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Gina’s Story: Endometriosis, the Endocannabinoid System, and Emerging Approaches to Care
Published: August 2025
Disclaimer: This is an anonymised patient case study, written with patient consent. The decision-making in this case study was undertaken by a doctor. The information in this document does not constitute medical advice or treatment recommendations. The use of cannabis based medications is the responsibility of a qualified medical professional who may initiate treatment after reviewing a patient's medical history. Most medical cannabis products are unapproved medicines and are regulated by the Therapeutic Goods Administration (TGA) Special Access Scheme (SAS), for which individual responses may vary.
Meet Gina (pseudonym), a 38-year-old woman living with endometriosis—one of an estimated 10% of Australian women affected by this chronic condition, which involves the growth of endometrial-like tissue outside the uterus.1
Gina is seeking treatment for ongoing gastrointestinal and pain-related symptoms associated with endometriosis. Despite trialling a range of conventional medications, she’s experienced limited relief—particularly for her chronic pain, which significantly affects her ability to work and maintain daily functioning.
Endometriosis is a condition that can cause a wide range of chronic pelvic pain symptoms, including dysmenorrhea (painful periods), dyspareunia (pain during intercourse), fatigue, dyschezia (pain during bowel movements), and dysuria (pain during urination).1 It may also co-occur with other conditions such as irritable bowel syndrome, rheumatoid arthritis, psoriasis, anxiety, depression, and chronic fatigue syndrome.1
Despite the substantial burden of endometriosis, many patients consider conventional medical treatments to be suboptimal—often citing limited efficacy and unwanted side effects.1 Current management typically involves a combination of medical and/or surgical interventions, including hormonal therapies, non-opioid and opioid analgesics, and neuropathic pain agents.1 While surgery can be effective, it carries high costs, long wait times, and high recurrence rates—often leading to the need for repeat procedures.1,2
Gina’s consultation with her doctor
Limited access to surgery and variable responses to pharmacological treatments, have led patients with endometriosis to self-management strategies.1 Cannabis use—both prescribed and non-prescribed—is increasingly reported, with some individuals noting improvements in symptom severity.1 These trends highlight a need for more research into cannabis-based therapies as potential adjuncts in endometriosis care.1
This case study explores how Gina’s medical team carefully assessed her clinical presentation, medical history, potential psychological and cardiovascular risk factors, and possible drug interactions before initiating medical cannabis to support her pain management and overall wellbeing.
Gina’s doctor collected the following information:
- Patient information and presentation
- Personal and family medical history
- Current and past medications and treatments
- Specialist and other healthcare involvement
- Lifestyle factors
Discover Gina’s patient profile below.
Presenting conditionFemale, aged 38 years
Presenting condition – endometriosis
Symptoms
- Excruciating dysmenorrhoea since menarche
- Vomiting, diarrhoea and nausea
- Low appetite and weight loss
- Headaches
Pain assessmentPosition – lower abdomen
Quality – severe, accompanied by sweating, crying or doubling over in pain
Type – intermittent sharp pains and general abdominal tenderness
Radiates – to arms or legs
Severity
- Good days – 6–8/10
- Bad days – 10/10
Timing – menstruation and ovulation
Triggers – stress
Personal and family medical historyMedical history
- Endometriosis (stage 4) – diagnosed in 2019
- Pericarditis post coronavirus – diagnosed 2022*
- Generalised anxiety disorder and depression – diagnosed 18 years prior
- Vitamin D deficiency
Allergies
- Latex
Medical history (family)
- Maternal aunt – endometriosis
*This may be a risk factor for medical cannabis.3
Current and past medications and treatmentsCurrent medications
- Drospirenone – 4 mg/day
Past medications
- Tapentadol
- Physiotherapy sessions – with minimal benefit
- Remedial massage sessions – with minimal benefit
Specialist and other healthcare involvementCardiologist review of pericarditis – referred back to GP care after diagnosis
Lifestyle factorsSmoking – No
Social considerations
- Driving – drives to work 2 days per week and on occasional weekend trips
- THC roadside liability understood: Yes
- Workplace drug testing – N/A
- Operates heavy machinery – N/A
Previous use of cannabis
- Use – non-prescribed cannabis daily between 2016 and 2019
- Administration – flower via joint or pipe
- Amount – 2 g per day
- Effects – reduced pain, relieved bowel cramps, assisted with sleep
Assessing risks
After reviewing Gina’s profile, her doctor notes potential risk factors relating to her anxiety, cardiovascular health, driving and previous use of non-prescribed cannabis.
Below, explore Gina’s potential risk factors and how her doctor managed them.
AnxietyGiven Gina’s diagnosis of generalised anxiety disorder, her doctor monitored her closely, with regular check-ins to assess mood and anxiety symptoms.
As THC can cause feelings of altered mood and anxiety, it should be administered with caution in individuals with anxiety disorder.4
Her doctor ensured that Gina understands the potential mood-related side effects and equipped her with strategies to manage them effectively if they occur.
Additionally, she emphasised the importance of starting on a low dose and gradually increasing the dosage as specified in the treatment plan.
Cardiovascular healthBefore prescribing medical cannabis products, her doctor confirmed that Gina’s cardiovascular health is stable by:
- Reviewing previous cardiac assessments and reports from Gina’s cardiologist
- Obtaining approval from Gina’s cardiologist and consulting Gina’s regular GP before commencing treatment
- Monitoring Gina’s electrocardiogram and vital signs throughout the course of her treatment
This is of particular importance as cannabis products with THC can cause tachycardia, and is not advised for patients with a history of angina or myocardial infarction.4
DrivingAs Gina drives to work occasionally, her doctor ensured that Gina is aware of the laws around driving.
Current medical cannabis prescribing legislation does not exempt patients from THC-related drug-driving offences.4 THC can impair driving performance and increase crash risk—particularly in occasional users—with effects lasting up to eight hours after oral dosing.5 Patients using THC-containing products should avoid driving and other safety-sensitive tasks, especially during treatment initiation and shortly after each dose.5
In contrast, there is no evidence that CBD impairs driving.5 Patients taking CBD-only medicines can lawfully drive if they are not impaired.5,6
Non-prescribed use of cannabisGina’s doctor is also concerned about her previous use of non-prescribed cannabis.
Cannabis acquired on the black market is unlikely to achieve the desired results and can cause unpredictable and severe adverse reactions as it may contain hazardous ingredients and contaminants—such as microbes, heavy metals and pesticides.7,8
Devising a treatment plan
After reviewing Gina’s presentation and medical history, her doctor created a treatment plan to help Gina manage her endometriosis symptoms.
Developing a risk management and follow-up plan
Gina’s doctor provided her with a risk management plan which included symptom tracking and monitoring of adverse effects, as well as follow-ups scheduled at 4 to 8 weeks to review progress and adjust treatment as needed.
Discover Gina’s risk management and follow-up plan below
Risk management plan- Asked Gina to keep a symptom diary to record pain scores, doses and other symptoms
- Informed Gina of how to report and respond to adverse effects
- Conducted a pre-treatment Depression Anxiety Stress Scales (DASS) assessment and will follow up at each check-in
- Advised Gina to start low and go slow
- Reviewed Gina’s cardiovascular reports and test results, and obtained cardiologist and GP support before commencing treatment
Follow-up plan- Follow-ups scheduled for 4- and 8-weeks after initial treatment
- Review progress and adjust plan as required
- Monitor cardiovascular results
- Monitor psychiatric state via DASS results (conducted at each appointment)
At 4 weeks: Gina reported that the CBD oil was moderately effective but not as effective as the inhaled product.
In response, her doctor prescribed a different oil with the following profile and dosage instructions:
- THC 10 mg/mL : CBD 10 mg/mL
- Start: 0.1 mL twice a day
- After 2 days: increase by 0.1 mL
- Every 2 days thereafter: increase by 0.2 mL to full symptom control
- Maximum daily dose: 3.0 mL
At 8 weeks: Gina shared that she found the new oil effective, and uses 1.5 mL daily. Gina and her doctor agreed to touch base again in 4 weeks.
Exploring the Science in Gina’s Case
What Is the Relationship Between Medical Cannabis, the Endocannabinoid System, and Endometriosis?
Gina’s doctor has prescribed her with medical cannabis; understanding its proposed mechanism could provide insight into why it may have a role in Gina’s care.
Studies have shown that cannabinoid receptors (CB1 and CB2) are highly expressed in ovaries with endometriosis, compared with stromal tissues surrounding the lesion.10,11
As cannabinoid receptors have been implicated in the management of chronic pain and inflammation, these findings suggest that medical cannabis may offer a targeted approach for managing endometriosis-related pain and inflammation at the lesion site.10,11
A recent literature review found that compared to conventional strategies such as analgesics and heat therapy, medical cannabis offered symptom relief for individuals with endometriosis.10
This flow diagram illustrates the potential key therapeutic targets within the endocannabinoid system that interact with cannabis compounds.10
Adapted from Cummings et al. 202410However, there remains a lack of randomised controlled trials specifically evaluating medical cannabis efficacy for endometriosis-related pain.10 This gap in evidence highlights an important direction for future research—particularly in light of emerging findings that a dysregulated endocannabinoid system may contribute to the pathophysiology of endometriosis.10
Key Takeaways
Endometriosis remains a complex condition that significantly impacts quality of life.1 While conventional treatments can help, many patients—like Gina—continue to experience debilitating symptoms despite best-practice interventions.1
Emerging evidence suggests a potential role for the endocannabinoid system in modulating inflammation, pain, and other symptoms associated with endometriosis.10,11 Though clinical research is still developing, the expression of cannabinoid receptors in endometriotic tissue, alongside promising patient-reported outcomes, highlights the potential role of medical cannabis as an adjunctive therapy in selected patients.10,11
Gina’s case illustrates how a personalised, cautious, and evidence-informed approach—grounded in thorough risk assessment and multidisciplinary collaboration—can support safe access to medical cannabis. As with any therapeutic decision, individual patient factors, clinical history, and shared decision-making remain central to guiding care.
Adverse event monitoring: Medical cannabis products may be associated with adverse events. For more information please contact medinfo@saged.com.au. Medical cannabis products are not suitable for use during pregnancy or breastfeeding, for anyone with a history with psychotic disorders, or for those with unstable cardiovascular disease. Treatment for patients under 18 years is recommended under the guidance of a paediatrician. Patients should not drive or operate machinery while being treated with some forms of medicinal cannabis.
Veeva job code: MONT-SGD-2025-0014
Date of preparation: July 2025
Gina’s Story: Endometriosis, the Endocannabinoid System, and Emerging Approaches to Care
Published: August 2025
Disclaimer: This is an anonymised patient case study, written with patient consent. The decision-making in this case study was undertaken by a doctor. The information in this document does not constitute medical advice or treatment recommendations. The use of cannabis based medications is the responsibility of a qualified medical professional who may initiate treatment after reviewing a patient's medical history. Most medical cannabis products are unapproved medicines and are regulated by the Therapeutic Goods Administration (TGA) Special Access Scheme (SAS), for which individual responses may vary.
Meet Gina (pseudonym), a 38-year-old woman living with endometriosis—one of an estimated 10% of Australian women affected by this chronic condition, which involves the growth of endometrial-like tissue outside the uterus.1
Gina is seeking treatment for ongoing gastrointestinal and pain-related symptoms associated with endometriosis. Despite trialling a range of conventional medications, she’s experienced limited relief—particularly for her chronic pain, which significantly affects her ability to work and maintain daily functioning.
Endometriosis is a condition that can cause a wide range of chronic pelvic pain symptoms, including dysmenorrhea (painful periods), dyspareunia (pain during intercourse), fatigue, dyschezia (pain during bowel movements), and dysuria (pain during urination).1 It may also co-occur with other conditions such as irritable bowel syndrome, rheumatoid arthritis, psoriasis, anxiety, depression, and chronic fatigue syndrome.1
Despite the substantial burden of endometriosis, many patients consider conventional medical treatments to be suboptimal—often citing limited efficacy and unwanted side effects.1 Current management typically involves a combination of medical and/or surgical interventions, including hormonal therapies, non-opioid and opioid analgesics, and neuropathic pain agents.1 While surgery can be effective, it carries high costs, long wait times, and high recurrence rates—often leading to the need for repeat procedures.1,2
Gina’s consultation with her doctor
Limited access to surgery and variable responses to pharmacological treatments, have led patients with endometriosis to self-management strategies.1 Cannabis use—both prescribed and non-prescribed—is increasingly reported, with some individuals noting improvements in symptom severity.1 These trends highlight a need for more research into cannabis-based therapies as potential adjuncts in endometriosis care.1
This case study explores how Gina’s medical team carefully assessed her clinical presentation, medical history, potential psychological and cardiovascular risk factors, and possible drug interactions before initiating medical cannabis to support her pain management and overall wellbeing.
Gina’s doctor collected the following information:
- Patient information and presentation
- Personal and family medical history
- Current and past medications and treatments
- Specialist and other healthcare involvement
- Lifestyle factors
Discover Gina’s patient profile below.
Female, aged 38 years
Presenting condition – endometriosis
Symptoms
- Excruciating dysmenorrhoea since menarche
- Vomiting, diarrhoea and nausea
- Low appetite and weight loss
- Headaches
Position – lower abdomen
Quality – severe, accompanied by sweating, crying or doubling over in pain
Type – intermittent sharp pains and general abdominal tenderness
Radiates – to arms or legs
Severity
- Good days – 6–8/10
- Bad days – 10/10
Timing – menstruation and ovulation
Triggers – stress
Medical history
- Endometriosis (stage 4) – diagnosed in 2019
- Pericarditis post coronavirus – diagnosed 2022*
- Generalised anxiety disorder and depression – diagnosed 18 years prior
- Vitamin D deficiency
Allergies
- Latex
Medical history (family)
- Maternal aunt – endometriosis
*This may be a risk factor for medical cannabis.3
Current medications
- Drospirenone – 4 mg/day
Past medications
- Tapentadol
- Physiotherapy sessions – with minimal benefit
- Remedial massage sessions – with minimal benefit
Cardiologist review of pericarditis – referred back to GP care after diagnosis
Smoking – No
Social considerations
- Driving – drives to work 2 days per week and on occasional weekend trips
- THC roadside liability understood: Yes
- Workplace drug testing – N/A
- Operates heavy machinery – N/A
Previous use of cannabis
- Use – non-prescribed cannabis daily between 2016 and 2019
- Administration – flower via joint or pipe
- Amount – 2 g per day
- Effects – reduced pain, relieved bowel cramps, assisted with sleep
Assessing risks
After reviewing Gina’s profile, her doctor notes potential risk factors relating to her anxiety, cardiovascular health, driving and previous use of non-prescribed cannabis.
Below, explore Gina’s potential risk factors and how her doctor managed them.
Given Gina’s diagnosis of generalised anxiety disorder, her doctor monitored her closely, with regular check-ins to assess mood and anxiety symptoms.
As THC can cause feelings of altered mood and anxiety, it should be administered with caution in individuals with anxiety disorder.4
Her doctor ensured that Gina understands the potential mood-related side effects and equipped her with strategies to manage them effectively if they occur.
Additionally, she emphasised the importance of starting on a low dose and gradually increasing the dosage as specified in the treatment plan.
Before prescribing medical cannabis products, her doctor confirmed that Gina’s cardiovascular health is stable by:
- Reviewing previous cardiac assessments and reports from Gina’s cardiologist
- Obtaining approval from Gina’s cardiologist and consulting Gina’s regular GP before commencing treatment
- Monitoring Gina’s electrocardiogram and vital signs throughout the course of her treatment
This is of particular importance as cannabis products with THC can cause tachycardia, and is not advised for patients with a history of angina or myocardial infarction.4
As Gina drives to work occasionally, her doctor ensured that Gina is aware of the laws around driving.
Current medical cannabis prescribing legislation does not exempt patients from THC-related drug-driving offences.4 THC can impair driving performance and increase crash risk—particularly in occasional users—with effects lasting up to eight hours after oral dosing.5 Patients using THC-containing products should avoid driving and other safety-sensitive tasks, especially during treatment initiation and shortly after each dose.5
In contrast, there is no evidence that CBD impairs driving.5 Patients taking CBD-only medicines can lawfully drive if they are not impaired.5,6
Gina’s doctor is also concerned about her previous use of non-prescribed cannabis.
Cannabis acquired on the black market is unlikely to achieve the desired results and can cause unpredictable and severe adverse reactions as it may contain hazardous ingredients and contaminants—such as microbes, heavy metals and pesticides.7,8
Devising a treatment plan
After reviewing Gina’s presentation and medical history, her doctor created a treatment plan to help Gina manage her endometriosis symptoms.
Developing a risk management and follow-up plan
Gina’s doctor provided her with a risk management plan which included symptom tracking and monitoring of adverse effects, as well as follow-ups scheduled at 4 to 8 weeks to review progress and adjust treatment as needed.
Discover Gina’s risk management and follow-up plan below
- Asked Gina to keep a symptom diary to record pain scores, doses and other symptoms
- Informed Gina of how to report and respond to adverse effects
- Conducted a pre-treatment Depression Anxiety Stress Scales (DASS) assessment and will follow up at each check-in
- Advised Gina to start low and go slow
- Reviewed Gina’s cardiovascular reports and test results, and obtained cardiologist and GP support before commencing treatment
- Follow-ups scheduled for 4- and 8-weeks after initial treatment
- Review progress and adjust plan as required
- Monitor cardiovascular results
- Monitor psychiatric state via DASS results (conducted at each appointment)
At 4 weeks: Gina reported that the CBD oil was moderately effective but not as effective as the inhaled product.
In response, her doctor prescribed a different oil with the following profile and dosage instructions:
- THC 10 mg/mL : CBD 10 mg/mL
- Start: 0.1 mL twice a day
- After 2 days: increase by 0.1 mL
- Every 2 days thereafter: increase by 0.2 mL to full symptom control
- Maximum daily dose: 3.0 mL
At 8 weeks: Gina shared that she found the new oil effective, and uses 1.5 mL daily. Gina and her doctor agreed to touch base again in 4 weeks.
Exploring the Science in Gina’s Case
What Is the Relationship Between Medical Cannabis, the Endocannabinoid System, and Endometriosis?
Gina’s doctor has prescribed her with medical cannabis; understanding its proposed mechanism could provide insight into why it may have a role in Gina’s care.
Studies have shown that cannabinoid receptors (CB1 and CB2) are highly expressed in ovaries with endometriosis, compared with stromal tissues surrounding the lesion.10,11
As cannabinoid receptors have been implicated in the management of chronic pain and inflammation, these findings suggest that medical cannabis may offer a targeted approach for managing endometriosis-related pain and inflammation at the lesion site.10,11
A recent literature review found that compared to conventional strategies such as analgesics and heat therapy, medical cannabis offered symptom relief for individuals with endometriosis.10
This flow diagram illustrates the potential key therapeutic targets within the endocannabinoid system that interact with cannabis compounds.10
Adapted from Cummings et al. 202410
However, there remains a lack of randomised controlled trials specifically evaluating medical cannabis efficacy for endometriosis-related pain.10 This gap in evidence highlights an important direction for future research—particularly in light of emerging findings that a dysregulated endocannabinoid system may contribute to the pathophysiology of endometriosis.10
Key Takeaways
Endometriosis remains a complex condition that significantly impacts quality of life.1 While conventional treatments can help, many patients—like Gina—continue to experience debilitating symptoms despite best-practice interventions.1
Emerging evidence suggests a potential role for the endocannabinoid system in modulating inflammation, pain, and other symptoms associated with endometriosis.10,11 Though clinical research is still developing, the expression of cannabinoid receptors in endometriotic tissue, alongside promising patient-reported outcomes, highlights the potential role of medical cannabis as an adjunctive therapy in selected patients.10,11
Gina’s case illustrates how a personalised, cautious, and evidence-informed approach—grounded in thorough risk assessment and multidisciplinary collaboration—can support safe access to medical cannabis. As with any therapeutic decision, individual patient factors, clinical history, and shared decision-making remain central to guiding care.
Adverse event monitoring: Medical cannabis products may be associated with adverse events. For more information please contact medinfo@saged.com.au. Medical cannabis products are not suitable for use during pregnancy or breastfeeding, for anyone with a history with psychotic disorders, or for those with unstable cardiovascular disease. Treatment for patients under 18 years is recommended under the guidance of a paediatrician. Patients should not drive or operate machinery while being treated with some forms of medicinal cannabis.
Veeva job code: MONT-SGD-2025-0014
Date of preparation: July 2025