The System That Regulates Everything—But Is Missing from Medicine: Why the Endocannabinoid System Is Still Ignored in Healthcare Education

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Ask most people—doctors included—what they know about the endocannabinoid system (ECS), and you’ll likely hear something about cannabis. (Admittedly, I thought the same.) That’s a problem.

Because the ECS isn’t just "the system cannabis interacts with." It’s a critical regulator of nearly every major function in the human body: mood, pain, inflammation, metabolism, hormone balance, immune function, sleep, fertility, memory, and more.

In short? The ECS helps keep the body in balance. But it's missing from the medical curriculum.

This knowledge gap affects everyone—but women may feel it most acutely. That’s because women are more likely to live with chronic, multisystem conditions like IBS, fibromyalgia, anxiety, pelvic pain, and metabolic dysfunction—where ECS dysregulation may be playing a central but unrecognized role.

🧠 A System Discovered by Accident—and Then Ignored

The ECS was discovered in the 1990s during research into cannabis, which is how it got its name. But that connection has become a branding problem.

Despite its foundational role in maintaining homeostasis, the ECS remains absent from most major medical textbooks—even the 2020 edition of Guyton and Hall’s Textbook of Medical Physiology fails to adequately include it.

This omission has persisted for over 30 years.

📉 What It’s Costing Us: The Real-World Impact

Because clinicians aren’t trained on the ECS:

• Patients with symptoms related to ECS imbalance (e.g., pain, fatigue, anxiety, hormonal disruption) are often misdiagnosed or dismissed.

• Women are told their symptoms are “normal” or “psychosomatic” instead of being assessed for systemic dysregulation.

• People exploring ECS-based therapies—including nutrition and cannabinoid-based treatments—are forced to self-educate or rely on unverified sources.

Even diet plays a role. The ECS is lipid-based, meaning it’s influenced by fatty acids like omega-3s and omega-6s. Modern diets, rich in omega-6s, may overstimulate the ECS—contributing to inflammation, obesity, and metabolic disorders.

As Dr. Broselid explains:

🌱 This Is Bigger Than Cannabis

Medical cannabis helped uncover the ECS, but it’s not the only way to interact with it. The ECS can also be influenced by stress, exercise, sleep, trauma, diet, and pharmaceuticals. Unfortunately, the associated stigma continues to linger.

A 2022 report from Volteface in the UK found that while 40,000 clinicians are eligible to prescribe medical cannabis, only about 100 do. Most cited lack of education, lack of clinical guidelines, and fear of stigma or career risk.

The focus on cannabis, while important, has overshadowed the more critical point: we are ignoring an entire regulatory system.

🩺 Why It Matters for Women

Ignoring the ECS has particularly harmful consequences for women, who are disproportionately affected by conditions involving this system:

• Endometriosis

• PCOS

• IBS

• Anxiety and mood disorders

• Chronic pelvic pain

• Perimenopausal and menopausal symptoms

• Metabolic dysfunction

Many of these conditions remain underdiagnosed or misunderstood because they span multiple systems—and the ECS is the invisible thread that connects them.

🔄 What Needs to Change

The system failure isn’t just clinical—it’s structural. As we work to build targeted ECS therapies, we face a reality where the science is decades ahead of policy, education, and public perception.

We don’t just need more cannabis research—we need to:

🧠 1. Integrate ECS education into all medical, nursing, and allied health curricula.

The ECS should be taught alongside the nervous, endocrine, and immune systems. It connects all three. Every clinician—regardless of specialty—should understand ECS signaling, dysfunction, and interaction with lifestyle, stress, pharmaceuticals, and nutrition.

🧬 2. Fund and prioritize ECS-related research beyond cannabis.

The ECS is involved in conditions from mood disorders to metabolic syndrome to chronic inflammation. But when research is siloed under "cannabis science," we miss opportunities to explore diet, stress, trauma, and hormone interactions through the ECS lens.

👩‍⚕️ 3. Equip clinicians with ECS-informed diagnostic and therapeutic tools.

We can’t treat what we don’t assess. ECS imbalance may not show up on a lab test—but neither do many chronic conditions women face. Training should focus on clinical red flags (e.g., pain + fatigue + gut issues), root-cause pattern recognition, and emerging non-cannabis interventions (e.g., diet, vagal tone stimulation, fatty acid modulation).

🧑‍🤝‍🧑 4. Normalize ECS in public health—not just “alternative” wellness.

Currently, conversations about the ECS live in cannabis culture, nutrition podcasts, or integrative medicine circles. But the ECS is not fringe. We need institutional messaging from academic centers, NIH, WHO, and public health campaigns to reposition it as a core system worth understanding.

🩺 5. Treat the ECS as a systems-level issue in healthcare innovation.

Many of today’s “unsolvable” conditions—especially those that disproportionately affect women (e.g., long COVID, fibromyalgia, IBS, endometriosis, PMDD)—may share ECS dysregulation as a root cause or contributing factor. Startups and health systems should treat the ECS like we now treat the microbiome: as a complex, systemic regulator with diagnostic and therapeutic potential.

I would LOVE to hear from you about this. I just learned of it and am fascinated! Send me an email.

📚 Sources

• Stevens, Ben. The ‘Glaring Omission’ of the Endocannabinoid System From Mainstream Medical Knowledge, And its Real World Impact Business of Cannabis, 30 April 2025.

• Paiva, C., Santos, T., Cunha-Oliveira, A. et al. Knowledge, opinions and experiences of nurses and nursing students in Portugal regarding the use of medical Cannabis. BMC Nurs 23, 788 (2024). https://doi.org/10.1186/s12912-024-02443-5

• Kowalski, Katya. Volteface. Known Unknowns: The barriers and hesitations faced by UK clinicians prescribing medical cannabis, 2 December 2022.

• ECS.Education. Guyton and Hall textbook analysis and academic citation metrics, 2023.

• Popescu-Spineni, D. M., Guja, L., Cristache, C. M., Pop-Tudose, M. E., & Munteanu, A. M. (2022). THE INFLUENCE OF ENDOCANNABINOID SYSTEM ON WOMEN REPRODUCTION. Acta endocrinologica (Bucharest, Romania : 2005), 18(2), 209–215. https://doi.org/10.4183/aeb.2022.209

👋 Let’s Keep the Conversation Going

Have you heard of the ECS before? Were you taught about it in your medical, nursing, or nutrition training? What do you wish clinicians understood better?

🧵Join the conversation in our Fempower Health Slack. If you haven’t yet joined, be sure to sign up!