals who report things like endometriosis and adenomyosis.”

A “promising therapeutic agent”

In a paper published last month, researchers at the University of Edinburgh examined the pathophysiology of endometriosis, highlighting processes implicated in the formation and growth of lesions, including pathways where CBD has demonstrated activity. Their findings indicate that CBD acts on a number of molecular targets implicated in the pathogenesis of endometriosis and its associated symptoms. 

While further work is needed, they say, to better understand which of the different mechanisms of action of CBD are most important in regulating endometriosis symptoms, CBD was deemed to be a “promising therapeutic agent” in the treatment of endometriosis, due to its “analgesic, anti-inflammatory, immunomodulatory, anti-angiogenic, antiproliferative, and neuroprotective effects”.

The study was co-authored by Dr Lucy Whitaker, Professor Andrew Horne and Professor Philippa Saunders, leading researchers in women’s health, along with Professor Clive Page and Charles Morgan of Ananda Developments, a company focused on the development of CBD-based therapies for complex inflammatory conditions.

“We are one of the first to start doing clinical trials in endometriosis, but there is so much evidence to suggest that CBD will be effective,” CEO of Ananda Developments, Melissa Sturgess, tells Femtech World.

“Endometriosis involves so many inflammatory pathways and immune system responses, [CBD] will modulate all of these inflammatory pathways, and it doesn’t take a sledgehammer approach, like many drugs do.”

The road to regulatory approval

Ananda has received funding from NHS Scotland to conduct clinical trials on its CBD-based oil formulation in the treatment of endometriosis and other complex pain conditions. It is the beginning of a journey which it is hoped will secure marketing authorisation from the MHRA, ultimately allowing it to be prescribed to patients through the NHS.

Millions of patients are already accessing medical cannabis globally, including tens of thousands in the UK where it is currently only available on private prescription. Ananda says it is committed to conducting the scientific research needed to convince regulators and medical professionals to take these compounds seriously, and make them available to patients in the same way as other pharmaceuticals.

“We feel that in order to get specialists prescribing, we need to be a licensed drug that is accepted by the NHS,” Sturgess adds. 

Clinical trials are crucial to help us fully understand the safety of these products, and their long-term effects on reproductive health. But while they require significant time and investment, a growing number of jurisdictions already have access to legal cannabis in some form.

Data from the latest Monitoring the Future study, conducted annually by researchers at the University of Michigan and funded by the National Institutes of Health, found that last year women aged 19-30 years reported consuming more cannabis than men for the first time. Improving sleep, reducing pain and aiding relaxation are thought to be among the top reasons for female consumption, with a growing variety of product formats, from edibles and oils, to topicals and beverages.

“There are so many more options available now than we had in the past,” adds Gruber.

“And it’s important to keep in mind that medical cannabis and recreational cannabis use are not the same.”