In endometriosis, the cells that form the lining of the uterus (the endometrium) occur outside of the organ, in places like the ovaries or Fallopian tubes. When a woman has her monthly menstrual cycle, the uterus sheds this endometrial lining—and the improperly growing cells along with it. Once shed, this tissue has nowhere to go and in some cases, it can cause pain that’s so severe that it can lead to hospitalization.
Worldwide, 6–15% of women who are of reproductive age have endometriosis. Typical treatments for endometriosis usually involve painkillers like nonsteroidal anti-inflammatory drugs (NSAIDs), hormonal birth control and surgery. However, these options can come up short for many women.
Jessica Peters, a cannabis clinician and founder of Moxie Meds, thinks that cannabidiol (CBD), one of cannabis’s many active compounds, can help women find relief from endometriosis—a condition she’s personally acquainted with.
Jessica first encountered CBD in 2010 when she was working at Market Street Cooperative, a now defunct dispensary that served a large portion of the San Francisco HIV/AIDS community. She took the position instead of pursuing work on a ship with the National Oceanic and Atmospheric Administration—a move she says she made partly because of how severe her endometriosis symptoms were.
“All I could think about was: If I have an endometriosis attack while I’m out at sea on a ship filled with 90% men and not at a hospital, I’m not going to make it through this. When I was younger, I can't recall any month in which I didn't miss school or work for at least one day [due to the pain caused by endometriosis],” she says.
When she first tried CBD during her menstrual cycle, she could tell something was different: “I really noticed a reduction of cramps; I really noticed this pain relief, and I thought, ‘Wow, what might be going on here?’” she says.
Her interest piqued, Jessica went on to work at Harborside Health Center, a medical cannabis dispensary in Oakland, CA, in hopes of further exploring CBD’s properties. At the time, CBD’s effects were largely unknown. She became the dispensary’s CBD specialist and began creating in-house products for them.
“At this point in time, my endometriosis [symptoms] had substantially changed. I could tell [CBD] was affecting it,” she says. “I would even withdraw it to see if my endo symptoms would come back, and in fact, they did—because that's what you do when you're science-minded: You torture your own body to see what might happen.”
Why did Jessica see such dramatic results from CBD, especially when nothing else she did—like conventional pharmaceuticals and alternative medicines—had much effect on her pain?
In recent years, research has indicated that the endocannabinoid system (ECS)—the network of receptors located throughout the body that’s responsible for cannabis’s psychoactive and therapeutic effects—could have a role to play in the development of treatments for endometriosis.
There are currently three receptors associated with the ECS: CB1, CB2 and TRPV1. Your body makes molecules called endocannabinoids that attach to these receptors; the most well-studied of these are anandamide (AEA) and 2-arachidonoylglycerol (2-AG), though there are others as well.
Research indicates that women with endometriosis have various imbalances in their ECS. They tend to have lower levels of CB1 receptors in their endometrial tissue and higher levels of endocannabinoids, like AEA, in their blood. CB1 and AEA play a role in how our body perceives pain. Thus, the imbalance of these components is likely influencing how they work to manage pain.
The cannabis plant makes molecules called phytocannabinoids that can also attach to ECS receptors. Tetrahydrocannabinol (THC) and CBD are two of the most well-studied of these phytocannabinoids. THC is remarkably similar in structure to AEA, so it can attach to the same receptor in your body to elicit various therapeutic effects.
We still don’t fully understand how CBD influences the ECS. In some cases, it attaches directly to CB1 and CB2 receptors. In other instances, CBD slows the breakdown of your body’s endocannabinoids; it may even influence how other substances attach to ECS receptors.
Working at Harborside, Jessica had more access to CBD-rich extracts, as well as the resources to study CBD’s properties. She eventually stumbled on a paper that mentioned the terpene beta-caryophyllene as the first “dietary cannabinoid.”
Beta-caryophyllene is one of the many terpenes found in the cannabis plant. Terpenes are aromatic compounds that are found in many different foods. They are what gives lemons their characteristic citrusy smell, for instance.
Terpenes aren’t notable just for their aromas: It’s now thought that terpenes can affect the nature of the high you experience when consuming cannabis. Knowing this, Jessica set out to explore beta-caryophyllene’s properties.
She looked for food-based sources of beta-caryophyllene and created a handout to give to her patients at Harborside. She noticed that those who consumed more foods rich in beta-caryophyllene seemed to have more success in using cannabis for whatever their particular condition was.
When Jessica was eventually approached by some investors to create cannabis products for the now-defunct Moxie Meds, she immediately knew she wanted to develop something for women. Her previous work led her to ask, "Could you put beta-caryophyllene in the medication, and if you did, would that change it?"
True to her background in the sciences, Jessica found folks who were willing to serve as guinea pigs. As she was already familiar with their cannabis dosing regimen, she added safe levels of beta-caryophyllene into their medication and observed the effects.
Ultimately, she discovered that if beta-caryophyllene was added to a patient’s cannabis medication, they usually needed less CBD and THC to get the same—or in some cases, better—effect.
This discovery also had an impact on Jessica’s own dosing regimen for her endometriosis. Prior to this revelation, Jessica was taking 40–50 mg of CBD and THC in a 1:1 ratio, three times a day. Since adding beta-caryophyllene, she takes about 7.5 mg of CBD in a 4:1 CBD to THC ratio and only uses the 1:1 CBD to THC ratio for pain relief, if needed. At this point, she hasn’t had an endometriosis attack in about five years; she now considers her endometriosis asymptomatic.
“We don't have the science yet to prove this, but it’s strongly my belief that [CBD with the addition of beta-caryophyllene has] regulated my hormonal functioning,” she says. “If I’m doing my protocol correctly, I don't need a lot of pain relief. I don't need to bring out that 1:1 very often.”
We don’t yet have the science to fully explain why Jessica and her patients saw such positive results, but there are some clues that may point us in the right direction. As previously mentioned, women with endometriosis tend to have fewer CB1 receptors in their endometrium. However, the opposite is true for CB2: Studies suggest that women with endometriosis have a higher expression of this receptor, perhaps as part of the body’s inflammatory response.
Cannabinoids that attach to CB2 receptors can control the release of cytokines, small proteins that can control the actions of cells. These cytokines are in turn responsible for a variety of immune responses, including the release of pro-inflammatory compounds. It’s thought that compounds that attach to CB2 can have therapeutic applications to many diseases.
Scientists are still working on identifying compounds that bind to CB2—we know that THC can bind to this receptor, but it often doesn’t. However, research does indicate that beta-caryophyllene selectively activates CB2.
Jessica acknowledges that there’s still a lot we don’t know about CBD’s relationship with the CB2 receptor, but based on what’s she’s witnessed, she’s made a few inferences.
“The presence of beta-caryophyllene seems to allow CBD to either bind to those [CB2] receptors more efficiently, or more preferentially. It's doing something that’s allowing CBD to increase its efficacy,” she says.
Unfortunately, Jessica’s company, Moxie Meds, was forced to shut down after the 2017 fires in northern California. As a result, that magical formula of CBD and beta-caryophyllene is currently unavailable. It’s “brutal” to watch this happen, says Jessica. She has since referred patients back to her Harborside handout as a way for them to add more beta-caryophyllene into their diet.
Though her next steps are unclear, it’s apparent that cannabis education as it relates to women’s health is of great importance to her, and she’ll likely continue to work in this context.
“Women's health in a Western context is quite ignored. Other countries have endometriosis-specific medications pharmaceutical-wise; we don't even have that,” she says. “We're not looking for this disease; we're not talking about it.”
“I spent much of my life thinking I just had a really bad [menstrual] cycle,” she adds. “Now with just a combination of cannabinoids, terpenes and phytonutrients, [my endometriosis] isn’t present in any way. It’s shocking and amazing, and it should be of great scientific curiosity to medical practitioners. And it’s incredibly frustrating that it’s not.”
Jessica continues to consult with physicians in other states, educating them on cannabis’s effects on the body. Meanwhile, awareness of endometriosis is on the rise, with celebrities like Lena Dunham and Padma Lakshmi speaking out about their experiences.
While women in the United States still don’t have access to medications specifically intended to treat the symptoms of endometriosis, cannabis and its constituents can provide hope for the many women whose lives are deeply impacted by this condition.
Photo credit: Jasper Graetsch