A new international review has assessed the accumulating evidence around medicinal cannabis for endometriosis, concluding that the treatment warrants greater attention in clinical practice even as large-scale trials remain scarce.
The study was led by associate professor and NICM director of research Dr Mike Armour, with Australian Natural Therapeutics Group (ANTG) chief scientific officer Justin Sinclair among the co-authors. It examined global research into how cannabinoids might help manage the symptoms of endometriosis.
The review found a credible scientific basis for cannabis use in this condition and called on clinicians to factor it into broader, multidisciplinary treatment plans.
The authors acknowledged that high-quality clinical evidence is still limited, but pointed to observational studies and patient surveys that consistently show women using medicinal cannabis reporting reductions in pelvic pain, better sleep and an improved quality of life.
"Substantial cross-sectional and retrospective data consistently demonstrates patient-reported benefits across multiple symptom domains, including pain reduction, improved sleep quality, and gastrointestinal symptom management," the authors wrote.
"Given the low levels of satisfaction with current treatment options, consideration should be given to trialling medicinal cannabis as part of the interdisciplinary management of endometriosis."
The review counted at least seven clinical trials now active around the world with a specific focus on endometriosis, including three being conducted in Australia that are testing CBD oils, balanced THC:CBD formulations and vaporised flower.
The paper also provided practical guidance for prescribers: begin with a "start low, go slow" approach using CBD-predominant oils, titrate doses gradually, and introduce THC only when necessary under medical supervision.
"Medicinal cannabis should be considered as a potential treatment option as part of a shared decision-making approach between the patient and health care provider," the authors added.
"This approach requires medical supervision, comprehensive screening for risk factors, appropriate medication tapering protocols (if relevant), and a careful approach to dosage."
The review also drew attention to persistent barriers in the real world.
Fewer than one in four women report being satisfied with existing hormonal or surgical treatments, and many continue to access illicit cannabis because of the cost of legal alternatives, workplace drug-testing laws, reluctance among some clinicians and ongoing social stigma.
Similar challenges have previously been reported in connection with a failed Victorian randomised controlled trial testing medicinal cannabis for endometriosis.
That trial was abandoned after drug-driving laws and strict eligibility requirements stopped participants from enrolling.
