Association between clinically suspected endometriosis lacking histologic evidence and anxiety, depression and cannabidiol-containing products.

Meyer R.; Sun J.; Lombardi C.; Shats M.; Yu P.; Abbasi F.; Berberian A.; Manlinguez A.; Kulkarni S.; Pisarska M. et al. · European journal of obstetrics & gynecology and reproductive biology: X · 2026

**Background & Methods** This clinic-based observational study from a quaternary hospital in Los Angeles analyzed data from 454 patients in The Biologic and Epidemiologic Markers of Endometriosis (BEME) study to examine the association between clinically suspected endometriosis with negative pathology (CSENP), psychiatric comorbidities, and cannabinoid product use. The study employed multivariable regression analysis to compare outcomes across three groups: confirmed endometriosis, CSENP, and controls. **Key Findings** - CSENP patients demonstrated significantly higher risk of depression compared to those with confirmed endometriosis (adjusted odds ratio 2.27; 95% CI 1.03-5.03; p=0.043), suggesting psychiatric burden exists independently of histopathologic confirmation. - Cannabis use for pain management was substantially lower in controls compared to endometriosis patients (aOR 0.32; 95% CI 0.16-0.64), while CSENP patients were more likely to use cannabis specifically for depression management compared to confirmed endometriosis patients (aOR 1.92; 95% CI 1.01-3.65). - Patients with clinically suspected endometriosis despite negative pathology demonstrate similar patterns of anxiety and depression as those with histologically confirmed disease, indicating a need for long-term psychiatric management regardless of lesion confirmation. **Dosage & Administration** Not reported. The study did not provide information on cannabinoid dosage, frequency, specific cannabinoid ratios (CBD:THC), or routes of administration. **Safety & Adverse Effects** Not specifically reported for study participants. However, the authors note concerns about known side-effects of long-term cannabis use warrant caution in interpretation, though specific adverse effects were not detailed in this analysis. **Evidence Quality** This review-based observational study has significant limitations affecting evidence quality. The authors explicitly acknowledge the observational nature of data collection, absence of dosage information, and lack of standardized cannabis product characterization. The cross-sectional design prevents causal inference regarding cannabis use and psychiatric symptoms. Selection bias may influence results given the quaternary hospital setting. Long-term follow-up data are absent, limiting understanding of disease progression and treatment efficacy. The authors recommend cautious interpretation of cannabis findings and emphasize the need for prospective follow-up studies to optimize clinical management strategies for CSENP patients.

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