“A dose of relief?”: Results of an international survey exploring self-reported effectiveness, dose and dosage forms of cannabis for endometriosis pain and related symptoms

Background Endometriosis is a common, chronic inflammatory condition impacting 10–14% of reproductive aged females. Common symptoms include severe dysmenorrhea, pelvic pain and fatigue. Current symptom management options are often unsatisfactory, and new, low risk pain management options urgently needed. Previous research has found people with endometriosis self-reporting either legal or illicit cannabis use to manage the pain and associated symptoms of endometriosis. This international study aims to explore how people with endometriosis access cannabis, and the dosage formats and dose frequency utilised. Respondent self-rated symptomatic effectiveness of medicinal cannabis was also investigated. Methods An online, anonymous, cross-sectional survey was developed in conjunction with endometriosis advocacy groups and patient support networks, and distributed internationally. The survey enquired about legal (medical or adult use/social) versus illicit cannabis consumption for therapeutic purposes, current symptoms, medical and self-management strategies employed, self-rated symptom relief associated with cannabis use, and the dosage format and dose frequency utilised. Results 889 respondents from 28 countries were eligible for data analysis. The average duration respondents had been utilising cannabis to manage their symptoms was 4.4 years. Dried cannabis flower-joints (46.8%) and oral oils (31%) were the highest-rated dosage formats for symptom management. There was evidence that self-rated effectiveness is higher for those using dried cannabis flower as a joint (i.e., inhaled) across numerous symptoms, compared to not utilising cannabis flower as a joint. By contrast, oral oils had a lower self-rated effectiveness. Reasons behind dosage form choices focused on fast onset of action for inhaled formats, and longer duration of effect for orally ingested products. Conclusions Cannabis utilisation for endometriosis symptom management is frequently utilised, and is primarily of illicit origin. Self-reported effectiveness of cannabis is noted across a wide range of symptoms, from chronic pelvic pain and dysmenorrhoea to improving sleep and reducing nausea, and dosage frequency is suggestive of individualised dosing regimens which is consistent with the pharmacological duration of action, and speed of onset, that cannabinoids can provide across different symptom clusters. Whilst such evidence is encouraging, more robust data from clinical trials are needed to fully assess the efficacy of cannabis-based medicinal products.