CBD & the Treatment of Dysmenorrhea, Endometriosis, & Adenomyosis

­As body systems go, the endocannabinoid system (ECS) is an infant, having been discovered in the waning decades of the twentieth century. For over a hundred years, science had been trying to isolate the mysteries of cannabis. Cannabidiol (CBD) was the first natural cannabinoid to be isolated from the cannabis plant, but it was soon found not to be the primary psychoactive ingredient. It would be another 30 years before ∆9-tetrahydrocannabinol (THC) was isolated, and the rest, as they say, was history.

The discovery of the cannabinoid receptors CB-1 and CB-2 in mammals, and the subsequent recognition of the ECS as the largest regulatory system in mammalian physiology, has made careers, as well as created career paths in science. But for the millennia prior, you didn’t have to be a scientist to understand, or enjoy the potential of cannabis on the human story. Discovered in pottery dating back to the Egyptian pre-pyramid dynasties, cannabis has been used as intoxicant, medicine, as well as tool of the shamanistic art as long as there has been civilization.

Historically, humans have looked for relief from their discomforts since they could pose the thought in their developing primate minds, and nature was their abundant pharmacy. A female’s pelvic pain is mostly unique and distinct from their male counterparts; it is with, and without, cyclicality and may, or may not be, correlated with menses (Latin, mensis: month). This, too, demanded a solution.

Nature’s narcotics (opium, laudanum), anti-inflammatories (salicylates like willow and poplar bark), and intoxicants (fruit and grain fermentation to ethanol, mushrooms, cocaine, cannabis) were often explored, consumed, and abused in order to obtain some level of relief from what ailed. The primary pain maladies of the female pelvis are, dysmenorrhea, endometriosis, and adenomyosis, and historically, cannabis has been a favorite choice for the specific dimorphic discomforts of a woman’s pelvis.

In fact, in my gynecology practice, a significant amount of my patients use cannabis on a monthly, or daily schedule, specifically to help with pelvic pain or monthly cramping. I had always assumed it was the psychoactive properties of THC that gave them relief, which I’m sure it does. But it’s the other, non-THC cannabinoids (CBD being the most abundant and most well-known), that are likely the major contributors of relief from the cyclical nagging of pelvic pain.

As research on the ECS expanded exponentially, one of the first questions asked was, “Where does it exist?” It was initially assumed to be a part of the central nervous system, which would make sense, given cannabis’ psychoactive effects. However, CB-1 and CB-2 receptors were found throughout the body and, furthermore, a significantly large concentration of cannabinoid receptors were found in the female reproductive system.

As has already been discussed on this forum, the presence in mammals of receptors to an exogenous phytocompound (THC, CBD, etc.), simply mandates that there exist endogenous compounds with similar ligands, hence the ECS. The first two endogenous cannabinoids discovered were AEA (N-arachidonoylethanolamine, anandamide) and 2-AG (2-arachidonoylglycerol). It has subsequently been determined that the ECS, via anandamide, 2-AG, and the hundreds of other endocannabinoids, helps to maintain homeostasis in animals.

Pain control is a major part of homeostasis and, to the interests of this review, it has been shown to be female reproductive system specific as well. CB receptors are found throughout the female pelvis, including the uterus/endometrium, fallopian tubes, and ovaries. It was shown that there are CB-1 receptors within the nerve cells of ectopic endometrial implants (endometriosis and adenomyosis), and the activation of these receptors with CB-1 receptor agonists reduces pain.

Likewise, it was shown that the synthetic cannabinoid, WIN55, 212-2 (hundred-fold activity of natural cannabinoids) stopped the growth of in vitro endometrial tissue and increased anti-proliferation effect in vivo (murine) endometrial cells. This shows that exogenous cannabinoids could be clinically relevant in treating abnormal uterine bleeding, endometriosis, or adenomyosis, and that they, in this study, possibly exhibited an effect similar to progesterone.

As mentioned, women have been using cannabis recreationally to help with their painful monthly menstrual cramps (dysmenorrhea). There was a statistical significance reported in one study that showed cannabis was an effective analgesic for menstrual pain. Recently, Peng and colleagues showed that a phytochemical, paenol, with known anti-inflammatory 2 properties, apparently works via the CB-2 receptor (a CB-2 antagonist blocked the effects of paenol) to reduce dysmenorrhea (decreased writhing behavior), as well as decrease PGE-2 and TNF-a in the murine uterus.

Anecdotally, it has been known for millennia that consuming cannabis has many effects that are pleasing and relieving to humans. It is now clear that the phytocannabinoids found in cannabis, are agonists (stimulators) to the receptors of the endocannabinoid system, the largest regulatory system in mammalian physiology. This relationship with nature is not unique. Opioids from poppies, and the endorphin (endogenous morphine) system, are another such relationship connecting the inner world with the outer. For one, it shows that nature conserves biochemistry that works. It also suggests that humans tend to seek, gather, and, ultimately, domesticate nature when it pleases the mind and body.

Pain is a daily reminder of danger, disease, injury, and sometimes, normal physiology (menstrual cramps). Clearly this is a group of molecules that should be used for pain, and specifically those pelvic maladies unique to women. As a functional gynecologist, I have added cannabidiol to my repertoire to help relieve my patients’ pain. Also, I am comfortable in asking my colleagues to use high quality, organically obtained and extracted, full spectrum CBD to maintain entourage effect, in their practices for pain throughout the body, but very specifically for dysmenorrhea, endometriosis, and adenomyosis.

Ongoing research indicates that cannabinoids will be an important addition to augmenting and treating infertility, pelvic dysfunction, and even malignancies (observations of increasing apoptosis, autophagy, inflammation against tumor cells, as well as blocking angiogenesis and metastatic potential in neoplasms). It is clear that the use and domestication of cannabis sativa and cannabis indica may turn out to be as important as the domestication of any crop.

Now that we have nationwide legalization for the use of non-THC cannabinoids, we can once again use these molecules in the public eye, now more refined and tailored for CBD’s effect rather than THC. As I have been introduced to, and have become more familiar with, supplementing the ECS with full spectrum cannabinoids (specifically Formula30A), I have come to realize two important things.

One, that we are at a frontier in human physiology and therapy with these molecules. To paraphrase Newton: what we know is a drop, what we do not know is an ocean. And the second, that this is a group of molecules that is so ingrained into mammalian evolution and so prevalent throughout the body, that it is clearly of enormous importance. So important, that I now recommend that all my patients take Formula30A CBD on a daily basis. As I do.

To your good health,

Dr. George Branning

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Dr. Branning received his undergraduate degree from The University of Texas in Austin, before completing medical school at UT Southwestern in Dallas. He then finished his residency in Obstetrics and Gynecology at Baylor University Medical Center, Dallas. After 23 years of practicing general ObGyn, and delivering over 4000 babies, Dr. Branning completed the coursework with the Institute for Functional Medicine. It was transformative. It changed the way Dr. Branning practices medicine, and “made it fun, again”. He no longer practices Obstetrics, having delivered his last baby in 2018, and instead has dedicated his practice to functional gynecology and medicine for women and their partners. In addition to having a busy general gynecology and robotic surgery practice in Frisco, Texas, Dr. Branning has dedicated a large portion of his time to hormonal health, functional sexual wellness, and preventative health care to his patients. Dr. Branning lectures often on these subjects.

George Branning, M.D.