April Pride: This podcast discusses cannabis and is intended for audiences 21 and over. Today on How to do the Pot. A condition that affects one in 10 women that can cause debilitating pain, lead to invasive surgeries and hard to tolerate drugs even infertility, and yet it often takes years to get diagnosed and patients often have to advocate fiercely for their doctors to take them seriously. We’re talking about autoimmune diseases and how to do the pot when you have or might have endometriosis.

April Pride: So many of us are walking around in tremendous amounts of pain and the people we interact with likely have no idea. Loyal listeners have heard us talk about pain in the past. Today we talk about a very specific and challenging kind of pain that disproportionally impacts women. Often goes undisclosed, untreated or disbelieved. I’m April Pride, I do the pot and I talked to a lot of women who also consume cannabis. Many of them medical patients who consume for a variety of autoimmune disorders. What is an autoimmune disorder? How does this get in the way of being your best self on every level as a partner, professional, just a person in the world?

April Pride: In recent years in my professional life, I’ve been learning about the promising results of cannabis on a woman’s pelvic health, and yet in my personal life, I was hearing from multiple women I loved about their premature hysterectomy. Ultimately, as a result of undiagnosable endometriosis, which come to find out is an autoimmune disorder. It’s also to blame for my co-founder, Ellen Scanlon’s infertility.

Ellen Scanlon: So it was a really, really hard time. And my diagnosis was literally called unexplained infertility. No one knew what was going on. I went to so many doctors, I went to everyone that you can go to in multiple cities across the country. Time is your enemy in fertility, especially in your late 30s so getting an answer quickly to what might be going on can make a big difference in your chances of having a baby. And I share my experience here. I share it with people when they ask me about it because if it can help women who have unexplained infertility learn about endometriosis as a possible cause and then either rule it out or move towards IVF, then they can spare themselves years of uncertainty expense, the emotional roller coaster. I think for me, one of the hardest parts was trying to plan for the future when the future felt so uncertain.

April Pride: According to the Mayo Clinic, endometriosis is an often painful disorder in which tissue similar to the tissue that normally lines the inside of your uterus, the endometrium grows outside your uterus. You’ve heard us talk before about how cannabis can treat pain, so why are we not talking in a big way about cannabis and endometriosis? You’ll hear from Dr. Jessica Knox.

Dr. Jessica K.: Hello, I’m Dr. Jessica Knox, more commonly known as Dr. Jessica because I am one of four doctors in my family who are all Dr. Knox’s. So I’m Dr. Jessica or Dr. Jess.

April Pride: And Dr. Michele Ross.

Dr. Michele R.: My name is Dr. Michele Ross. I’m a neuroscientist and I sort of have had this very long and interesting journey into the cannabis industry.

April Pride: That journey included work as both a doctor and a patient.

Dr. Michele R.: As a neuroscientist with fibromyalgia and a whole bunch of other health conditions, I was on a lot of different pharmaceuticals and for me what actually worked was none of those pharmaceuticals. It was actually cannabis.

April Pride: Likewise, Dr. Jess found that her medical training didn’t account for the ways people were using cannabis and getting better.

Dr. Jessica K.: I started working in cannabis clinics immediately after finishing my residency. My mother, Dr. Janice had started working in cannabis clinics four years prior to that. So she started reading and learning and as she read and learned and was digging into all this science about cannabis and the endocannabinoid system, she was sharing that information with the rest of the family, with my sister and me and our father. And she was also telling the stories of the patients she saw, which for me was I think most impactful because I was felt like I was beating my head against a wall every day, just managing these long lists of meds.

Dr. Jessica K.: And people weren’t getting better or feeling better, but I was hearing stories of patients in these cannabis clinics where my mom was working, who they were feeling better. Their quality of life was through the roof. They could play with their kids or they could relax after work without feeling intoxicated. It was a completely new paradigm for me that, there’s this other option outside of anything in which I was trained in medical school or residency that is doing better for patients. Let me go see what that’s about.

April Pride: You might have heard Dr. Jess mentioned the endocannabinoid system a moment ago.

Dr. Jessica K.: The endocannabinoid system is this complicated, intricate communication system within our body that modulates all of our other systems. So most people know about, the cardiovascular system, our heart, they know about the neurological system, the respiratory system. These are the systems we all learned about in health class, in high school, but nobody learned about the endocannabinoid system.

April Pride: Just discovered in the 1990s, a system that has been a part of the human body since there were humans. It’s the body’s way of maintaining balance, flushing toxins, rebounding from stress through naturally formed neuro transmitters. Endocannabinoids. I recommend that you listen to our episode on pain for way more on the endocannabinoid system or we’re going call it here, the ECS and how it operates. For our purposes today, however, we’re going to focus on the just emerging research on what happens when the ECS isn’t working right. It’s deficient in endocannabinoids.

April Pride: Dr. Ross, the neurologist you heard from earlier, she’s been looking closely at how a poorly functioning ECS can cause all sorts of problems in the body, especially for women. She cites the work of Dr. Ethan Russo who has identified a few different conditions that may be linked to a deficiency and the ECS. Essentially what happens when the body’s balancing method is thrown out of balance.

Dr. Michele R.: When you have one disorder of endocannabinoid deficiency, you seem to have all the other ones too. They were very much a cluster. You’ve got your migraines, your fibro, all these different pain disorders, but endometriosis is actually a disease that impacts one in 10 women worldwide, and yet the treatments for it are just awful. They include surgery, medications that cause even more problems for women. It’s just devastating despite being so common. And so we find that women respond very well to cannabis treatment.

April Pride: The link between these diseases, painful, hard to treat, often ignored and tending to affect women. In fact, 80% of all autoimmune diagnoses go to women, but Dr. Ross had something even more revealing to tell us.

Dr. Michele R.: We also find that there’s some reasons why the endocannabinoid system is out of whack with endometriosis. If you look at receptors, cannabinoid receptors and the reproductive regions, there’s a lot lower number of these cannabinoid receptors. There’s definitely what we would consider endocannabinoid deficiency in our reproductive system and it’s associated with our pain levels. So when you give women cannabis, whether it’s oral, whether they’re smoking it, whether it’s THC suppository, they all seem to benefit in terms of pain, in terms of spasms, in terms of just quality of life.

April Pride: I know Dr. Ross just threw a lot of information at us there. So let me double down for a moment. From what scientists understand, there are simply fewer receptors to receive the body’s natural chemicals for managing pain in places like the uterus. Those natural chemicals, of course, are endocannabinoids. Just a small deficiency then can cause massive pain. Cannabis seems for many patients to write the imbalance that take a painful disease and make it excruciating. Treating pain is a big deal, especially when women’s pain is so often minimized. Take menstrual cramps, for example.

Dr. Jessica K.: For a lot of the reproductive issues, whether it’s dysmenorrhea, so that’s menstrual cramps, which is probably one of the most common things that women experience as related to our sex. Dysmenorrhea is due to basically prostaglandin release as our endometrial tissue breaks down, and we have a period. Prostaglandin are release to cause uterine contractions and cramping to cause inflammation. But we know that for instance, CBD can inhibit the enzyme that creates prostaglandins. So if we can use CBD on somebody who has menstrual cramps, we can often reduce their pain because we’re reducing the root cause.

April Pride: You just heard Dr. Jess referred to uterine contractions. Yes, cramps. The joked about monthly pain, many women suffer are in fact small contractions like you have in labor. When women are expected to play through the pain, it can be even more difficult to diagnose extreme cramping that can be a symptom of endometriosis. It can take a decade for an American woman with endometriosis to understand that her cramps are not normal and black women face an additional hurdle. A recent University of Virginia study found that false beliefs about biological differences between blacks and whites continue to shape the way we perceive and treat black people. They are associated with racial disparities in pain assessment and treatment recommendations.

April Pride: In other words, black Americans often have their pain disbelieved or treated differently and as we’ve said, pain is the primary symptom of endometriosis. As damaging as this diseases for all women, it takes a particular toll on women of color, black women in particular. And a further delay in diagnosis tends to lead to more invasive treatments such as hysterectomy. For a long time there weren’t options. You had to have surgery to confirm you had it, and so most women are dealing with some type of pain med or other side effects. You may not hear from your doctor that cannabis can help, but it can. It can.

April Pride: You kind of have to hear about it through a friend and then experiment on your own. People don’t know that there might be other options because there haven’t been. That’s why doctors like Jessica Knox and Michele Ross are so focused on spreading the word about cannabis and the benefits it can have for patients with endometriosis and other autoimmune diseases, but it’s not only cannabis research, we need to make endometriosis more manageable.

Ellen Scanlon: I would really love to see a better test for this disorder because right now the diagnosis is a laparoscopy, so it’s a surgery that you need to recover from just to diagnose your disease. Do I have this disease or is it my pain from something else? So you have to get the surgery to even be diagnosed and it’s just I’ve really, really big hurdle.

April Pride: So what’s the best way to figure out if cannabis can work for you? Just like you would with any personal decision. It’s great to ask lots of questions when a doctor is prescribing cannabis. I asked Dr. Jess where a new patient should start. What are the three most important medical questions patients should ask about cannabis?

Dr. Jessica K.: I think patients should ask … Well, first a patients should want their clinician to know about cannabis and ideally about the endocannabinoid system. So I think a patient should ask their clinician or should ask around like what is going on with my endocannabinoid system such that I’m having this issue. Once we know like what’s going on with their endocannabinoid system, we can help guide them to the appropriate cannabis based medication. I think it’s also really important for a patient to ask about or to make known their goals. A lot of times patients have goals that are not just specific to the ailment. A lot of diseases are also associated with poor sleep or feeling anxious or decreased productivity or energy at work. And so I think having a clear idea of what your goals are. A third question should always be what is the quality and safety of my cannabis medicine?

April Pride: All right. You’re probably saying to yourself April, I already know I’m in pain. I’ve been poked at, prescribed pain meds. You’ve convinced me that there’s some compelling science to explore here. Just tell me how to do the pot. There are a bunch of different compounds in cannabis that can contribute to how it makes us feel and what benefits or challenges we can experience. And there were so many ways to ingest it.

April Pride: For today’s high five, I asked Dr. Ross to run through a few and how they might affect different people differently. Number one, smoking.

Dr. Michele R.: When you’re smoking cannabis, it enters your system very fast because you’re inhaling it, it’s absorbed by your lungs and it goes into your bloodstream very fast. It doesn’t get metabolized, can cause you euphoria that causes inflammation reduction, pain reduction, spasm reduction. It’s definitely the most fast acting way that you can use cannabis. And then depending on your body, the duration could be anywhere from three hours to four hours. Of course, it’s not easy to control. So that’s why some people use other methods.

April Pride: Number two, sublinguals.

Dr. Michele R.: If you’re consuming, say CBD or THC drops under the tongue, that’s called sublingual administration, and it’s really where it’s absorbed through your cheek or under your tongue. This is a fantastic way to get cannabis into the body without having to absorb some of those toxins from burning cannabis. When you’re smoking, you absorb ammonia and some of these other toxins, so it’s not the cleanest way to use cannabis, but these drops get absorbed into your bloodstream. They can start working in anywhere from five to 15 minutes. They can be in your system again for like about three to four hours, but it works really, really fast.

April Pride: Number three, edibles.

Dr. Michele R.: There’s also what we call oral administration or edibles. This can be anything from drinks to powders to edibles like gummy bears or brownies or things like that.

April Pride: Number four, suppositories. Vaginal suppositories are shaped like an applicatorless tampon. They’re small, they’re easy to insert and you want to be inverted, at least your pelvis inverted for 20 minutes after you’ve inserted it so that it doesn’t melt and end up in your underwear. For me, I find that any kind of pelvic pain suppositories go directly to the source. That’s my favorite way to deal with pelvic pain and number five, the bath bomb. Bath bombs are another super effective and very efficient way to deal with pelvic pain because you absorb cannabinoids through your vagina while you’re in the bathtub.

April Pride: Great April. Thank you so much for letting me know these five different ways that I can help relieve my endometrial pain or my pelvic pain, but where the hell do I get this stuff? We have an answer for you. We here at How to do the Pot think that you should visit Fleur Marché to learn more about each of these product categories. They have best in class products that are hemp derived CBD products and they also offer a lot of descriptors in terms of use cases. Say you have a need beyond pelvic pain. I think that they do an unbelievable job of making sure that you understand what those products are for. Each of the products have been vetted by the two founders. Two women who are also mothers and most recently had worked at goop before founding this marketplace.

April Pride: My favorite products on the site, the four beginner kits that they offer for sleep, PMS, calm and beauty. If you have no idea which product to choose, choose a kit, try a few things. This is going to be a process before you find out the exact product that works for you. So perhaps it’s not you that suffers from PMS or sleep or calm or perhaps you’re beautiful enough. Maybe you have a friend this holiday season who could use a kit, best secret Santa gift ever. Visit fleurmarche.com that’s F-L-E-U-R M-A-R-C-H-E like it’s french .com and enter promo code. Do the Pot, D-O-T-H-E-P-O-T for 15% off at checkout.

April Pride: The reason that we chose to focus on endometriosis for this episode on autoimmune, it’s not because I haven’t talked to so many women who have been diagnosed with fibromyalgia, who have rheumatoid arthritis. There are plenty of conditions that people are treating with cannabis, but there are so many women that don’t know that endometriosis is also something that they can treat with cannabis. It’s a little bit more complicated. So your pelvis has the second highest number of receptors in your body, second to the brain. So the best way to mitigate pain in your pelvis is probably to insert a vaginal suppository. And that’s just not something that women are talking about, but it will help with your pain.

April Pride: There are 15 research studies that the NIH pulled together and one report that shows that cannabinoid medicine has an impact not only on pain symptoms associated with endometriosis, but also on retarding its growth. And no one is making that connection. In my mind, no one was making that connection. I’m talking to women whose lives have been turned upside down for decades because of this, but we’re not talking about how cannabis is something that could potentially be very helpful for them. So that is why I think this topic and this episode is so important because that connection needed to be made.

April Pride: The complications around a woman’s period, the pain that she experiences, it’s been normalized. I remember being in high school and my friends were prescribed Anaprox, which come to find out not too long ago, I found out it is a pretty hardcore muscle relaxer that they’re prescribing to 16 year old girls. So these painful periods are not experienced by everybody, but they are again experienced by one in 10 women.

Ellen Scanlon: I got terrible cramps, terrible, terrible. I’ve passed out from the pain. I’ve gotten into like absolute full body sweat, complete incapacitation, laying on my bed, just like counting the minutes before the pain medicine would kick in. When I think about labor, I was in labor for 13 hours and I would say like the first 10 of it were not that dissimilar to some of the worst moments of the cramps that I experienced.

April Pride: If this sounds like you, you may want to consider cannabis as a form of medication to medicate some of these symptoms and you should also talk to your doctor. We need research. Women should not have to wait until they’re having a hysterectomy or they’re having an egg implanted so that they can carry a child that they’ve waited so long and worked so hard to have to find out that the reason that they’ve had painful periods, that they’re bleeding out, that they can’t conceive and that they’re having hysterectomy at 40 is because of endometriosis when again, they’ve been experiencing symptoms for decades. We need to find out sooner. If you’d like to share your experience with cannabis, send us a voice memo at hi@dothepot.com H-I D-O-T-H-E-P-O-T.com.

April Pride: Thanks everyone for listening today. If you liked the episode, please share it with someone. And please rate and review us on Apple podcasts. It helps more people find the show. Thanks also to my co-founder, Ellen Scanlon, our marketing manager, Allie Mussolini, producer, Gina Delvac and Steven Hoffman and Ben Adair at Western Sound. I’m April Pride and we’ll be back soon with more How to do the Pot.