What is Endometriosis?
Endometriosis is a complex, multifaceted disease that affects about 10% of women of reproductive age. This condition is characterized by the growth of endometrial tissue outside the uterus, meaning that the lining that should grow every month only on the walls of the womb, also develops in other parts of the body, typically the fallopian tubes, ovaries, and the tissue lining the pelvis.
Although it is uncommon, endometriosis can also affect other organs, as in the case of thoracic endometriosis, which affects the lungs and can potentially cause serious health issues.
However, these cases are isolated, and most people affected by this disease usually have extrauterine growth in the reproductive organs and, in some cases, in nearby organs such as the intestines or bladder.
What symptoms does endometriosis cause?
The main symptom of this disease tends to be chronic pelvic pain associated with menstruation. Although the causes aren’t clear, scientists are investigating the potential origins of this health issue. While symptoms can vary greatly depending on the patient, the most common are:
- Very painful periods: Dysmenorrhoea (intense pain and cramps during menstruation) is the most well-known symptom of this condition, with many patients reporting that it can be incredibly debilitating.
- Pain during or after sexual intercourse.
- In certain cases, pain when urinating or during bowel movements (especially during the menstrual cycle).
- Excessive menstrual bleeding and bleeding between periods.
- Infertility: In some cases, endometriosis can cause difficulty or inability to conceive.
- Before or during periods: nausea, fatigue, diarrhea, or constipation.
What’s the cause of endometriosis?
One of the challenges in treating this disease is that its exact causes are unknown. However, studies conducted in recent years suggest that the endocannabinoid system may be related to this pathology.
A study published in 2023 has gone even further, pointing out that it isn’t only the system of endocannabinoid receptors in our body that’s involved in the processes triggering this health problem, but also the gut microbiota, which plays a crucial role in its development.
The conclusions of this study open a new perspective for the treatment of endometriosis.
Endocannabinoid System and Endometriosis: How are They Related?
The endocannabinoid system in our body is responsible for regulating various bodily functions to maintain what is known as “homeostasis” (which means balance and optimal functioning).
Among other vital functions, this system made up of CB1 and CB2 receptors regulates pain perception and inflammation.
Several studies suggest that a decrease in CB1 receptor activity may be directly linked to endometriosis, as it may facilitate the growth of extrauterine ectopic tissue and increase pelvic pain.
This recent study, which our article is based on, discovered that fluctuations in endocannabinoids (the molecules similar to cannabinoids produced by our body) had a direct relation to the severity of pain associated with endometriosis and the growth of extrauterine endometrial tissue.
The study found that levels of endocannabinoids like anandamide and 2-AG (very similar to THC and CBD in cannabis) fluctuated depending on the severity of the pain and ectopic growth of the patients. This implies abnormal activation of the endocannabinoid system in these areas.
The researchers concluded that the regulation of the endocannabinoid system is crucial for the treatment of the symptoms of endometriosis, and that the possible manipulation of the CB1 and CB2 receptors (with endogenous or exogenous cannabinoids) could offer new treatments for this disease.
But the findings of this study don’t end here… There’s more!
Gut Microbiota and Endometriosis: The Microbiota-Gut-Uterus Axis
In recent years, the scientific and medical community has focused on the importance of gut microbiota for our overall health. This bacterial ecosystem housed in our intestines plays a key role in the regulation and proper functioning of our immune and hormonal systems.
This study also discovered that women suffering from endometriosis can also have specific alterations in their gut microbiota. This disorder is known as “dysbiosis” and could be the cause of chronic inflammation, among other symptoms.
The study indicates that an exacerbated increase in bacteria like Prevotella or Escherichia coli was directly linked to the symptoms of bloating and digestive discomfort in patients suffering from endometriosis. A microbial imbalance that, in turn, appeared to elevate inflammatory markers like TNF-α and IL-6, which perpetuate systemic inflammation in the body.
Thus, the study’s results suggest that restoring the balance of the gut microbiota might be key to lessening inflammatory symptoms and improving gastrointestinal discomfort in endometriosis patients.
Restoring gut microbiota to a healthy balance isn’t a swift or easy process, as it requires detailed analysis by a health professional to identify existing imbalances, and a diet specifically monitored and designed by that professional.
Moreover, this is often a process that can take weeks or even months, and which requires changes in eating habits. However, the overall health benefits are worth it, not just for patients with endometriosis but for many others experiencing different health issues rooted in a damaged or imbalanced microbiota.
Therapies involving phased diets, as well as probiotics (which should be applied during the initial dietary phases depending on the case), could play a significant role in treating endometriosis.
Connection Between the Endocannabinoid System and Gut Microbiota in Endometriosis
One of the most intriguing aspects of this study is the research on the connection that exists between the endocannabinoid system and gut microbiota, and how this relationship could be key for future, more effective treatments for endometriosis.
The endocannabinoid system has been found to regulate intestinal inflammation and to help protect the permeability of its barrier (preventing toxic elements from crossing it and accessing our system).
More specifically, protective effects of the endocannabinoid system (ECS) were observed in the gut through the increase of endocannabinoids, including 2-AG, and resulting in decreased inflammation and improved intestinal permeability.
The discovery of this link opens up the possibility of combined treatments aimed at regulating both systems to treat the symptoms of endometriosis.
Cannabinoids for the Treatment of Endometriosis: Therapeutic Potential
Multiple studies have focused on how the administration of phytocannabinoids (cannabinoids derived from the cannabis plant) can modulate the endocannabinoid system and thus provide treatments for various diseases, including endometriosis.
Cannabinoids such as THC or CBD have been shown to act as anti-inflammatory and analgesic agents, which could be very useful for endometriosis sufferers.
But this study wanted to go further, pointing out that treatments with cannabinoids could regulate the expression of CB1 receptors in the affected area (the endometrium and surrounding organs), thereby reducing both pain and ectopic growth of endometrial tissue.
And not only that… This study also found that the protective effects of the endocannabinoid system in the gut by increasing endocannabinoids (including 2-AG) resulted in reduced inflammation and improved gut permeability.
As mentioned earlier, the imbalance of the intestinal microbiota could be another potential cause for the progression of endometriosis. Therefore, treatments aimed at modulating the endocannabinoid system would have a direct positive impact on the microbial balance of the intestinal flora. This would in turn reduce inflammatory markers such as TNF-α, which are key in inflammatory responses and tissue invasion by parasites or microbes, as well as in neoplastic processes that involve uncontrolled growth of abnormal cells or tissues in the body.
Conclusion
This study shows that cannabinoids could be the future for the treatment of endometriosis. However, more extensive clinical trials are necessary to evaluate their effectiveness and safety in treating this disease.
Nonetheless, research like this offers hope to thousands of patients suffering from this disease, paving the way for future therapies that could rely on simultaneous manipulation of both systems to effectively treat inflammation and pain.
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