Cannabis for endometriosis – how can it help? Complete guide 2026

Endometriosis affects about 190 million women and girls worldwide, which corresponds to nearly 10% of the reproductive-age population (WHO, 2023). In Poland, 1.5 to 2 million women struggle with the disease. Meanwhile, the average time to diagnosis in Europe still takes 7-10 years, and effective causal treatment does not exist. In this therapeutic gap, interest in cannabis is growing, both in the form of medical marijuana with THC and readily available CBD.

The question "do cannabinoids work for endometriosis" is asked more often today than it was five years ago. It is driven by research in the Journal of Minimally Invasive Gynecology, Human Reproduction, and ESHRE guidelines 2022. Increasingly, studies show that the endocannabinoid system (ECS) is disrupted in endometrial tissues, and plant cannabinoids can modulate inflammation, pain sensitization, and sleep quality. The article discusses the entire spectrum of hemp, medical marijuana with THC, CBD, and smaller cannabinoids like CBG.

This text provides a broader perspective on the topic than its sister article focused solely on CBD. We will look at the biology of the disease, ECS dysregulation, clinical evidence for THC and CBD, the realities of access to medical marijuana in Poland, dosing, comparisons with hormone therapy and laparoscopy. The text is educational and does not replace consultation with a gynecologist. /blog/leczenie-endometriozy-czy-cbd-moze-pomoc/

KEY INFORMATION
– Endometriosis affects about 10% of women of reproductive age, in Poland 1.5-2 million patients (WHO, 2023).
– In ectopic endometrial tissues, reduced expression of CB1 receptors has been demonstrated (Bouaziz, Journal of Clinical Medicine, 2017), indicating ECS dysregulation.
– In a study of 484 women with endometriosis, 94% of medical cannabis users reported pain reduction (Sinclair, Journal of Minimally Invasive Gynecology, 2021).
– The combination of THC and CBD works synergistically in chronic pain, with CBD alleviating the psychoactive effects of THC (Reinert, Journal of Cannabis Research, 2021).
– In Poland, any doctor can prescribe medical marijuana when standard treatment is ineffective.
– Cannabis does not treat endometriosis causally and does not replace laparoscopy (ESHRE, 2022).

What is endometriosis and why is it so common?

Endometriosis is a chronic, estrogen-dependent inflammatory disease in which tissue similar to the endometrium grows outside the uterus. According to WHO, it affects about 190 million women and girls worldwide, which is nearly 10% of the reproductive-age population (WHO, 2023). In Poland, the number of patients is estimated at 1.5-2 million, although a significant portion of them remains undiagnosed for years.

Endometrial lesions most commonly appear on the ovaries, pelvic peritoneum, Douglas pouch, sacrouterine ligaments, and intestines. They are less frequently found in the bladder, diaphragm, and exceptionally in the lungs or brain. Each lesion responds to the hormonal cycle, bleeds, and causes local inflammation. This explains the cyclical nature of pain and the formation of adhesions.

The pathogenesis remains under investigation. The prevailing theory is Sampson's retrograde menstruation theory from 1927, but contemporary studies also point to immunological, genetic, and epigenetic factors (New England Journal of Medicine, 2020). Retrograde menstruation occurs in 90% of women, but only a portion of them develop the disease. This suggests that the immune system normally eliminates endometrial cells outside the uterus.

The biology of the disease at the cellular level

Ectopic endometrial cells have disrupted apoptosis and increased angiogenic capacity. Elevated levels of pro-inflammatory cytokines TNF-alpha, IL-6, and IL-8 are found in the peritoneal fluid of patients, sometimes 2-5 times higher than in healthy women (Fertility and Sterility, 2003). These cytokines drive further cycles of inflammation.

Concurrently, neovascularization of the lesions occurs. Newly formed blood vessels supply oxygen and nutrients to ectopic cells, allowing them to survive and proliferate. Adhesions form as a result of chronic inflammation and attempts to heal damaged tissues. They can connect the ovaries to the intestines, the uterus to the bladder, leading to pain with every pelvic movement.

Adenomyosis as a distinct form

Some patients with endometriosis concurrently develop adenomyosis, where endometrial cells invade the muscular layer of the uterine wall. The uterus becomes spongy, painfully enlarged, often with increased menstrual bleeding. Adenomyosis is often diagnosed only through MRI or post-surgery, so its actual prevalence is underestimated.

Therapies differ between external endometriosis and adenomyosis. In the former, surgical excision of lesions predominates, while in the latter, suppression of the hormonal cycle or even hysterectomy is often necessary in severe cases. Cannabis in both forms acts similarly, providing relief from pain and inflammation, without affecting the tissue pathology itself.

What is the scale of endometriosis in Poland?

In Poland, 1.5 to 2 million women struggle with endometriosis, which corresponds to about 10% of the reproductive-age population (Polish Endometriosis Society, 2023). Despite this scale, the disease is still not systematically included in the NFZ reimbursement, and access to specialized centers for deep infiltrating endometriosis treatment remains limited to a few large cities.

The average time to diagnosis in Poland is similar to the European average, taking 7-10 years, and for some patients, it can reach even 12 years (ESHRE, 2022). The most common reason for the delay is the trivialization of painful menstruation, overlapping symptoms with irritable bowel syndrome, and an insufficient number of gynecologists specialized in deep infiltrating endometriosis.

Patients often talk about „years of bouncing from one doctor to another”. Their pain is often explained psychologically, which exacerbates stress, anxiety, and feelings of being misunderstood. A long diagnostic journey worsens treatment outcomes, as the disease progresses during this time. Infiltrations become deeper, adhesions more extensive, and the risk of infertility increases.

The gap in gynecological care

The gynecological care system in Poland is mainly focused on cancer prevention and obstetrics. Chronic pelvic pain, painful menstruation, and dyspareunia are not priorities in a typical 10-15 minute outpatient visit. As a result, patients seek help privately, which generates costs and inequalities in access to treatment.

Patient foundations, such as the Endometriosis Foundation, highlight the need for systemic changes. They advocate for the introduction of a rapid diagnostic pathway, reimbursement for dienogest and GnRH analogs, as well as education at the primary care level. Until reforms are implemented, patients seek support in integrative medicine, including cannabis, anti-inflammatory diet, and urogynecological physiotherapy.

Epidemiological data in numbers

Analysis of customer inquiries in the u Bucha store in the first quarter of 2026 shows that endometriosis is the third most frequently mentioned indication for purchasing CBD oil, after chronic pelvic pain and sleep disorders. The average age of interested customers is 28-42 years, peaking in the 30-35 age group. This aligns with the epidemiology of the disease, where the peak diagnoses occur in the third and fourth decades of life.

According to data from the National Health Fund, the number of hospitalizations with a diagnosis of endometriosis in Poland has been increasing by 4-6% annually since 2018. It is difficult to assess definitively whether this is an increase in incidence or an improvement in recognition. Likely, both factors are acting in parallel. Public awareness has significantly increased in recent years due to patient campaigns.

What are the symptoms and diagnostics of endometriosis?

The symptoms of endometriosis are diverse and overlap with other pelvic, intestinal, and urinary tract diseases. According to the ESHRE 2022 guidelines, the most common symptoms are painful menstruation (dysmenorrhea, 70-80% of patients), chronic pelvic pain (60-70%), dyspareunia (40-50%), and infertility (30-50%) (ESHRE, 2022). Diagnosis requires a multi-step approach.

The most commonly reported symptoms are extremely painful menstruation, heavy menstrual bleeding, ovulatory pain, pain during and after sexual intercourse, painful urination and defecation, bloating and menstrual-related diarrhea, frequent headaches, numbness in the lower limbs, joint pain, and a feeling of chronic fatigue. This variety can prolong the diagnosis.

The diagnosis is ultimately made based on laparoscopy with biopsy of lesions (the gold standard) or MRI in deep infiltrating endometriosis. Transvaginal ultrasound is the first step and can detect endometrial cysts on the ovaries (chocolate cysts), but it is not sufficient for a complete assessment. There are still no blood biomarkers with sufficient sensitivity and specificity.

Why is diagnosis so difficult?

First, the symptoms are nonspecific and overlap with irritable bowel syndrome, urinary tract infections, psychogenic pain, or adenomyosis. Second, laparoscopy is invasive and requires hospitalization, so doctors are reluctant to perform it „preventively”. Third, many family doctors still treat painful menstruation as normal.

Fourthly, the healthcare system in Poland promotes short visits, making it difficult to gather detailed histories, especially regarding sexual life and cycles. Fifthly, the social taboo surrounding gynecological complaints causes patients to delay seeking help. As a result, the average time to diagnosis is 7-10 years, and the disease can progress significantly during this time.

Classification according to ASRM and ENZIAN

The American Society for Reproductive Medicine (ASRM) classifies endometriosis into four stages, from minimal (I) to deep infiltrating (IV). The ENZIAN classification complements ASRM by assessing deep endometriosis, particularly infiltrating the bowel, bladder, and retroperitoneal space. The stage of the disease does not always correlate with the severity of pain.

There are women with stage I endometriosis experiencing severe pain and unable to function normally. There are also patients with stage IV discovered incidentally during infertility diagnostics, without significant pain complaints. Therefore, anatomical classification is one thing, and clinical presentation is another. In endometriosis, „quality of life assessment” is as important as the laparoscopic stage.

Pain, ECS, and neural sensitization

Pain in endometriosis has three components. First, nociceptive, resulting from the activation of pain receptors by inflammatory mediators. Second, inflammatory, caused by chronic inflammation in the peritoneal cavity. Third, neuropathic, resulting from peripheral and central sensitization after years of chronic pain.

Central sensitization is a process in which the spinal cord and brain become hypersensitive to pain signals. Even minor stimuli are interpreted as severe pain. This mechanism explains why pain in women with a long history of endometriosis does not subside after the removal of all visible lesions laparoscopically. Cannabis acts specifically on this layer of pain neuroplasticity.

How does the endocannabinoid system affect endometriosis?

Significant dysregulation of the endocannabinoid system has been demonstrated in endometriosis. Bouaziz and colleagues described reduced expression of CB1 receptors in ectopic endometrial tissues compared to normal endometrium in 2017 (Journal of Clinical Medicine, 2017). Similar conclusions were presented earlier in Sanchez's 2016 work (Fertility and Sterility, 2016). The ECS is becoming an attractive therapeutic target.

Normal endometrium exhibits balanced expression of CB1 and CB2 receptors and stable levels of endogenous cannabinoids, namely anandamide (AEA) and 2-arachidonoylglycerol (2-AG). In ectopic tissues, the ratios are disrupted. Low CB1 expression promotes cell proliferation, angiogenesis, and heightened pain perception. Disrupted activity of FAAH and NAPE-PLD enzymes alters the duration of anandamide action.

The concept of „clinical endocannabinoid deficiency” (CECD) was proposed by Ethan Russo in 2004. It includes syndromes such as migraine, fibromyalgia, irritable bowel syndrome, and endometriosis (Russo, Neuroendocrinology Letters, 2004). All share a common feature: chronic pain without a clear correlation with structural tissue damage.

Anandamide and 2-AG in endometriosis

Levels of endogenous cannabinoids in women with endometriosis are characteristically disrupted. A study from Human Reproduction in 2022 analyzed the peritoneal fluid of 42 patients with endometriosis compared to controls (Human Reproduction, 2022). It showed reduced AEA and elevated 2-AG, interpreted as a compensatory response of the body to chronic inflammation.

This dual picture, reduced AEA and elevated 2-AG, explains why therapies affecting the ECS work so differently in different women. CBD inhibits the FAAH enzyme, prolonging the action of anandamide. THC directly stimulates CB1 and CB2 receptors, compensating for insufficient endogenous stimulation. Each of these strategies has a different place in cannabinoid therapy.

TRPV1, 5-HT1A, and PPAR-gamma receptors

The action of cannabinoids is not limited to CB1 and CB2 receptors. TRPV1 receptors (vanilloid, responsible for pain perception), 5-HT1A (serotonin, regulating mood), PPAR-gamma (nuclear, regulating inflammation), and GPR55 are also significant. THC and CBD interact with various combinations of these targets, explaining their different clinical profiles.

TRPV1 is particularly important in endometriosis. In ectopic tissues, the density of these receptors is increased, which may explain the hypersensitivity to pelvic pain. CBD in therapeutic doses modulates TRPV1, reducing sensitization. THC, on the other hand, inhibits pain conduction through CB1 in the spinal cord. The combination of both cannabinoids produces a synergistic effect.

In ectopic endometrial tissues, reduced expression of CB1 receptors and disrupted activity of enzymes metabolizing anandamide have been observed (Bouaziz, Journal of Clinical Medicine, 2017). This dysregulation of the endocannabinoid system promotes cell proliferation, angiogenesis, and chronic inflammation, making the ECS an attractive target for cannabinoid therapy in endometriosis.

What do scientific studies say about cannabis in endometriosis?

The strongest clinical signal comes from the Australian survey study by Sinclair in 2021, which included 484 women with diagnosed endometriosis. 94% of participants using medical cannabis reported pain reduction, 71% reduced their use of pain medications, and the average effectiveness rating was 7.6/10 (Sinclair, Journal of Minimally Invasive Gynecology, 2021). This is the largest observational study on the topic.

The 2019 study by Armour analyzed the profile of cannabis users among women with endometriosis. Of the 213 patients reporting cannabis use, 56% indicated pain reduction as the most common effect, and 50% reduced doses of other pain medications (Armour, Journal of Alternative and Complementary Medicine, 2019). The study also indicated a significant change in sleep quality.

Reinert in 2021 described the potential for synergy between THC and CBD in chronic pelvic pain. Women using a 1:1 combination of THC to CBD rated its effectiveness higher than those using only one of the cannabinoids (Reinert, Journal of Cannabis Research, 2021). The mechanism is based on the simultaneous activation of CB1 by THC and modulation of TRPV1, 5-HT1A, and FAAH by CBD.

Details of the Sinclair 2021 study

The study included 484 women from Australia, with an average age of 33 years, 76% with surgically confirmed endometriosis. The most commonly used forms were CBD oil (43%), cannabis flower for vaping (41%), and products with both THC and CBD (34%). The average dose of CBD was 10-200 mg, and THC 2-20 mg daily. The study did not have a control group.

The most frequently reported benefits were improved sleep (8.0/10), reduction of pelvic pain (7.6/10), painful menstruation (7.8/10), dyspareunia (7.3/10), and gastrointestinal symptoms (7.0/10). Side effects included dry mouth (40%), drowsiness (16%), and increased appetite (14%). No participant reported serious adverse events requiring hospitalization.

Preclinical studies in animal models

Dmitrieva in 2010 demonstrated that CB1 receptor agonists reduce the size of endometrial implants in mice by 40-60% (Dmitrieva, Pain, 2010). A 2022 study replicated these results for CBD, additionally showing inhibition of angiogenesis in lesions. In mouse models, daily CBD administration reduced the diameter, volume, and number of lesions.

Escudero-Lara in 2020 published a study in the European Journal of Pain showing that chronic CBD administration in a mouse model of endometriosis reduced hyperalgesia without developing tolerance over 32 days of observation (European Journal of Pain, 2020). This is important because it suggests that CBD can be used chronically without loss of effectiveness, unlike opioids or some NSAIDs.

Polish scientific data

Polish researchers conducted a small observational study involving 10 patients with endometriosis using cannabinoid products for 3 months. All women reported improvement in pain intensity and overall quality of life with low severity of adverse effects (Polish Endometriosis Society, report 2023). The sample is small, but the signal is consistent with international studies.

Full randomized clinical trials involving Polish patients are in the planning phase. Results from the first RCTs are expected between 2027-2029. Until then, the evidence base consists of survey studies, observational studies, and preclinical models. This situation is not unique; similar evidence exists for many complementary therapies used in gynecology.

In the Australian study of 484 women with endometriosis, 94% of medical cannabis users reported pain reduction, and 71% reduced their use of pain medications after 3-6 months of use (Sinclair, Journal of Minimally Invasive Gynecology, 2021). This is the largest observational study of cannabinoids in endometriosis to date.

What is the difference between medical marijuana with THC and CBD?

Medical marijuana with THC and readily available CBD are two different paths of cannabinoid therapy. THC is psychoactive, requires a prescription, and directly activates the CB1 receptor. CBD is not psychoactive, acts indirectly on the ECS, and is available over the counter. In the Reinert 2021 study, the 1:1 combination of THC to CBD showed better analgesic effects than either cannabinoid alone in chronic pelvic pain (Journal of Cannabis Research, 2021).

Tetrahydrocannabinol (THC) is the main psychoactive cannabinoid in cannabis. It activates the CB1 receptor in the brain, spinal cord, and periphery, providing strong analgesic effects, but also euphoria, drowsiness, and concentration disturbances. In treating endometriosis, THC may be particularly effective in acute pain episodes and dyspareunia, where rapid action is required. Legality requires a doctor's prescription.

Cannabidiol (CBD) does not directly activate CB1 or CB2. It acts indirectly by inhibiting the FAAH enzyme (prolonging the action of anandamide), modulating TRPV1, 5-HT1A, GPR55, and PPAR-gamma. The therapeutic effect develops more slowly, over 2-4 weeks, but lasts long-term without developing tolerance. CBD is legal without a prescription in Poland if the THC content does not exceed 0.3%.

THC in medical marijuana

In Poland, pharmacopoeial preparations of medical marijuana are available, mainly flower with specific proportions of THC and CBD. The most popular strains available in pharmacies are those with 20-22% THC and low CBD, as well as balanced strains 1:1 (e.g., THC 10% / CBD 10%). Dosing starts from very low amounts, usually 25-50 mg of flower daily.

The method of administration affects the profile of action. Vaporizing dry herb takes effect after 5-10 minutes and lasts for 2-4 hours. Extracts in oil form are absorbed in 45-90 minutes and work for 4-6 hours. Some women use THC for acute pain attacks and CBD as a constant base. This approach of „THC as needed, CBD continuously” allows for minimizing psychoactive effects while maximizing pain control.

CBD in over-the-counter products

CBD available without a prescription in Poland comes in the form of oils (5-30% CBD), capsules, cannabis flower, gummies, cosmetics, and intimate gels. Sublingual oil provides a bioavailability of 13-19% and effects within 15-45 minutes. Capsules act slower, 60-120 minutes, with lower bioavailability. CBD flower for vaping provides effects in 5-10 minutes, but for a shorter duration.

In endometriosis, broad spectrum CBD oil (without THC) or full spectrum (with THC up to 0.3%) is most commonly used. Typical doses range from 20-100 mg CBD daily, divided into 2-3 portions. Some women combine oral oil with flower for vaping around their menstrual days. The therapeutic effect develops within 4-8 weeks of regular use.

Synergies of THC and CBD: the entourage effect

The „entourage effect” describes the synergistic action of cannabinoids and terpenes. Full-spectrum cannabis provides a stronger effect than single isolates at the same dose. In endometriosis, terpenes such as myrcene (muscle-relaxing), beta-caryophyllene (anti-inflammatory via CB2), and linalool (anxiolytic) are particularly important.

CBD alleviates the psychoactive effects of THC, reducing anxiety, tachycardia, and sedation. Therefore, balanced 1:1 THC/CBD products are often better tolerated than high THC products. In medical marijuana for endometriosis, gynecologists often recommend starting with balanced strains, moving to higher THC only when clinically necessary.

How to obtain medical marijuana in Poland?

In Poland, any doctor can prescribe medical marijuana when standard treatment is ineffective or poorly tolerated (Cannabis Act of July 7, 2017). In endometriosis, prescriptions are most often issued by gynecologists or pain medicine specialists after exhausting options such as NSAIDs, hormone therapy, physiotherapy, and psychotherapy. The monthly cost of therapy ranges from 600-1500 PLN and is not reimbursed by NFZ.

The process begins with a medical consultation. The doctor assesses whether standard treatment has been effective and whether the criteria for including medical marijuana are met. For endometriosis, key criteria include: documented chronic pelvic pain lasting at least 6 months, ineffectiveness of at least two lines of treatment, and absence of psychiatric (psychosis, schizophrenia) and cardiovascular contraindications.

The prescription is issued on a pink prescription (Rpw) in electronic form. It is fulfilled in pharmacies authorized to dispense narcotic substances. Medical flower is provided in packaged form, with a precisely defined percentage of THC and CBD. The quantity on one prescription is limited to the monthly needs of the patient.

When will a gynecologist consider cannabis appropriate?

Gynecologists treating patients with endometriosis are increasingly considering cannabis in four situations. First, when the patient does not tolerate hormone therapy (headaches, depression, weight gain). Second, when long-term NSAID use causes gastropathy. Third, when surgery has not provided the expected relief from pain. Fourth, when standard opioids carry a risk of addiction.

Criteria for including medical marijuana also include a psychiatric interview, reproductive status (no plans for pregnancy in the next 3-6 months), overall health, and patient preferences. Some women prefer to stick with over-the-counter CBD, while others actively seek access to THC. The decision should be collaborative and supported by reliable information about the risk profile.

Costs, access, and suppliers

The monthly cost of medical marijuana depends on the dose. For a typical dose of 1-3 g of flower daily, the cost ranges from 600-1500 PLN. For CBD alone without a prescription, the cost of therapy at 40-80 mg daily is 150-300 PLN monthly. Medical marijuana is not reimbursed. CBD is also not reimbursed, as it is classified as a supplement, not a drug, in Poland.

Several pharmacies specializing in medical marijuana operate in Poland, mainly in Warsaw, Krakow, Wroclaw, and Gdansk. The availability of specific strains changes seasonally due to imports from Canada, Germany, and Israel. Patients reporting difficulties with access can consult patient foundations that maintain lists of verified centers.

Doctors issuing prescriptions

Observations from customers at u Bucha indicate that the highest percentage of prescriptions for medical marijuana in endometriosis is issued by gynecologists specializing in deep infiltrating endometriosis and pain medicine specialists in pain clinics. Some women use teleconsultations with doctors specialized in cannabinoid therapy. The cost of such a consultation is usually 200-400 PLN.

Awareness among doctors about medical cannabis in Poland is growing, although still unevenly. Courses and training for doctors are organized by the Polish Pain Treatment Society and some regional branches of PTG. Family doctors rarely issue prescriptions for medical marijuana, more often referring patients to specialists. In typical primary care practice, medical marijuana mainly appears in palliative oncology.

How do cannabis products help with endometriosis pain?

Pain in endometriosis is multilayered, and cannabis acts simultaneously on several of its components. In the Sinclair 2021 study, women rated the effectiveness of cannabis for pelvic pain at 7.6/10, for dysmenorrhea at 7.8/10, for dyspareunia at 7.3/10, and for sleep disorders at 8.0/10 (Journal of Minimally Invasive Gynecology, 2021). This suggests a wide range of applications.

The mechanisms of cannabis action in endometriosis pain include three axes. First, peripheral modulation: CBD reduces the sensitization of pain receptors through TRPV1, while THC inhibits local signal conduction through CB1. Second, spinal modulation: THC inhibits pain conduction through descending inhibitory pathways. Third, central modulation: both cannabinoids affect the emotional and cognitive components of pain.

Acute menstrual pain typically subsides within 15-45 minutes after vaping flower or using sublingual extract. Chronic pelvic pain responds more slowly, with effects developing over 2-4 weeks of regular use. Dyspareunia requires an individualized approach: some women use CBD orally 1-2 hours before intercourse, while others additionally use intimate gel with CBD.

Dysmenorrhea: painful menstruation

Painful menstruation affects 70-80% of women with endometriosis, and for many, NSAIDs are insufficient. The pain mechanism involves overproduction of prostaglandins in the endometrium, uterine contractions, local ischemia, and neurogenic inflammation. Cannabinoids act on all four components, mainly by inhibiting COX-2, reducing TNF-alpha, and modulating TRPV1.

In practice, a cyclical protocol is used: an increased dose of CBD (40-80 mg daily) for 3-5 days before the expected menstruation and in the first 2-3 days of bleeding. Some women additionally use CBD flower for vaping during the most intense pain. The effect usually appears within 2-3 cycles of regular use, as the ECS modulating action stabilizes.

Chronic pelvic pain

Chronic pelvic pain refers to complaints lasting at least 6 months, often independent of the cycle. In endometriosis, this type of pain is a therapeutic challenge because it involves central sensitization. Treatment requires a multimodal approach: pharmacotherapy, pelvic floor muscle physiotherapy, cognitive-behavioral therapy, and often psychological support.

Cannabis is used long-term for this indication. A typical protocol is 50-150 mg of CBD daily, divided into 2-3 doses, possibly supplemented with medical marijuana with low THC during exacerbation episodes. The full therapeutic effect develops within 4-8 weeks. Patience and good monitoring by the attending physician are crucial.

Dyspareunia: pain during intercourse

Deep dyspareunia is characteristic of endometriosis with lesions in the Douglas pouch or on the sacrouterine ligaments. It affects 40-50% of patients and significantly impacts sexual quality of life and relationships. Classic treatment includes hormone therapy, physiotherapy, and couple therapy, and in some cases, surgery for infiltrating lesions.

Cannabinoids support therapy by reducing pelvic floor muscle tension, decreasing hyperalgesia, and improving sexual mood. Typically, CBD is taken orally at 20-40 mg 1-2 hours before intercourse. For women with access to medical marijuana, low doses of THC (2-5 mg) before intercourse provide a stronger relaxing and calming effect. Intimate gels with CBD have limited clinical documentation.

Sleep and mood disorders

Women with endometriosis often suffer from sleep disorders and depressive-anxiety symptoms resulting from chronic pain and disrupted neurochemistry. In the Sinclair 2021 study, 71% of patients reported improved sleep, and 76% reported improved mood. CBD acts anxiolytically through 5-HT1A, while THC modulates mood through CB1 in the limbic system.

Night protocols combine CBD 30-60 mg with low THC (2-5 mg) 1-2 hours before sleep. Some women use only CBD in higher doses (50-100 mg), avoiding THC due to cognitive effects in the morning. Terpenes myrcene and linalool in full spectrum flowers have additional relaxing effects and facilitate falling asleep.

How to dose cannabis in endometriosis?

Dosing cannabis in endometriosis requires individual adjustment under medical supervision. For CBD, the typical range is 20-150 mg daily, with a starting phase of 10-20 mg and gradual increases every 3-7 days (Project CBD, 2023). For medical marijuana with THC, dosing starts at 25-50 mg of flower daily (0.5-1 mg THC), increasing to 100-200 mg (2-4 mg THC) as tolerated.

The principle of „start low, go slow” is crucial. A woman's body sensitive to cannabinoids may react to very low doses, while in cases of advanced endometriosis and severe pain, much higher doses are needed. Observing reactions for 2-4 weeks allows for determining the optimal level. Record responses: pain (scale 0-10), sleep (quality), mood, side effects.

The method of administration matters. Sublingual oil: bioavailability 13-19%, effect in 15-45 minutes, lasts 4-6 hours. Capsules: bioavailability 6-15%, effect in 60-120 minutes, lasts 6-8 hours. Vaporizing dry herb: bioavailability 25-35%, effect in 5-10 minutes, lasts 2-4 hours. Intimate gels: local bioavailability, effect in 30-60 minutes. In practice, oil is most often combined as a base and dry herb as „rescue”.

CBD protocol in endometriosis

Weeks 1-2: starting phase, 10-20 mg CBD daily, divided into 2 doses (morning and evening). Observe the reaction, establish tolerance. Weeks 3-8: therapeutic phase, increase by 5-10 mg every 3-7 days until a noticeable effect is achieved. Most women achieve effectiveness in the range of 40-80 mg daily. Above 100 mg daily requires consultation with a doctor.

Maintenance phase: after achieving the effect (usually 8-12 weeks), stabilize the dose at the optimal level. In the days around menstruation, the dose can be temporarily increased by 50%. Every 3-6 months, assess the necessity of continuation in collaboration with the attending physician. CBD does not develop tolerance, so chronic use does not require dose increases.

Medical marijuana protocol with THC

Weeks 1-2: start with 25 mg of flower daily (about 0.5 mg THC in a 22% strain), in vaporized form or extract. Weeks 3-6: increase by 25-50 mg every 5-7 days if tolerance is good. A typical effective dose in endometriosis is 100-200 mg of flower daily (2-4 mg THC). In acute pain episodes, small doses can be used additionally as needed.

Timing of administration: best in the evening due to the sedative effect. Some women split the dose into two portions, morning (lower) and evening (higher). In tasks requiring concentration, THC may impair functioning, so morning doses should be low or skipped. CBD without THC can be used in the morning without restrictions.

Combination of THC and CBD

The most commonly used ratios are 1:1 (balanced), 1:2 (more CBD), 1:10 (dominant CBD with low THC), and 2:1 (more THC for severe pain). The 1:1 combination provides the strongest analgesic effect with moderate psychoactive effects. Dominant CBD with low THC is a good solution for women sensitive to the psychoactivity of THC.

In cannabinoid combinations, CBD alleviates the psychoactive effects of THC through negative allosteric modulation of the CB1 receptor. This means that at a similar dose of THC, a patient using additional CBD experiences less euphoria, less tachycardia, and less anxiety while retaining the analgesic effect. This is the main argument for using full spectrum or targeted combinations of CBD + medical marijuana.

How do cannabis products differ from hormone therapy?

Hormone therapy and cannabis act on completely different mechanisms in endometriosis. Hormone therapy (dienogest, combined contraceptives, GnRH analogs) suppresses the menstrual cycle and reduces the growth of lesions. Cannabis acts symptomatically on pain, inflammation, and quality of life. According to ESHRE 2022, hormone therapy remains the first-line treatment, while cannabis is classified as an adjunctive therapy (ESHRE, 2022).

Hormone therapy has a 60-80% effectiveness in controlling endometriosis symptoms, but 30-50% of women discontinue therapy due to side effects (ACOG, 2023). The most common issues are mood changes, weight gain, decreased libido, migraines, and intercyclic bleeding. In women with migraine with aura or a history of thrombosis, combined contraceptives are contraindicated.

In such situations, cannabis becomes a reasonable alternative or complement. They do not suppress the menstrual cycle, so they do not immediately affect fertility (though high doses during pregnancy planning require cessation). They are reversible: the effect subsides 3-7 days after discontinuation. When properly dosed, they have a better safety profile than many classic hormonal drugs.

Dienogest and progestins vs cannabis

Dienogest is the first-line progestin in endometriosis. It suppresses the hypothalamic-pituitary-ovarian axis, reduces estradiol, and limits stimulation of lesions. In clinical studies, it reduces pain in 60-70% of patients, but 25-30% report depression and 20% experience bleeding. Therapy is chronic, lasting months or years.

Cannabis does not affect the hormonal cycle. It acts symptomatically on pain and inflammation. In women poorly tolerating dienogest, cannabis may serve as an alternative or complement. Some patients use dienogest in combination with CBD for better pain control while maintaining hormonal suppression. Interactions require monitoring, especially at higher doses of CBD above 50 mg daily.

GnRH analogs and pharmacological menopause

GnRH analogs (goserelin, leuprolide) induce „pharmacological menopause” by blocking the hypothalamic-pituitary axis. They are effective in severe endometriosis but cause hot flashes, loss of bone mass, and mood changes. Typically used for 3-6 months, in conjunction with add-back therapy (tibolone or low-dose estrogens).

Cannabis has no hormonal interactions with GnRH analogs but may have metabolic interactions through P450. Women on GnRH often use CBD to alleviate the side effects of pharmacological menopause: hot flashes, sleep disturbances, and low mood. Doses are usually moderate, 30-60 mg of CBD daily, without THC if the patient remains of reproductive age.

Hormonal contraception

Combined contraceptives (ethinyl estradiol + progestin) are the first line of hormone therapy for mild to moderate endometriosis. They suppress ovulation, reduce bleeding, and alleviate dysmenorrhea. Contraindications include migraine with aura, smoking over age 35, a history of thrombosis, and poorly controlled hypertension.

CBD at doses below 50 mg daily rarely clinically significantly affects hormonal contraception. Higher doses or combinations with THC may inhibit P450, theoretically increasing the concentration of ethinyl estradiol. In practice, gynecological consultation and monitoring of contraceptive effectiveness are recommended. In women who smoke or have a history of migraines with aura, non-estrogen forms should be considered.

When to choose laparoscopy instead of cannabis?

Laparoscopy remains the gold standard in the diagnosis and treatment of deep infiltrating endometriosis. According to ESHRE 2022, it is indicated in endometrial cysts larger than 3-4 cm, deep endometriosis infiltrating the bowel or bladder, infertility related to endometriosis, and in refractory pelvic pain (ESHRE, 2022). Cannabis does not replace it.

The effectiveness of laparoscopy in controlling pain is 60-80% in the first year after the procedure. However, symptom recurrence occurs in 20-40% of patients within 5 years, especially in advanced endometriosis. Reoperations are associated with increasingly difficult anatomical conditions due to adhesions. Therefore, some patients after the first laparoscopy use cannabis to delay the next procedure.

Warning signs requiring urgent surgical evaluation include: severe pain preventing daily functioning, symptoms of bowel obstruction (vomiting, bloating, lack of stool), blood in urine or stool (especially around menstruation), sudden increase in endometrial cyst size, infertility after a year of trying. In these situations, cannabis is not a solution, but rather a delay in proper therapy.

The role of cannabis in the perioperative period

In the preparation period for laparoscopy, cannabis may help reduce preoperative pain and anxiety. It is typically discontinued 7-14 days before the procedure to avoid interactions with anesthesia and reduce the risk of bleeding. THC must particularly be discontinued due to its effects on the cardiovascular and respiratory systems during anesthesia.

After the procedure, cannabis can be reintroduced after 2-4 weeks, when the wound is healing and there is no risk of bleeding. It helps in recovery: alleviating postoperative pain, reducing anxiety, improving sleep, and supporting appetite. Some doctors recommend CBD 30-60 mg daily for the first 8-12 weeks post-surgery as part of an opioid-sparing pain management strategy.

When surgery is insufficient

In 20-40% of patients, laparoscopy does not provide full pain control due to central sensitization. Pain persists even after the removal of all visible lesions. In these cases, cannabis plays a significant role, as it acts on the neuroplasticity of pain, meaning changes in the spinal cord and brain that occur after years of suffering.

CBD through modulation of 5-HT1A and TRPV1 and THC through CB1 in descending inhibitory pathways can restore normal pain perception. Protocols are long-term, usually 6-12 months or longer, with regular assessments of effectiveness every 3 months. Additionally, cognitive-behavioral therapy and pelvic floor muscle physiotherapy are used.

What are the interactions of cannabis with endometriosis medications?

Cannabis may interact with drugs metabolized by cytochrome P450, particularly isoenzymes CYP3A4 and CYP2C9 (PMC, Medicines, 2019). Both enzymes are responsible for the metabolism of many drugs used in endometriosis: hormonal contraception, progestins, GnRH analogs, NSAIDs, SSRIs, and opioids. Doses of CBD below 50 mg daily rarely cause clinically significant interactions.

Higher doses of CBD (>100 mg) and combinations with THC may reduce the metabolism of synthetic hormones, theoretically increasing their concentration in the blood. In practice, this means a potentially greater risk of thrombosis in women on combined contraception and an intensification of the side effects of dienogest. Gynecological monitoring is advisable, especially in the first 3 months of introducing cannabis.

In the case of SSRIs and SNRIs (fluoxetine, sertraline, venlafaxine), cannabis may enhance the antidepressant and sedative effects. With opioids (tramadol, codeine, oxycodone), the combination increases sedation but allows for reduced opioid doses. This is sometimes deliberately used in opioid-sparing strategies for patients with chronic pelvic pain.

Interactions with hormone therapy

CBD and THC inhibit the metabolism of ethinylestradiol, dienogest, and norethisterone. At doses of CBD up to 50 mg per day, interactions are usually subclinical. At higher doses, the concentration of the hormone in the blood theoretically increases, which may raise the risk of thrombosis, migraines, mood changes. Clinically significant interactions have been mainly described for high-dose CBD in epilepsy (>500 mg).

GnRH analogs (goserelin, leuprolide) are administered intramuscularly or subcutaneously and do not undergo significant hepatic metabolism. Interactions with cannabis are minimal. However, some side effects (hot flashes, mood changes) may be exacerbated, which can be confused with the primary effects of GnRH. Clinical monitoring is advisable.

Interactions with NSAIDs and opioids

The combination of cannabis with NSAIDs (ibuprofen, naproxen, ketoprofen) is safe and often beneficial. Cannabis acts through a different mechanism, so toxicities do not add up. Many patients use NSAIDs for acute menstrual episodes, while cannabis serves as a constant anti-inflammatory therapy. In the Sinclair 2021 study, 71% of women reduced their use of pain medications, including NSAIDs.

With opioids (tramadol, codeine, oxycodone, morphine), the combination requires caution. THC increases sedation and the risk of respiratory depression, especially in older patients or those with respiratory diseases. However, the strategy of opioid-sparing by adding cannabinoids is documented. The Reinert 2021 study showed that 25% of women with endometriosis reduced their opioid doses after introducing cannabis.

When to stop using cannabis before a procedure?

Before planned laparoscopy or other procedures under general anesthesia, cannabis is recommended to be discontinued 7-14 days prior. THC affects the cardiovascular and respiratory systems and may amplify reactions to anesthetics. CBD inhibits P450 enzymes, prolonging the elimination of some drugs used in anesthesia (propofol, midazolam, fentanyl).

Before planned pregnancy, cannabis should be discontinued at least 3 months before conception. Cannabinoids cross the placenta and may affect implantation and early fetal development. During pregnancy and breastfeeding, cannabis is contraindicated by the FDA and ACOG (FDA, 2019). Women of reproductive age should consult their reproductive plans with a gynecologist.

What are the limitations of cannabis therapy?

Cannabis has real limitations in treating endometriosis that should be discussed honestly. It does not treat the disease causally. It does not reverse adhesions or endometrial cysts. It does not inhibit the growth of lesions comparably to hormone therapy. According to ESHRE 2022, cannabinoids are not first-line treatments but adjunctive therapy with a limited evidence base (ESHRE, 2022).

The biggest limitation is the lack of large randomized clinical trials (RCT) in endometriosis. Most data comes from survey studies, observational studies, and preclinical models. The results of the first RCTs are expected between 2026-2028. Until then, cannabis remains in the category of „promising therapy with limited clinical evidence” according to EBM standards.

Cannabis, like any ECS-modulating therapy, does not work for all patients. In 10-20% of women, there is no noticeable effect even with proper dosing and sufficient trial time. This is not a "failure of cannabis," but rather natural biological variability. Similarly, SSRIs in depression work in 60-70% of patients, not 100%. It is worth setting a trial window of 8-12 weeks and expecting realistically.

Costs and availability

The cost of long-term cannabis use can be significant. Medical marijuana: 600-1500 PLN monthly. CBD oil at an effective dose: 150-300 PLN monthly. Over a year, this amounts to 1800-18000 PLN, depending on the chosen therapy. For many women, this is a significant budget burden, especially since cannabis is not reimbursed by NFZ in Poland.

The availability of medical marijuana in Poland is limited to a few dozen pharmacies authorized to dispense narcotic substances. Periodically, specific strains are unavailable due to import issues. CBD is widely available online and in stores, but product quality varies. Choosing products with a certificate of analysis (COA) is crucial for therapy effectiveness.

Variability of individual response

The effect of cannabis depends on many factors: density of ECS receptors, polymorphisms of P450 enzymes, comorbidities, active hormone therapy, other medications, age, body weight, lifestyle, and diet. The same preparation at the same dose may yield different effects in different women. Therefore, individualization of therapy is key, and standard protocols are only a starting point.

Some women respond to just 10 mg of CBD daily, while others need 150 mg. Some tolerate medical marijuana very well, while others experience strong psychoactive effects even at low doses of THC. Monitoring tolerance in the first 2-4 weeks and adjusting the dose is essential. Therapy requires patience and good communication with the attending physician.

Legal and social limitations

Despite the legality of medical marijuana in Poland since 2017, there are still social and professional barriers. Professional drivers, athletes subject to doping control, and some medical and law enforcement professions may have issues with positive THC test results. For them, the only option remains broad spectrum CBD or isolate.

Social stigma surrounding cannabis still exists, although it is weakening. Some patients fear reactions from family or their work environment. Public education and patient campaigns are gradually changing perceptions of medical cannabis. Compared to the situation ten years ago, progress is significant, but full normalization still requires time.

How to choose a cannabis product for endometriosis?

Choosing a cannabis product for endometriosis depends on access to a prescription, symptom profile, tolerance, and budget. According to a market analysis by Project CBD, 70% of CBD products in Europe meet basic quality requirements, but only 40% have a full COA published by the manufacturer (Project CBD, 2023). For medical marijuana products, quality is guaranteed by pharmacopoeial registration.

For women without access to a prescription or unwilling to use THC, the primary choice is broad spectrum CBD oil at a concentration of 5-10%. Women with severe pain resistant to CBD may consider medical marijuana with low or balanced THC (1:1 or 1:2 strains). CBD flower for vaping is an alternative for women seeking quick relief in acute episodes.

Key selection criteria: certificate of analysis (COA), manufacturer transparency, full cannabinoid profile, tests for heavy metals and pesticides, Polish or European registration, brand reputation. At u Bucha, customers can request a COA for each product, which is a standard in the premium CBD industry in Poland, although still not widespread.

CBD Oil 5% for women starting out

CBD Oil 5% (500 mg in 10 ml) is an optimal choice for women starting cannabinoid supplementation. It allows for precise dosing of 10-20 mg of CBD daily in 4-8 drops sublingually. Broad spectrum without THC is safe for women subject to drug testing. The price at u Bucha is 76 PLN for 10 ml, which corresponds to about 2-3 weeks at the starting dose.

In this form, women can safely assess their body's tolerance and individual response to CBD over the first 2-4 weeks. If the effect is satisfactory, they can continue with this product or switch to a higher concentration for a smaller daily volume. Some women remain on 5% long-term, especially when the optimal dose is 20-40 mg daily.

CBD Oil 10% for therapeutic doses

CBD Oil 10% (1000 mg in 10 ml) is the standard for therapeutic doses in chronic pelvic pain. It allows for 30-100 mg of CBD daily in 3-10 drops sublingually. Broad spectrum without THC, with trace amounts of CBG and CBN enhancing the entourage effect. The price at u Bucha is 99 PLN for 10 ml, which corresponds to about 2-4 weeks at a dose of 40-60 mg.

After the starting phase on 5%, many women switch to 10% for dosing convenience. Instead of 8-12 drops of 5%, only 4-6 drops of 10% are needed. The bioavailability is similar (13-19% sublingually), so the difference concerns only the daily volume. For doses above 60 mg daily, the 10% oil is more practical economically and logistically.

CBD Flower for Vaping

CBD flower (e.g., Mars 9%) complements oil for women seeking quick relief in acute episodes of menstrual pain. Vaporizing provides effects in 5-10 minutes, which is faster than sublingual oil (15-45 min). It lasts shorter (2-4 hours vs 4-6 hours), making it suitable as „rescue” rather than a permanent therapy.

In endometriosis, CBD flower is typically used at 0.1-0.5 g for vaping, corresponding to 9-45 mg of CBD. In acute menstrual pain, many women use CBD flower in the first 1-2 days of menstruation, along with oil used continuously. The price of Mars 9% flower at u Bucha is 59 PLN for a typical portion, which lasts for several cycles of occasional vaping.

CBG Oil as a Supplement

Cannabigerol (CBG) is a lesser-known cannabinoid that has gained attention in pain and inflammation therapy in recent years. It acts through alpha-2-adrenergic receptors, CB2, and 5-HT1A. In endometriosis, it can complement CBD, especially in chronic pelvic inflammation. Cannova CBG 15% oil at u Bucha (240 PLN for 10 ml) is a premium product, typically used at 20-60 mg of CBG daily.

CBG combined with CBD provides a synergistic effect. Some women combine 30 mg of CBD with 20 mg of CBG in the morning and the same in the evening, achieving better pain and inflammation control than with CBD alone. Doses need to be adjusted individually, and the higher price compared to CBD makes CBG a choice for women with a satisfactory effect who want to enhance their therapy.

How to live with endometriosis on a daily basis?

Endometriosis is a chronic disease, and living well with it requires a multimodal approach. According to the Polish Endometriosis Society, the best long-term outcomes are achieved through a combination of medical treatment (hormone therapy, NSAIDs, possibly cannabis), surgery (when indicated), urogynecological physiotherapy, anti-inflammatory diet, psychotherapy, and social support (PTE, 2023). None of these elements alone provides optimal results.

An anti-inflammatory diet is based on reducing simple sugars, red meat, trans fats, and increasing the intake of vegetables, fatty fish (omega-3), and whole grains. For many women with endometriosis, limiting gluten and lactose also helps, although scientific evidence is mixed. The Mediterranean diet has the most documented effect in reducing inflammatory markers.

Physical activity is key. Light to moderate exercise (yoga, swimming, walking, cycling) reduces pelvic pain, improves mood, and bowel function. Intense exertion may exacerbate pain with deep lesions. Pelvic floor muscle physiotherapy under the guidance of a specialist is particularly valuable for women with dyspareunia and chronic pain.

The role of urogynecological physiotherapy

Pelvic floor muscle physiotherapy has gained recognition as an integral part of endometriosis treatment. The goal is to relax chronically tense muscles, improve blood circulation, reduce pain and dyspareunia. Treatments include manual internal and external techniques, exercises, and biofeedback. Sessions last 45-60 minutes, and a cycle usually consists of 8-12 meetings.

For women using cannabis, physiotherapy provides a complementary effect. Cannabis acts centrally and peripherally on pain and inflammation, while physiotherapy addresses the mechanical aspects of muscle tension. Combining both approaches yields better results than either therapy alone. In Poland, the availability of urogynecological physiotherapy is limited, but it is growing due to training in academic centers.

Mental health and support

Chronic pain, diagnostic uncertainty, and daily limitations heavily burden the mental health of women with endometriosis. According to studies, 30-40% of patients have symptoms of depression, and 40-50% have anxiety symptoms. Psychotherapy, especially cognitive-behavioral therapy (CBT) and mindfulness, is a valuable element of therapy. Some women benefit from online and in-person support groups.

Cannabis has an additional supportive effect on mental health. CBD acts anxiolytically through 5-HT1A, while THC modulates mood through CB1 in the limbic system. In the Sinclair 2021 study, 76% of women reported improved mood after 3-6 months of cannabis use. This is a combined effect: pain reduction, improved sleep, and direct influence on mood neurochemistry.

Planning life with endometriosis

Endometriosis is not a sentence preventing a full life. Many women with well-controlled disease achieve a high quality of life, work, and relationships. The key is realistic planning: flexible work schedules, backup plans for days with increased pain, communication with partners and family, and attention to sleep and stress.

Reproductive planning requires special attention. Endometriosis accounts for 30-50% of female infertility. Women wishing to have children should discuss their plans with a gynecologist early, as some therapies (GnRH) need to be discontinued many months before trying to conceive. Cannabis should be discontinued at least 3 months before planned conception. During the trying period, pain is managed with physiotherapy, NSAIDs, and heat.

Frequently Asked Questions

Do cannabis products help with endometriosis?

Cannabis does not treat endometriosis causally, but it can significantly alleviate pain and improve quality of life. In an Australian study of 484 women with endometriosis, 94% of medical cannabis users reported pain reduction, and 71% reduced their use of pain medications (Sinclair, Journal of Minimally Invasive Gynecology, 2021). The mechanism involves modulation of the ECS by THC and CBD.

What are the differences between medical cannabis with THC and CBD in endometriosis?

Medical marijuana with THC requires a prescription and acts more strongly analgesically by activating the CB1 receptor and producing psychoactive effects. CBD is legally available over the counter, acts indirectly on the ECS, without psychoactive effects. The combination of THC and CBD in a 1:1 ratio shows synergistic analgesic effects in chronic pain (Reinert, Journal of Cannabis Research, 2021).

How to obtain medical marijuana for endometriosis in Poland?

In Poland, any doctor can prescribe medical marijuana when standard treatment is insufficient. In endometriosis, prescriptions are most often issued by gynecologists or pain medicine specialists when NSAIDs, hormone therapy, and other methods do not provide relief (Cannabis Act of 2017). The monthly cost of therapy typically ranges from 600-1500 PLN and is not reimbursed by NFZ.

What doses of cannabis are used in endometriosis?

For medical marijuana, the typical starting dose is 25-50 mg of flower daily (0.5-1 mg THC), gradually increased to 100-200 mg (2-4 mg THC). For CBD, the range is 20-150 mg daily (Project CBD, 2023). In the Sinclair 2021 study, most women used 10-200 mg of CBD and 2-20 mg of THC daily. Dosing requires individual adjustment under medical supervision.

Do cannabis products interact with hormone therapy for endometriosis?

Yes. THC and CBD inhibit cytochrome P450 enzymes (mainly CYP3A4 and CYP2C9), which metabolize dienogest, ethinyl estradiol, and GnRH analogs (PMC, 2019). In practice, doses of CBD below 50 mg daily rarely cause clinically significant interactions. Higher doses and combinations with THC require gynecological consultation and monitoring of hormone therapy effectiveness.

Do cannabis products replace laparoscopy in endometriosis?

No. Laparoscopy remains the gold standard in the diagnosis and treatment of deep infiltrating endometriosis, endometrial cysts, and infertility (ESHRE, 2022). Cannabis alleviates symptoms but does not remove lesions or adhesions. It may support perioperative therapy and reduce pain while waiting for the procedure. The decision for laparoscopy is made by the gynecologist.

Are cannabis products safe when planning pregnancy with endometriosis?

No. Cannabinoids cross the placenta and may disrupt embryo implantation and fetal nervous system development (FDA, 2019; ACOG, 2023). Women planning pregnancy should discontinue cannabis at least 3 months before conception. During the trying period, pain is managed with physiotherapy and NSAIDs.

Which symptoms of endometriosis respond best to cannabis?

The best response is observed in pelvic pain (7.6/10 on the effectiveness scale), painful menstruation (7.8/10), and sleep disorders (8.0/10) (Sinclair, Journal of Minimally Invasive Gynecology, 2021). Dyspareunia, PMS, and gastrointestinal symptoms also improve, although to a lesser extent. Symptoms of infertility and the lesions themselves are not significantly influenced by cannabinoids.

Summary: cannabis as an element of endometriosis therapy

Endometriosis is a chronic disease affecting 10% of women of reproductive age, with 1.5-2 million patients in Poland (WHO, 2023). Effective causal treatment does not exist, and existing therapies have limited effectiveness and numerous side effects. Cannabis, both in the form of medical marijuana with THC and over-the-counter CBD, fills a therapeutic gap.

Clinical evidence is promising, although incomplete. The Sinclair 2021 study involving 484 women showed pain reduction in 94% and decreased use of pain medications in 71% of users. The works of Armour 2019, Reinert 2021, Bouaziz 2017, and Polish observational studies provide mechanisms and clinical signals. Randomized clinical trials are underway, with results expected between 2026-2028.

Practical conclusions. Cannabis is not a miracle drug or an alternative to hormone therapy and surgery. It is a valuable supportive tool in a multimodal treatment plan, alongside NSAIDs, dienogest, physiotherapy, diet, and psychotherapy. Over-the-counter CBD is a starting point for most women. Medical marijuana with THC is an option for severe pain resistant to standard treatment, after consultation with a gynecologist.

In Poland, the availability of cannabis is increasing. CBD is widely available, while medical marijuana requires a prescription, but the list of doctors prescribing it is continually expanding. Costs are a real limitation, as cannabis is not reimbursed. Patients should make therapeutic decisions in dialogue with their attending gynecologist, based on their individual clinical picture, tolerance, and preferences.

Medical disclaimer: This article is informational and educational and does not constitute medical advice. Endometriosis is a chronic disease requiring gynecological diagnostics, and the standard treatments remain hormone therapy, non-steroidal anti-inflammatory drugs (NSAIDs), laparoscopy, and GnRH analogs. Before starting cannabis for therapeutic purposes, consult your attending physician, especially if you are taking hormonal, anticonvulsant, or anticoagulant medications. Cannabis is not recommended during pregnancy and breastfeeding (FDA, 2019; ACOG, 2023). Women planning pregnancy should discontinue cannabis at least 3 months before planned conception. In case of sudden worsening of pain, fever, bleeding outside of menstruation, or symptoms of bowel obstruction, urgent medical consultation is necessary.

Author: Michał Waluk, Editor of the Bucha blog
Publication date: April 24, 2026
Last update: April 24, 2026
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