The endocannabinoid system is implicated in pain perception and inflammation. Cannabinoids that bind to endocannabinoid system receptors in cannabis include delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). Palmitoylethanolamide (PEA), a fatty acid amide, boosts endogenous cannabinoids. Given the growing popularity of medicinal cannabis, researchers sought to define patterns of cannabis usage for gynecologic pain and its analgesic efficacy.

They searched PubMed, EMBASE, Scopus, Cochrane, and for phrases like “woman,” “cannabis,” and “pain” or “pelvic pain” or “endometriosis” or “bladder pain” or “cancer.” The search was limited to English-language literature published between January 1990 and April 2021, excluding animal studies. The original search generated 5,189 articles with 3,822 unique citations. Studies were considered if they looked at non-pregnant adult women who used cannabis to treat gynecologic discomfort (eg, chronic pelvic pain, vulvodynia, endometriosis, interstitial cystitis, malignancy). RCTs, cohort studies, and cross-sectional studies were all included in the research. The program Covidence was utilized to conduct the systematic review. 

A total of 59 papers were examined for a comprehensive evaluation, with 16 meetings the inclusion criteria. Cannabis consumption varied between 13% and 27%. The majority of women swallowed or inhaled cannabis and used it many times each week, with THC and CBD levels ranging from 70 mg to 2,000 mg, respectively. Pain alleviation was reported by 61% to 95.5% of those polled. All 6 prospective cohort studies and 1 randomized controlled trial using PEA-combination medicines found considerable pain alleviation, with the average decrease in pain after 3 months of therapy being 3.35+1.39 on a 10-point visual analog scale. One fatty acid amide enzyme inhibitor RCT, on the other hand, did not alleviate discomfort.

According to survey results, the majority of women said cannabis relieved their pain from a variety of gynecologic diseases. Pain relief was found in cohort studies and an RCT using PEA-combination medicines. However, interpretation of the research was hampered due to differences in cannabis formulations, administration methods, and doses, which precludes making a conclusive comment about cannabis for gynecologic pain treatment.