Current research projects

PARTNER

Western Sydney University’s NICM Health Research Institute and School of Medicine.

SUMMARY

Dementia causes a decline in memory and thinking that impacts on everyday activities. In older Australians, dementia is the greatest cause of disability and the second leading cause of death (the leading cause in women),[1] and currently there is no cure or treatment that can slow its progression. Alzheimer’s disease is the most common cause of dementia, contributing to up to 70% of cases,[2] with the disease beginning in the brain decades before there are any symptoms. This makes early intervention in people who have a high risk of Alzheimer’s disease a priority area for drug discovery and new treatments.[3]

SCOPE

People who have a decline in memory and thinking but can still go about their everyday activities may have an early Alzheimer’s disease stage called ‘mild cognitive impairment’ which can increase their risk of dementia >5-fold.[4–7] Importantly, mild cognitive impairment represents a window of opportunity for early intervention to prevent future decline and implement strategies that enable people to maintain their everyday function and promote quality of life. With a 98% failure rate at developing Alzheimer’s disease drugs since 2004,[8] new medicines that can tackle early stages of the disease are urgently needed. Fortunately, cannabis contains hundreds of phytocannabinoids and other compounds, some of which may have the therapeutic potential to address the underlying brain changes occurring in the early stages of Alzheimer’s disease and aid with its clinical management. [9, 10]

RESEARCH

A major challenge in Alzheimer’s disease and mild cognitive impairment drug discovery is moving new therapeutic leads from the early stages of preclinical animal-based research into human trials. [8, 11] To help address this, ANTG have invested in research with two leading Alzheimer’s disease researchers at Western Sydney University to test ANTG’s Eve (CBD-dominant) extract. Associate Professor Genevieve Steiner-Lim and her team at NICM Health Research Institute will begin the ‘CANCOG Trial’ in 2023. The trial, which is a double-blind, randomised, placebo-controlled human clinical trial, will investigate the feasibility of ANTG’s Eve oral oil in people with mild cognitive impairment who have a high risk of Alzheimer’s disease. In parallel, Professor Tim Karl and his Behavioural Neuroscience team in the School of Medicine are leading the investigation of ANTG’s Eve extract in the laboratory. The team are testing its therapeutic efficacy in improving cognition and hope to provide further insights into how the treatment works that will complement the clinical trial, with their research started in August 2022.

PUBLICATIONS

1. Australian Bureau of Statistics, Causes of Death, Australia, 2016. 2017.

2. World Health Organization (WHO), Global action plan on the public health response to dementia 2017 – 2025. 2017: Geneva: World Health Organization (WHO).

3. Chong, T.W.H., Macpherson, H., Schaumberg, M.A., Brown, B., Naismith, S.L., Steiner, G.Z., 2021. Dementia Prevention: the time to act is now. Medical Journal of Australia. doi: 10.5694/mja2.50972

4. Campbell, N.L., et al., Risk factors for the progression of mild cognitive impairment to dementia. Clinics in geriatric medicine, 2013. 29(4): p. 873-893.

5. Sperling, R.A., et al., Toward defining the preclinical stages of Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement, 2011. 7(3): p. 280-92.

6. Petersen, R.C., Mild cognitive impairment as a diagnostic entity. Journal of Internal Medicine, 2004. 256(3): p. 183-194.

7. Albert, M.S., et al., The diagnosis of mild cognitive impairment due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement, 2011. 7(3): p. 270-9.

8. Kim, C. K., Lee, Y. R., Ong, L., Gold, M., Kalali, A., & Sarkar, J. (2022). Alzheimer’s Disease: Key Insights from Two Decades of Clinical Trial Failures. Journal of Alzheimer’s disease : JAD, 87(1), 83–100. https://doi.org/10.3233/JAD-215699

9. Coles, M., Steiner-Lim, G.Z., Karl, T., 2022. Therapeutic Properties of Multi- Cannabinoid Treatment Strategies for Alzheimer’s Disease. Frontiers in Neuroscience, 16:962922. doi: 10.3389/ fnins.2022.962922

10. Steiner-Lim, G.Z., Coles, M., Christofides, K., Butt, A., Metri, N.J., Jaye, K., McPartland, J., Al- Modhefer, Z., Karamacoska, D., Russo, E., Karl, T., submitted. Medicinal cannabis for Alzheimer’s disease. In: R. Zeine, B. Teasdale (Eds.), Medical Marijuana and the Effects of Cannabinoids on Fighting Cancer, Multiple Sclerosis, Epilepsy, Parkinson’s and Other Neurodegenerative Diseases, IGI Global, Pennsylvania, USA.

11. Henshaw, F.R., Dewsbury, L.S., Lim, C.K., Steiner, G.Z., 2021. The effects of cannabinoids on pro- and anti-inflammatory cytokines: A systematic review of in vivo studies. Cannabis and Cannabinoid Research, 6, 3, 177-195. doi: 10.1089/can.2020.0105.

PARTNER

NICM Health Research Institute, Western Sydney University.

SUMMARY

Pharmacokinetics is the study of the time course of how a drug or substance is absorbed, distributed, metabolised, and then eliminated from the body.[1] This type of study is typically conducted with healthy volunteers who are under medical supervision. Study participants are administered the drug or compound being trialled, and then have blood samples taken at set time intervals. These blood samples are then sent to the laboratory for analysis so that data can be generated. This type of scientific investigation allows scientists to determine things like the bioavailability of drugs (i.e., how much of the drug actually gets into our systemic circulation and causes a pharmacological effect).[2] Another way to think about pharmacokinetics is the things that the body does to the drug or compound being ingested. This information is a mainstay of all modern pharmaceutical medicines as it assists health care practitioners with understanding the medicine more completely, and is also an important aspect of safety.

SCOPE

As part of ANTG’s commitment to providing medical practitioners with up-to-date information on our medicinal cannabis products, we are collaborating with the TGA certified analytical laboratories of NICM Health Research Institute at Western Sydney University. Dr Mitchell Low and Professor Dennis Chang are leading a pharmacokinetic study into ANTGs Elan in healthy individuals to obtain data on how Elan (CBD 100mg/mL oral oil) is absorbed, distributed, metabolised and excreted. We anticipate results from this trial will be ready to share with health care professionals in mid 2023.

RESEARCH

Given the importance of pharmacokinetic data being available to health care professionals to make informed decisions, this research will assist them in selecting appropriate dosage forms and medicinal cannabis products for the clinical care of their patients. It will also identify if there are any safety concerns and whether different variables, like taking CBD with food or on an empty stomach, will change the bioavailability of the medicine.

PUBLICATIONS

1. Fan J, de Lannoy, I.A.M. Pharmacokinetics. Biochemical Pharmcology. 2014;87(1):93-120.

2. Doogue MP, Polasek TM. The ABCD of clinical pharmacokinetics. Ther Adv Drug Saf. 2013;4(1):5- 7. doi: 10.1177/2042098612469335. PubMed PMID: 25083246; PubMed Central PMCID: PMCPMC4110820.

PARTNER

University of Newcastle, NSW, Australia.

SUMMARY

Acute myeloid leukaemia (AML) is a rare and serious form of cancer that impacts the blood and bone marrow [1]. Bone marrow, a spongy tissue housed within certain bones in our body, is the factory where blood cells such as our red blood cells (which are important for carrying oxygen), white blood cells (which fight infections) and platelets (which assist in blood clotting) are made [2]. In AML, there is an overproduction of immature white blood cells that do not function properly, which also slows down the production of other cells such as platelets and red blood cells [3]. Due to this, patients with AML can suffer symptoms such as anaemia, poor immune function and can bruise and bleed easily. Left untreated, the prognosis for the patient is very poor and can deteriorate rapidly.

SCOPE

AML is considered quite rare with an incidence of around 4 per 100,000 per year, and can occur at any age from infants to the elderly [4]. This being said, it is uncommon in those under 45 years of age and is usually first diagnosed in those over 60. Interestingly, AML is the most common type of leukaemia in adults, with over 20,000 cases in the USA every year [5, 6], and closer to home, over 900 Australians are diagnosed annually [1]. Sadly, AML has one of the poorest survival rates of all of the leukaemias [7], with an estimated 5-year overall survival of less than 30%, ranking it as one of the deadliest of all cancers [8]. The use of chemotherapy remains the most common medical treatment for AML [9], with 35-40% of patients 60 years of age and younger experiencing curative treatment, but this figure drops sharply to 5-15% in those older than 60 [10]. Given such evidence, new strategies and therapies are urgently needed to improve survival, particularly considering the growing aging population worldwide.

RESEARCH

ANTG has been collaborating with Associate Professor Matthew Dun and his Cancer Signalling Research Group at the University of Newcastle since 2018. Preliminary research has focused on pre-clinical studies (i.e., laboratory-based investigations) exploring the impact of a unique high cannabidiol (CBD) and low tetrahydrocannabinol (THC – the constituent in cannabis commonly associated with intoxication) cannabis variety named ‘Eve’ in models of cancer, including AML. As yet unpublished research has highlighted that Eve extract provides a survival benefit to preclinical AML models in vivo.. Additional research has also highlighted that the same novel extracts do not impact the health of the normal bone marrow. With such encouraging results, research is continuing to progress along the standard scientific track, with additional patient derived xenograft animal studies currently being tested to confirm the preclinical benefits of Eve for the treatment of AML. Should positive findings from these be received, then the next stop will be human clinical trials.

REFERENCES

1. Acute myeloid leukaemia. Leukaemia Foundation. [cited 2022 05/09/2022]. Available from:

https://www.leukaemia.org.au/blood-cancer-information/types-of-blood-cancer/leukaemia/acute- myeloid-leukemia/.

2. Patton KT, Thibodeau, G.A. Anatomy & Physiology (Adapted International Edition). 9th ed: Elsevier Inc; 2016.

3. Acute myeloid leukaemia. Cancer Research UK [03/09/2022]. Available from:

https://www.cancerresearchuk.org/about-cancer/acute-myeloid-leukaemia-aml/about-acute- myeloid-leukaemia.

4. Julisson G, Lehmann, S., Lazarevic, V. Epidemiology and etiology of AML. In: Rollig C, Ossenkoppele, G.J., editor. Acute Myeloid Leukemia: Hematologic malignancies: Springer; 2021. 5. De Kouchkovsky I, Abdul-Hay M. ‘Acute myeloid leukemia: a comprehensive review and 2016 update’. Blood Cancer J. 2016;6(7):e441. Epub 20160701. doi: 10.1038/bcj.2016.50. PubMed PMID: 27367478; PubMed Central PMCID: PMCPMC5030376.

6. Cancer Stat Facts: Leukemia – Acute Myeloid Leukemia: National Cancer Institute; 2022 [03/09/2022]. Available from: https://seer.cancer.gov/statfacts/html/amyl.html.

7. Redaelli A, Lee JM, Stephens JM, Pashos CL. Epidemiology and clinical burden of acute myeloid leukemia. Expert Rev Anticancer Ther. 2003;3(5):695-710. doi: 10.1586/14737140.3.5.695. PubMed PMID: 14599092.

8. Green SD, Konig H. Treatment of Acute Myeloid Leukemia in the Era of Genomics- Achievements and Persisting Challenges. Front Genet. 2020;11:480. Epub 20200527. doi: 10.3389/fgene.2020.00480. PubMed PMID: 32536937; PubMed Central PMCID: PMCPMC7267060. 9. Jakobsen NA, Vyas P. From genomics to targeted treatment in haematological malignancies: a focus on acute myeloid leukaemia. Clin Med (Lond). 2018;18(Suppl 2):s47-s53. doi: 10.7861/clinmedicine.18-2-s47. PubMed PMID: 29700093; PubMed Central PMCID: PMCPMC6334029.

10. Dohner H, Weisdorf, D.J., Bloomfield, C.D. Acute Myeloid Leukemia. N Engl J Med. 2015;373:1136- 52. doi: 10.1056/NEJMra1406184.

11. Afrin F, Chi M, Eamens AL, Duchatel RJ, Douglas AM, Schneider J, et al. Can Hemp Help? Low- THC Cannabis and Non-THC Cannabinoids for the Treatment of Cancer. Cancers (Basel). 2020;12(4). Epub 20200423. doi: 10.3390/cancers12041033. PubMed PMID: 32340151; PubMed Central PMCID: PMCPMC7226605.

A double-blind, randomised and placebo-controlled human clinical trial investigating the efficacy and safety of cannabidiol (CBD) oral oil for the management of abdominal pain in patients with IBS.

PARTNER

SVG Pharmaceuticals

SUMMARY

Irritable Bowel Syndrome (IBS) is a common and debilitating gastrointestinal disorder that affects the colon (large bowel), and whilst it is not considered lifethreatening, it can severely impact the quality of life of those people that have it. Symptoms frequently experienced in IBS include abdominal pain and cramping (commonly relieved by passing a stool), bloating or distension, as well as diarrhoea and constipation.[1] Changes in stool consistency, appearance and/or frequency are also common.[2, 3] Whilst the exact cause (i.e., aetiology) of IBS is not fully understood, the brain-gut axis (i.e., the communication pathway between the brain and the gastrointestinal system), altered gastrointestinal movement, alteration in bowel microflora, food sensitivities, previous gastrointestinal infections and intestinal inflammation have all been implicated.[2, 4] IBS typically affects females more than males, and is also more common in younger people and with those that have mental health issues such as anxiety or depression.[5] There is no specific biomarker or test to identify IBS, and medical doctors usually rule out more serious gastrointestinal conditions before diagnosing IBS (what is known as a diagnosis by exclusion). Current pharmaceutical medications available for IBS sufferers work for some, but many others still struggle to bring their symptoms under control, and whilst restrictive diets and other lifestyle interventions are useful, they are sometimes hard to stick to long-term.[6] With this in mind, scientists and medical doctors are continuing to unlock the complex factors contributing to IBS, including investigating if cannabis- derived active constituents like cannabidiol (CBD) may play a part in symptomatic management.

SCOPE

IBS has been estimated to affect between 9-23% of the world’s population,[2] so it is very common. It has a prevalence of between 7-16% in the USA with direct costs associated with the condition amassing to US$1 billion annually.[7] In Australia around 1 in 5 people can experience IBS at some time in their lifetime,[1] and it has a significant impact on peoples quality of life. Given its chronic (i.e., long-term) nature, many studies have demonstrated the negative impact IBS has to people’s quality of life, mental health, work, academic and social lives,[8-10] and has even been shown to contribute to decreases in work productivity, with one study showing a productivity loss of 34%.[8]

RESEARCH

ANTG has partnered with SVG Pharmaceuticals and Dr Christopher Schneider, a leading gastroenterologist and researcher, to conduct a double-blind, randomised and placebo-controlled human clinical trial investigating the efficacy and safety of cannabidiol (CBD) oral oil for the management of abdominal pain in patients with IBS. The study protocol has been approved by an independent Human Research Ethics Committee and recruitment for this clinical study is currently underway.

For more information: svgpharma.com.au

PUBLICATIONS

1. Irritable Bowel Syndrome Better Health Channel: Department of Health, State Government of Victora, Australia; [26/08/2022]. Available from: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/irritable-bowel-syndromeibs.

2. Saha L. Irritable bowel syndrome: pathogenesis, diagnosis, treatment, and evidence-based medicine. World J Gastroenterol. 2014;20(22):6759-73. doi: 10.3748/wjg.v20.i22.6759.
PubMed PMID: 24944467; PubMed Central PMCID: PMCPMC4051916.

3. Black CJ, Ford AC. Best management of irritable bowel syndrome. Frontline Gastroenterol. 2021;12(4):303-15. Epub 20200528. doi: 10.1136/flgastro-2019-101298. PubMed PMID: 34249316; PubMed Central PMCID: PMCPMC8231425.
4. Occhipinti K, Smith JW. Irritable bowel syndrome: a review and update. Clin Colon Rectal Surg. 2012;25(1):46-52. doi: 10.1055/s-0032-1301759. PubMed PMID: 23449495; PubMed Central PMCID: PMCPMC3348735.

5. Ford AC, Sperber AD, Corsetti M, Camilleri M. Irritable bowel syndrome. Lancet.

2020;396(10263):1675-88. Epub 20201010. doi: 10.1016/S0140-6736(20)31548-8. PubMed PMID: 33049223.

6. Gravina AG, Dallio M, Romeo M, Di Somma A, Cotticelli G, Loguercio C, et al. Adherence and Effects Derived from FODMAP Diet on Irritable Bowel Syndrome: A Real Life Evaluation of a Large Follow-Up Observation. Nutrients. 2020;12(4). Epub 20200327. doi: 10.3390/nu12040928. PubMed PMID: 32230832; PubMed Central PMCID: PMCPMC7231245.

7. Camilleri M. Diagnosis and Treatment of Irritable Bowel Syndrome: A Review. JAMA. 2021;325(9):865-77. doi: 10.1001/jama.2020.22532. PubMed PMID: 33651094.

8. Pare P, Gray J, Lam S, Balshaw R, Khorasheh S, Barbeau M, et al. Health-related quality of life, work productivity, and health care resource utilization of subjects with irritable bowel syndrome: baseline results from LOGIC (Longitudinal Outcomes Study of Gastrointestinal Symptoms in Canada), a naturalistic study. Clin Ther. 2006;28(10):1726-35; discussion 10-1. doi: 10.1016/j.clinthera.2006.10.010. PubMed PMID: 17157129.

9. Hulisz D. The burden of illness of irritable bowel syndrome: current challenges and hope for the future. J Manag Care Pharm. 2004;10(4):299-309. doi: 10.18553/jmcp.2004.10.4.299. PubMed PMID: 15298528.

10. Wang YT, Lim HY, Tai D, Krishnamoorthy TL, Tan T, Barbier S, et al. The impact of irritable bowel syndrome on health-related quality of life: a Singapore perspective. BMC Gastroenterol. 2012;12:104. Epub 20120809. doi: 10.1186/1471-230X-12-104. PubMed PMID: 22873839; PubMed Central PMCID: PMCPMC3436771.

PARTNER

University of New England, Armidale, NSW, Australia.

SUMMARY

Plants produce secondary metabolites which not only assist the plant in growth, adaptation and survival,[1] but which humans can also utilise as medicines. When it comes to cannabis, humans have used this plant as a medicine for thousands of years.[2] Cannabis chemovars uniquely express different levels of active constituents which are used as medicines, such as terpenes and cannabinoids like THC and CBD.[3, 4] These active constituent levels in the plant need to be standardised at certain levels so reproducible results can be obtained clinically, but this is a challenging process. The genetics of the cannabis varieties being grown and numerous environmental inputs (e.g., temperature, relative humidity, photosynthetically available radiation (PAR), electrical conductivity (EC) and nutrient/irrigation output) can all impact on cannabinoid levels at different stages of the plant’s life cycle. Whilst our cultivation team are already doing a great job in producing consistent medicinal crops, this project seeks to further optimise our understanding and processes to continue innovation throughout the company and the sector.

IMPACT

ANTG has numerous different Cannabis chemovars at our cultivation facility, and this project seeks to understand, characterise, and stabilise the cannabinoid and terpene concentrations of these chemovars based on environmental inputs and seasonal variables, which would allow the company to fine-tune harvest schedules based on evidence-based outcomes by season, stage of flowering and chemotype.

RESEARCH

Innovation is an important aspect of any business and is particularly important in the medicinal cannabis sector. ANTG has partnered with leading academics from the University of New England by providing funding and industry expertise to support a PhDi candidate to pursue this research project. The successful candidate will be working onsite with our own in-house cultivation experts and in tandem with the academic experts at UNE, to investigate and develop optimal strategies and processes to help us further understand the important role standardisation of environmental variables plays in growing high purity and quality assured medicines for Australian patients.

REFERENCES

1. Park SH, Pauli CS, Gostin EL, Staples SK, Seifried D, Kinney C, et al. Effects of short-term
environmental stresses on the onset of cannabinoid production in young immature flowers of
industrial hemp (Cannabis sativa L.). J Cannabis Res. 2022;4(1):1. Epub 20220104. doi: 10.1186/
s42238-021-00111-y. PubMed PMID: 34980266; PubMed Central PMCID: PMCPMC8725245.
2. Clarke R, Merlin, MD. Cannabis evolution and ethnobotany. Berkeley USA: University of California
Press; 2013.
3. ElSohly MA, Radwan MM, Gul W, Chandra S, Galal A. Phytochemistry of Cannabis sativa L. Prog
Chem Org Nat Prod. 2017;103:1-36. doi: 10.1007/978-3-319-45541-9_1. PubMed PMID: 28120229.
4. Russo EB. Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage
effects. Br J Pharmacol. 2011;163(7):1344-64. doi: 10.1111/j.1476-5381.2011.01238.x. PubMed
PMID: 21749363; PubMed Central PMCID: PMCPMC3165946.

PARTNER

Deakin University, Melbourne, Victoria.
NICM Health Research Institute, Western Sydney University, Sydney, NSW

SUMMARY

Endometriosis is an oestrogen dependent, chronic inflammatory condition characterised by the presence of endometrial-like tissue outside of the uterus.[1, 2] Endometriosis is a leading cause of chronic pelvic pain (CPP),[3] with 20-40% of women with CPP being diagnosed with endometriosis. [4, 5] Endometriosis-related CPP includes a constellation of painful symptoms such as severe pelvic pain,[4] dyschezia (pain on bowel motions), dysuria (pain on urination), dyspareunia (pain during sexual intercourse) and dysmenorrhoea (painful menses/cramping).[6] Prevalence rates of endometriosis worldwide are difficult to accurately quantify, but estimates range between 2-10% of the general female population,[7, 8] with prevalence as high as 50% in infertile women.[9] It has been estimated that endometriosis affects approximately 840,000 Australian women, and over 178 million women worldwide. Currently, the aetiology (i.e., cause) of endometriosis is unknown and there is no cure which highlights the importance of investigating alternative management options.

SCOPE

It is not uncommon for people with endometriosis to present to emergency departments due to unmanageable pain. This trial is investigating whether medicinal cannabis can reduce the presentations to hospital Emergency Departments (ED) of people with moderate to severe endometriosis who have previously presented to an ED twice in the past 6 months. The trial will also be investigating adverse effects, how well medicinal cannabis is tolerated and also secondary self-reported effectiveness data.

RESEARCH

IOpioid analgesics are not recommended for persistent pain or endometriosis-associated pain due to both a lack of efficacy and safety concerns.[10] However, despite this they continue to be prescribed; women with endometriosis having a four times greater risk of chronic opioid use compared to women without.[11] Despite substantial usage of these medications most women with endometriosis in Australia report poor pain and symptom control.[12, 13] Hence novel, less addictive pain management options are considered an urgent research priority in endometriosis both in Australia and internationally.[14, 15] This trial is being led by Professor Antonina MikockaWalus of Deakin University and Associate Professor Mike Armour from Western Sydney University’s NICM Health Research Institute. This project has been funded by the Victorian Government as part of the Victorian Medical Research Acceleration Fund, as well as in-kind contribution from ANTG, EndoHelp Australia and OnTracka Pty Ltd.

REFERENCES

1. Dunselman G, et al. ESHRE guideline Management of women with endometriosis. Human Reproduction. 2014;Advance Access:1-13.
2. Kennedy S, Bergqvist A, Chapron C, D’Hooghe T, Dunselman G, Greb R, et al. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod. 2005;20(10):2698-704. doi: 10.1093/ humrep/dei135. PubMed PMID: 15980014.
3. Hickey M, Ballard K, Farquhar C. Endometriosis. BMJ. 2014;348:g1752. doi: 10.1136/bmj. g1752. PubMed PMID: 24647161.
4. Whitaker LH, Reid J, Choa A, McFee S, Seretny M, Wilson J, et al. An Exploratory Study into Objective and Reported Characteristics of Neuropathic Pain in Women with Chronic Pelvic Pain. PLoS One. 2016;11(4):e0151950. doi: 10.1371/journal.pone.0151950. PubMed PMID: 27046128; PubMed Central PMCID: PMCPMC4821621.
5. Mowers EL, Lim CS, Skinner B, Mahnert N, Kamdar N, Morgan DM, et al. Prevalence of Endometriosis During Abdominal or Laparoscopic Hysterectomy for Chronic Pelvic Pain. Obstet Gynecol. 2016;127(6):1045-53. doi: 10.1097/AOG.0000000000001422. PubMed PMID: 27159755.
6. Armour M, Sinclair J, Chalmers KJ, Smith CA. Self-management strategies amongst Australian women with endometriosis: a national online survey. BMC Complement Altern Med. 2019;19(1):17. Epub 2019/01/17. doi: 10.1186/s12906-019-2431-x. PubMed PMID: 30646891; PubMed Central PMCID: PMCPMC6332532.
7. ESHRE. Guidelines on Management of Women with Endometriosis. 2013.
8. Vigano P, Parazzini F, Somigliana E, Vercellini P. Endometriosis: epidemiology and aetiological factors. Best Pract Res Clin Obstet Gynaecol. 2004;18(2):177-200. Epub 2004/05/26. doi: 10.1016/j. bpobgyn.2004.01.007. PubMed PMID: 15157637.
9. Meuleman C, Vandenabeele B, Fieuws S, Spiessens C, Timmerman D, D’Hooghe T. High prevalence of endometriosis in infertile women with normal ovulation and normospermic partners. Fertil Steril. 2009;92(1):68-74. doi: 10.1016/j.fertnstert.2008.04.056. PubMed PMID: 18684448.
10. As-Sanie S, Soliman AM, Evans K, Erpelding N, Lanier R, Katz NP. Healthcare utilization and cost burden among women with endometriosis by opioid prescription status in the first year after diagnosis: a retrospective claims database analysis. J Med Econ. 2020:1-7. doi: 10.1080/13696998.2019.1707212. PubMed PMID: 31856613.
11. Chiuve SE, Kilpatrick RD, Hornstein MD, Petruski‐Ivleva N, Wegrzyn LR, Dabrowski EC, et al. Chronic opioid use and complication risks in women with endometriosis: a cohort study in US administrative claims. Pharmacoepidemiology and Drug Safety. 2021.
12. Hawkey A, Chalmers KJ, Micheal S, Diezel H, Armour M. “A day-to-day struggle”: A comparative qualitative study on experiences of women with endometriosis and chronic pelvic pain. Feminism & Psychology. 2022. doi: 10.1177/09593535221083846.
13. Moradi M, Parker M, Sneddon A, Lopez V, Ellwood D. Impact of endometriosis on women’s
lives: a qualitative study. BMC Womens Health. 2014;14(1):123. Epub 2014/10/05. doi: 10.1186/1472-
6874-14-123. PubMed PMID: 25280500; PubMed Central PMCID: PMCPMC4287196.
14. As-Sanie S, Black R, Giudice LC, Gray Valbrun T, Gupta J, Jones B, et al. Assessing research
gaps and unmet needs in endometriosis. Am J Obstet Gynecol. 2019;221(2):86-94. doi: 10.1016/j.
ajog.2019.02.033. PubMed PMID: 30790565.
15. Australian Government Department of Health. National Action Plan for Endometriosis
2018 [12/1/19]. Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/
endometriosis

Through research, we find solutions.

“Education is the key to changing the narrative”

Justin Sinclair

Chief Scientific Officer, Australian Natural Therapeutics Group