Association Between Clinically Suspected Endometriosis Lacking Histologic Evidence and Anxiety, Depression and Cannabidiol-Containing Products

Endometriosis is a common gynecologic condition, characterized by the growth of endometrial-like epithelial and stromal cells at ectopic sites, most commonly within the peritoneal cavity. Disease symptoms associate poorly with lesion burden, and severe symptoms of endometriosis can occur in patients in whom lesions cannot be detected by surgical inspection or pathologic examination of excised biopsies. Anxiety and depression are prevalent in patients with confirmed endometriosis. Additionally, recent evidence highlights an increasing prevalence of cannabinoid-containing products for management of pelvic pain. This study aimed to examine these comorbid traits and cannabinoid-containing products use in patients with “clinically suspected endometriosis with negative pathology” (CSENP). This study used data collected through The Biologic and Epidemiologic Markers of Endometriosis (BEME) clinic-based study at a quaternary hospital in Los Angeles, California. 454 patients were included. After multivariable regression analysis, CSENP patients were at higher risk of depression compared to confirmed cases [adjusted odds ratio (aOR) 2.27; 95% confidence interval (CI) 1.03-5.03, p=.043]. Compared with women with endometriosis, controls were less likely to use cannabis for pain (aOR 0.32, 95% CI 0.16-0.64). Compared with patients with endometriosis, CSENP patients were also more likely to use cannabis for depression (aOR 1.92, 95% CI 1.01-3.65). Even in the absence of histopathologic confirmation of lesions, patients with pain symptoms similar to those found in endometriosis have similar patterns of anxiety and depression which may require long-term management. Long-term follow-up of CSENP patients will be valuable to optimize the best strategies for clinical care. Data presented for cannabis use should be interpreted with caution due to the observational nature of the data, lack of information on dosage, and concerns about known side-effects of long-term use.