Cannabis consumption and endometriosis management during the COVID-19 pandemic

Worldwide, 1 in 10 women suffer from endometriosis and often find it difficult to control their symptoms, which include painful intercourse, constipation, dysmenorrhea, and persistent pelvic pain.¹

Symptom management has been more challenging during the COVID-19 pandemic, due to limited access to healthcare. Mike Armour, PhD, of the NICM Health Research Institute at Western Sydney University in Penrith, New South Wales, Australia and colleagues set out to examine how frequently women used cannabis over a period of 12 weeks to manage their endometriosis symptoms during the pandemic in a survey-based study.

Researchers recruited women between the ages of 18-55 with the condition using social media to access some of the largest endometriosis support and advocacy groups worldwide. These included Nancy’s Nook, Endometriosis Australia, Endometriosis NZ, the World Endometriosis Organization, the Centre for Endometriosis Research, Endometriosis Ireland, and The Endometriosis Network Canada, for a total pool of about 95,000 women.¹ The authors ensured that surveys could only be taken once per IP address to prevent multiple submissions from an individual.

The anonymous, cross-sectional, online survey was designed by a team that included cannabis, endometriosis, and menstrual health academics and gynecologists. Researchers collected demographic information, endometriosis symptoms, diagnosis method, and current management approaches, in addition to current and previous cannabis use and method of consumption.

Armour and colleagues received 1635 responses worldwide, and reported the average age of respondents was 30 (mean 25 years).¹ Twenty percent of respondents said they had previously used cannabis. Pre-pandemic, 61% of women said they used cannabis at least once a day, with 51% using inhaled forms. Sixty-five percent of users reported they stopped using cannabis because of the pandemic. The authors said cannabis use increased among current users during the pandemic.

Fifty-one percent of respondents (846) said they consumed cannabis in the past 3 months; of these, 55% (465) reported using it for symptomatic management. “Legal access was associated both with a greater likelihood of using cannabis and greater disclosure to health care professionals,” the authors said.

Stress/anxiety was the most common reason (59%) participants reported using cannabis, followed by symptomatic management due to difficulty accessing medical care (48%) the authors reported. They also noted that the way women consumed cannabis changed during the pandemic, with increases in edibles and oil consumption (40% and 25.2% respectively) and a 39.5% decrease in inhalation methods. Survey respondents said the decline in inhaled use was due to respiratory health concerns during the COVID-19 pandemic.

One of the barriers to consumption was cost; this included both the cost of the product and the expense of obtaining a medical prescription in places where cannabis is not legal for recreational consumption. “Lack of public (Medicare-like) insurance reimbursement and limited private health insurance coverage push the out-of-pocket costs associated with cannabis medicines onto patient households, a burden not every patient/family can bear, regardless of its reported effectiveness in the management of endometriosis,” the authors wrote. They said this creates barriers for women who would use it to alleviate their symptoms.

Armour and colleagues noted several weaknesses of the study: there was no proof of diagnosis, selection bias may have occurred due to nonresponse in social media groups, and study participants may have experienced recall bias. Study strengths noted by researchers included international reach of the survey, the size of the sample, and the ability to report anonymously encouraged study participants to disclose information.

“Use of cannabis for symptom relief was common, with over half of respondents having used cannabis for symptom management in the 12 weeks preceding survey completion,” the authors said.

Reference

Armour M, Sinclair J, Cheng J, et al. Endometriosis and Cannabis Consumption During the COVID-19 Pandemic: An International Cross-Sectional Survey [published online ahead of print, 2022 Jan 21]. Cannabis Cannabinoid Res. 2022;10.1089/can.2021.0162. doi:10.1089/can.2021.0162