What Lena Dunham sought out earlier this week at a West Hollywood medicinal marijuana dispensary is anyone’s guess. But the visit, a month after she bravely chronicled her decade-long endometriosis battle in Vogue, could be an inadvertent reminder of cannabis’s increasing role in managing the chronic pain her condition causes. Dunham’s inflammatory disease affects one in ten women worldwide, yet a definitive diagnosis and treatment plan can be frustratingly elusive, prompting women to proactively seek out alternative therapies such as cannabis. To resolve her endometriosis, Dunham was open about undergoing eight failed medical procedures and tried to manage her pain through acupuncture, yoga and even what she called “a brief yet horrifying foray into vaginal massage.” Last year she underwent a hysterectomy, and yet, as Dunham writes in her poignant essay, the pain associated with endometriosis can still persist. “I know,” Dunham concedes of her surgery, “that it’s not a guarantee that this pain will disappear.”
In addition to legalization, and as awareness about endometriosis grows, more women are seeking promising new therapies for their pain and the medical community is responding to their call. About 29 states and Washington, D.C. have some state-regulated medical marijuana program and eight states now have recreational marijuana laws, yet the federal government still classifies cannabis as a schedule 1 drug. The stamp that ranks it alongside heroin, surpassing the dangers of cocaine and crystal methamphetamine, also limits researchers’ abilities to study the drug for medical purposes, leaving board-certified studies few and far between. Still, the drug’s effect on chronic pain—endometriosis’ most debilitating characteristic—tops the short list. UCSF professor of clinical medicine, Dr. Donald Abrams, MD, led an influential 2011 study on the pain-reducing effects of cannabinoids, the principle chemical compounds that naturally occur from medical marijuana. His findings confirmed that cannabis can dramatically reduce pain especially when used in conjunction with other forms of treatment, allowing patients to eliminate or lower their doses of potentially addictive medications such as opioids.
Dr. Perry Solomon, MD, a California-based board-certified anesthesiologist who is also the chief medical officer of HelloMD, one of the cannabis industry’s largest online communities connecting patients with doctors who tailor medical marijuana recommendations to specific conditions, agrees: “About 62-percent of people we work with use cannabis for chronic pain,” he says. “Everyone has a different tolerance and reacts differently, and your access really depends on what state you live in.” In addition to blocking pain signals, cannabis also reduces inflammation, explains Solomon, pointing out that some doctors think it could potentially slow the growth of uterine tissue outside the uterus—the telltale sign of endometriosis. Because the human endocannabinoid system works to maintain homeostasis in the body, communicating between cells and regulating pain-sensation, appetite, and mood, these medical experts believe cannabinoids, which act as natural modulators on the system, could be instrumental in returning the uterus to a more normal state. But, as with so many theories in the field, there is no substantial evidence yet to support this. Dunham’s physician, like most, does not prescribe cannabis.
Still, Solomon thinks future cannabis treatments for endometriosis is near, with specific targets on the uterus. “Localized suppositories closer to the uterus show more promise than systematic treatments like vaping,” he says, pointing out that smoking or ingesting tinctures or edibles send cannabinoids on a more roundabout path through the lungs, bloodstream, and gastric acid-lined stomach respectively. Solomon says this potentially more efficient method—pioneered by such CBD-rich products as Foria Relief and Fairwinds Feminine Relief, both of which are said to ease cramping and pelvic pain and relax muscles—includes THC, the psychoactive part of the plant responsible for its euphoria effects, so to increase its overall potency and effectiveness through what experts deem the “entourage effect.” Solomon says patients surprisingly report few psychoactive effects from the suppositories despite relatively high THC levels (each Foria serving contains 60 mgs of THC and 10 mgs of CBD), but acknowledges that generalizations are difficult without more extensive research.
“The golden ring here is to get an end-state product for specific conditions,” Solomon says. “We’ll need to do real evaluations, manufacture consistent products, and test large numbers of people.” Meanwhile, more women continue to seek alternative treatments for endometriosis in medicinal marijuana shops and elsewhere around the country—and as the demand for better options to mitigate the disease’s debilitating pain grows, so too, it stands to reason, may funding for research and new, improved therapies. That kind of power to collectively move the needle on a women’s health issue that touches more than 5 million individuals in the U.S. alone feels like a movement in the making—one that can be empowering. As Dunham writes in her essay: “I may have felt choiceless before, but I know I have choices now.”
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