Cannabis for Gynecological Pain: Growing Patient Use, Limited Clinical Evidence | Research

The takeaway

Women are increasingly using cannabis for endometriosis, pelvic pain, and period cramps — with retrospective data suggesting benefit — but clinical trials are nearly nonexistent.

Read this if you're a woman using cannabis for period pain, endometriosis, or pelvic pain — or a clinician asked about it by patients. The evidence gap is real, but so is the patient demand.

What the researchers found

Cannabis has a long history of use for menstrual and reproductive pain, predating modern medicine by centuries. This review examines the current evidence for cannabis in gynecological pain conditions — endometriosis, chronic pelvic pain, and primary dysmenorrhea (period cramps) — and finds a familiar pattern: lots of patient use, some encouraging retrospective data, but almost no controlled clinical evidence.

The growing evidence base comes primarily from retrospective studies, cohort data, and patient surveys. These consistently show that women are using cannabis for gynecological pain, that many find it helpful, and that it may reduce reliance on other pain medications. The most evidence exists for endometriosis, where surveys of patients report significant symptom relief, particularly for pain, sleep, and mood.

But the obstacles to medical cannabis adoption for these conditions go beyond the evidence gap. The authors identify a constellation of barriers: outdated drug-driving laws that penalize patients even when not impaired, workplace drug testing policies, the cost of quality-assured medical cannabis (not covered by insurance), a lack of cannabis education among healthcare professionals, and persistent stigma — particularly for women using cannabis.

The review notes that most women currently using cannabis for gynecological pain are using illicit rather than medical cannabis, largely because of these access barriers. This means they're using uncontrolled products without clinical guidance, which is suboptimal for both efficacy and safety.

Why it matters

Gynecological pain affects millions of women and is chronically undertreated. Endometriosis alone affects 10% of reproductive-age women, with limited effective treatments and an average 7-10 year diagnostic delay. Many patients have already turned to cannabis out of desperation — this review maps what we know and don't know about whether that's a good idea, and identifies the systemic barriers preventing better evidence from being gathered.

The numbers in context

Endometriosis affects approximately 10% of reproductive-age women. Most cannabis use for gynecological pain is with illicit rather than medical cannabis. The review identifies five key barriers to medical cannabis adoption: drug-driving laws, workplace testing, cost, clinician education gaps, and stigma. Clinical trial data for cannabis in any gynecological pain condition is described as lacking.

How the study worked

Retrospective cohort analysis and narrative review of evidence for cannabis use in gynecological pain conditions (endometriosis, chronic pelvic pain, primary dysmenorrhea). Examined published retrospective data, surveys, and cohort studies, as well as barriers to medical cannabis adoption.

Who was studied

Retrospective data from cannabis consumers with gynecological pain conditions, primarily endometriosis.

What this study cannot tell us

Most evidence comes from retrospective and survey data, which cannot establish causation. Self-reported cannabis effectiveness may reflect placebo effects, expectation bias, or recall bias. The review doesn't present original data. Clinical trial evidence is acknowledged as essentially absent. The review focuses on cannabis generally rather than specific cannabinoids, doses, or routes of administration. Geographic and legal variation in cannabis access limits the generalizability of findings.

How to read the evidence

This is a review combining retrospective cohort data with narrative synthesis. The patient use data is consistent but comes from uncontrolled settings. No randomized clinical trials exist for cannabis in gynecological pain.

When this study was published

Published in 2023. Clinical trials for cannabis in endometriosis and other gynecological conditions may be underway.

The bigger picture

This sits alongside RTHC-00099 (chronic pain patient experiences) in documenting the gap between patient use of cannabis and clinical evidence supporting it. The barrier analysis — stigma, cost, testing, clinician ignorance — echoes the workplace policy challenges described in RTHC-00082. For women with gynecological pain, these barriers compound: cannabis stigma layers on top of the existing stigma around women's pain being dismissed or undertreated.

Replication

Not stated in abstract.

Funding

Not reported in abstract.

Conflicts of interest

Not reported in abstract.

Questions still open

Would a randomized trial of medical cannabis for endometriosis pain show superiority over placebo? Which cannabinoid profiles and routes of administration are most effective for gynecological pain? Could cannabis reduce the need for hormonal treatments or opioids in endometriosis patients? How can clinician education about cannabis be improved to better serve women with these conditions?

Read the original research

The Place of Cannabinoids in the Treatment of Gynecological Pain.

Drugs, 83(17), 1571-1579

Drugs is a well-respected journal that publishes comprehensive reviews and studies on pharmacology and therapeutics.

View on PubMed ↗Publisher’s paper ↗

Citation

Sinclair, Justin; Abbott, Jason; Proudfoot, Andrew; Armour, Mike. (2023). The Place of Cannabinoids in the Treatment of Gynecological Pain.. Drugs, 83(17), 1571-1579. https://doi.org/10.1007/s40265-023-01951-z