Department of Obstetrics and Gynaecology (Drs. Mistry, Simpson, Morris, Karavadra, and Prosser-Snelling).
Department of Obstetrics and Gynaecology (Drs. Mistry, Simpson, Morris, Karavadra, and Prosser-Snelling).
J Minim Invasive Gynecol. 2022 Feb;29(2):169-176. doi: 10.1016/j.jmig.2021.11.017. Epub 2021 Nov 25.
To review the available literature on the effect of cannabis-based products on the female reproductive system and establish whether there is any evidence that they benefit or harm patients with endometriosis and, therefore, whether there is sufficient evidence to recommend them.
An electronic-based search was performed in PubMed, Embase, and the Cochrane Database. Reference lists of articles retrieved were reviewed, and a gray literature search was also performed.
The original database search yielded 264 articles from PubMed, Embase, and the Cochrane Database, of which 41 were included. One hundred sixty-one studies relating to gynecologic malignancy, conditions unrelated to endometriosis, or therapies unrelated to cannabis-based products were excluded. Twelve articles were included from a gray literature search and review of references.
TABULATION, INTEGRATION, AND RESULTS: Most available evidence is from laboratory studies aiming to simulate the effects of cannabis-based products on preclinical endometriosis models. Some show evidence of benefit with cannabis-based products. However, results are conflicting, and the impact in humans cannot necessarily be extrapolated from these data. Few studies exist looking at the effect of cannabis or its derived products in women with endometriosis; the majority are in the form of surveys and are affected by bias. National guidance was also reviewed: at present, this dictates that cannabis-based products can only be prescribed for conditions in which there is clear published evidence of benefit and only when all other treatment options have been exhausted.
Current treatment options for endometriosis often affect fertility and/or have undesirable side effects that impede long-term management. Cannabis-based products have been suggested as a novel therapeutic option that may circumvent these issues. However, there is a paucity of well-designed, robust studies and randomized controlled trials looking at their use in the treatment of endometriosis. In addition, cannabis use has a potential for harm in the long term, with a possible association with "cannabis use disorder," psychosis, and mood disturbances. At present, national guidance cannot recommend cannabis-based products to patients in the UK owing to lack of clear evidence of benefit. More comprehensive research into the impact of endocannabinoids in the context of endometriosis is required before their use can be recommended or prescribed.
综述大麻类产品对女性生殖系统影响的现有文献，确定它们是否对子宫内膜异位症患者有益或有害，并因此确定是否有足够的证据推荐使用这些药物。
在 PubMed、Embase 和 Cochrane 数据库中进行了基于电子的搜索。查阅了检索到的文章的参考文献，并进行了灰色文献搜索。
原始数据库搜索从 PubMed、Embase 和 Cochrane 数据库中获得了 264 篇文章，其中 41 篇被纳入。161 项研究涉及妇科恶性肿瘤、与子宫内膜异位症无关的疾病或与大麻类产品无关的治疗方法，被排除在外。从灰色文献搜索和参考文献综述中纳入了 12 篇文章。
列表、综合和结果：大多数现有证据来自于旨在模拟大麻类产品对临床前子宫内膜异位症模型影响的实验室研究。一些研究表明大麻类产品具有有益作用。然而，结果存在矛盾，这些数据并不能必然推断出对人类的影响。关于大麻或其衍生产品对子宫内膜异位症女性的影响的研究很少；大多数都是调查形式，受到偏见的影响。还审查了国家指导意见：目前，这规定大麻类产品只能在有明确已发表获益证据的情况下，并且只有在所有其他治疗选择都已用尽的情况下，才能用于处方。
子宫内膜异位症的现有治疗选择通常会影响生育能力和/或具有不良的副作用，从而阻碍长期管理。大麻类产品已被提议作为一种新的治疗选择，可能规避这些问题。然而，目前尚缺乏设计良好、强有力的研究和随机对照试验来观察它们在治疗子宫内膜异位症中的应用。此外，大麻的长期使用可能有害，可能与“大麻使用障碍”、精神病和情绪障碍有关。由于缺乏明确的获益证据，目前英国的国家指导意见不能向患者推荐大麻类产品。在推荐或处方使用之前，需要更全面地研究内源性大麻素在子宫内膜异位症中的影响。
