03/29/2026
is still framed as a disease of tissue. But what if it’s also a disease of signaling?
Yes, the endocannabinoid system ( ) also seems to be out of tune in ways that help lesions survive and make pain worse.
▶︎ Many women with endometriosis have different levels of endocannabinoids in their blood, especially higher and sometimes 2‑AG.
▶︎ In pelvic tissues, CB1 receptors (which usually help calm pain) are often reduced, while TRPV1 (a pro‑pain channel) is increased, pushing signals toward pain and inflammation.
▶︎ Inside the lesions themselves, CB1 and CB2 receptors are increased in the epithelial cells of endometriotic lesions compared with surrounding tissue.
Simply put:
▲ Outside the lesions: pain-calming ECS is turned down
▲ Inside the lesions: cannabinoid receptors are turned up
(!!!) This means that the lesions are packed with cannabinoid receptors, which means they are biologically “wired” to respond to cannabinoid‑type signals.
What this means for pain and symptoms
▶︎ Low CB1 + high TRPV1 = over-sensitive pain pathways and central sensitisation. This explains why pain can be excruciating and why anxiety, low mood, and poor sleep are so common alongside it.
What does this mean in practice?
▶︎ Because ECS dysregulation sits right on top of the core features of endometriosis, CB1/CB2 receptors and ECS enzymes are increasingly viewed as drug targets, not just interesting biology.
▶︎ Observational data suggest many patients are already self‑using cannabis or cannabinoid based products for symptom relief and report less pain and reduced use of other analgesics.
The question is no longer whether the ECS matters in endometriosis. It’s whether clinical medicine will catch up before another generation of women manages it alone.
This is the 5th post in a series examining women’s health through an ECS lens.
From migraine to endometriosis, from PCOS to IBS — each condition reveals a pattern: dysregulated ECS, overlooked by conventional medicine.