Appendix 1. Registry Characteristics by Willingness to Answer the Recreational Drug Usage Question

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Geoffrion R, Yang EC, Koenig NA, Brotto LA, Barr AM, Lee T, et al. Recreational cannabis use before and after legalization in women with pelvic pain. Obstet Gynecol 2021;137.

The authors provided this information as a supplement to their article.

Appendix 1. Registry Characteristics by Willingness to Answer the Recreational Drug Usage Question

Recreational drug usage question

Variable Declined to answer (n=276) Answered (n=3426) P

Demographic

Age, mean (SD), years 35.0 (8.7) 34.8 (8.3) 0.791

Education, n (%) <0.001

Unknown 25 82

Below or some high school 14 (5.6) 115 (3.4)

Completed high school 102 (40.6) 1013 (30.3)

Completed college or university 93 (37.1) 1539 (46.0)

Completed graduate school 42 (16.7) 677 (20.2)

Household income, n (%) 0.228

Unknown 76 1093

Less than $20,000 36 (18.0) 328 (14.1)

$20,000-$39,999 39 (19.5) 383 (16.4)

$40,000-$59,999 29 (14.5) 359 (15.4)

$60,000-$79,999 30 (15.0) 359 (15.4)

$80,000-$99,999 27 (13.5) 285 (12.2)

$100,000 or more 39 (19.5) 619 (26.5)

Currently working, n (%) 0.405

Unknown 17 56

No (not because of pelvic pain) 38 (14.7) 473 (14.0)

No (because of pelvic pain) 39 (15.1) 417 (12.4)

Yes 182 (70.3) 2480 (73.6)

Marital Status - Married/Common law, n (%) 135/263 (51.3) 2133/3425 (62.3) <0.001

Ethnicity, n (%) 0.065

Unknown 9 7

Caucasian 179 (67.0) 2417 (70.7)

Black 0 (0.0) 16 (0.5)

Asian 44 (16.5) 468 (13.7)

Hispanic 2 (0.7) 92 (2.7)

Other 42 (15.7) 426 (12.5)

Smoke currently, n (%) 58/262 (22.1) 441/3426 (12.9) <0.001

Drink any alcohol, n (%) 176/262 (67.2) 2077/3426 (60.6) 0.036

BMI, mean (SD), kg/m2 25.2 (5.5) 25.7 (6.2) 0.182

# missing 6 64

Medical

Co-morbidities, n (%)^

Chronic fatigue syndrome 14/257 (5.4) 143/3333 (4.3) 0.382

Fibromyalgia 22/263 (8.4) 218/3373 (6.5) 0.232

Migraines, chronic headaches 62/263 (23.6) 800/3373 (23.7) 0.958

Taking opioids/narcotics every day because of pelvic pain, n (%) 32/266 (12.0) 406/3426 (11.9) 0.931

Medications for pelvic pain, n (%)^

Anti-inflammatories 236/273 (86.4) 2895/3421 (84.6) 0.420

Opioids/narcotics 119/271 (43.9) 1425/3371 (42.3) 0.599

Nerve medications 43/248 (17.3) 466/3243 (14.4) 0.202

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Recreational drug usage question

Variable Declined to answer (n=276) Answered (n=3426) P

Muscle relaxants 9/275 (3.3) 172/3426 (5.0) 0.196

Herbal medications 27/275 (9.8) 307/3418 (9.0) 0.642

Gynecological

Parity, n (%) 0.322

Unknown 17 67

0 176 (68.0) 2141 (63.7)

1 41 (15.8) 486 (14.5)

2 31 (12.0) 531 (15.8)

3 9 (3.5) 151 (4.5)

4 or more 2 (0.8) 50 (1.5)

Age of onset of pelvic pain, mean (SD), years 19.9 (9.1) 20.9 (9.4) 0.125

# missing 65 1111

Previous hysterectomy, n (%) 28/271 (10.3) 300/3425 (8.8) 0.381

Post-menopausal, n (%) 7/251 (2.8) 38/3202 (1.2) 0.031

Endometriosis (suspected or confirmed), n (%) 212/275 (77.1) 2663/3420 (77.9) 0.766

Endometriosis stage, n (%) 0.935

Unknown 66 584

1 49 (33.6) 742 (35.7)

2 31 (21.2) 420 (20.2)

3 26 (17.8) 340 (16.4)

4 40 (27.4) 577 (27.8)

Other pain diagnoses

Abdominal wall trigger point, n (%) 86/266 (32.3) 942/3297 (28.6) 0.193

Pelvic floor myalgia, n (%) 94/270 (34.8) 1258/3350 (37.6) 0.371

Irritable bowel syndrome diagnosis, n (%) 164/275 (59.6) 1876/3426 (54.8) 0.118

Painful bladder syndrome diagnosis, n (%) 129/275 (46.9) 1577/3426 (46.0) 0.779

Validated questionnaires

PHQ-9, mean (SD) 9.9 (6.9) 9.0 (6.6) 0.024

# missing 15 28

GAD-7, mean (SD) 7.5 (6.0) 6.8 (5.6) 0.044

# missing 15 29

Pain catastrophizing scale, mean (SD) 22.3 (14.3) 21.3 (13.6) 0.245

# missing 15 25

EHP-30, mean (SD) 52.1 (24.7) 50.5 (24.0) 0.309

# missing 14 24

Pain score (severity of 3 or higher)

Painful menstrual cramps when bleeding, n (%) 264/275 (96.0) 3240/3426 (94.6) 0.310

Superficial dyspareunia, n (%) 141/275 (51.3) 1801/3426 (52.6) 0.679

Deep dyspareunia, n (%) 218/275 (79.3) 2714/3426 (79.2) 0.983

Dyschezia, n (%) 194/275 (70.5) 2306/3426 (67.3) 0.270

Other pelvic pain, n (%) 234/275 (85.1) 2949/3426 (86.1) 0.650

Back pain, n (%) 229/275 (83.3) 2804/3425 (81.9) 0.560

† Multiple categories can be selected for each woman.

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For dichotomized variables with missing data, the denominator represents the number of women with non-missing data.

The “Declined to answer” group included those who did not provide an answer or selected “preferred not to answer”. Three women answered the recreational drug question but did not specify which drug they used and they were excluded from the current comparison.

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Appendix 2. Registry Characteristics Between Cannabis Users and Nonusers in the Prelegalization and Postlegalization Periods

Prelegalization period Postlegalization period

Variable Cannabis users

(n=366) Non-users

(n=2394) P Cannabis users

(n=143) Non-users

(n=523) P

Demographic

Age, mean (SD), years 31.8 (7.8) 35.5 (8.3) <0.001 31.0 (7.6) 34.7 (7.8) <0.001

Education, n (%) <0.001 <0.001

Unknown 13 69 0 0

Below or some high school 26 (7.4) 86 (3.7) 1 (0.7) 2 (0.4)

Completed high school 171 (48.4) 742 (31.9) 33 (23.1) 67 (12.8)

Completed college or university 120 (34.0) 1013 (43.6) 95 (66.4) 311 (59.5)

Completed graduate school 36 (10.2) 484 (20.8) 14 (9.8) 143 (27.3)

Household income, n (%) <0.001 -

Unknown 58 374 142 519

Less than $20,000 68 (22.1) 260 (12.9) 0 (0.0) 0 (0.0)

$20,000-$39,999 63 (20.5) 318 (15.7) 0 (0.0) 2 (50.0)

$40,000-$59,999 61 (19.8) 297 (14.7) 1 (100.0) 0 (0.0)

$60,000-$79,999 43 (14.0) 315 (15.6) 0 (0.0) 1 (25.0)

$80,000-$99,999 28 (9.1) 257 (12.7) 0 (0.0) 0 (0.0)

$100,000 or more 45 (14.6) 573 (28.4) 0 (0.0) 1 (25.0)

Currently working, n (%) <0.001 <0.001

Unknown 12 44 0 0

No (not because of pelvic pain) 27 (7.6) 366 (15.6) 10 (7.0) 70 (13.4)

No (because of pelvic pain) 70 (19.8) 271 (11.5) 30 (21.0) 46 (8.8)

Yes 257 (72.6) 1713 (72.9) 103 (72.0) 407 (77.8)

Marital Status - Married/Common law, n (%) 184 (50.3) 1519 (63.5) <0.001 75/143 (52.4) 355/522 (68.0) <0.001

Ethnicity, n (%) <0.001 <0.001

Unknown

Caucasian 0

312 (85.2) 5

1642 (68.7) 2

113 (80.1) 0

350 (66.9)

Black 0 (0.0) 13 (0.5) 1 (0.7) 2 (0.4)

Asian 5 (1.4) 385 (16.1) 4 (2.8) 74 (14.1)

Hispanic 5 (1.4) 72 (3.0) 2 (1.4) 13 (2.5)

Other 44 (12.0) 277 (11.6) 21 (14.9) 84 (16.1)

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(n=366) Non-users

(n=143) Non-users

(n=523) P

Smoke currently, n (%) 112 (30.6) 258 (10.8) <0.001 29 (20.3) 42(8.0) <0.001

Drink any alcohol, n (%) 278 (76.0) 1384 (57.8) <0.001 107 (74.8) 308 (58.9) <0.001

BMI, mean (SD), kg/m2 25.6 (6.3) 25.6 (6.2) 0.898 26.6 (6.6) 26.0 (6.2) 0.305

# missing 7 51 3 3

Medical

Co-morbidities, n (%)†

Chronic fatigue syndrome 11/347 (3.2) 96/2320 (4.1) 0.392 9 (6.3) 27 (5.2) 0.596

Fibromyalgia 22/353 (6.2) 152/2354 (6.5) 0.872 10 (7.0) 34 (6.5) 0.834

Migraines, chronic headaches 71/353 (20.1) 533/2354 (22.6) 0.287 39 (27.3) 157 (30.0) 0.523

Daily opioids/narcotics use due to pelvic pain, n

(%) 68 (18.6) 294 (12.3) <0.001 15 (10.5) 29 (5.5) 0.035

Medications for pelvic pain, n (%)†

Anti-inflammatories 338/365 (92.6) 2107/2390 (88.2) 0.012 114 (79.7) 336 (64.2) <0.001

Opioids/narcotics 230/365 (63.0) 1056/2340 (45.1) <0.001 43 (30.1) 96 (18.4) 0.002

Nerve medications 68/334 (20.4) 347/2243 (15.5) 0.023 17 (11.9) 34 (6.5) 0.032

Muscle relaxants 21 (5.7) 127 (5.3) 0.732 6 (4.2) 18 (3.4) 0.668

Herbal medications 74/366 (20.2) 128/2391 (5.4) <0.001 44/142 (31.0) 61/519 (11.8) <0.001

Gynecological

Parity, n (%) <0.001 0.071

Unknown 10 49 0 8

0 258 (72.5) 1436 (61.2) 108 (75.5) 339 (65.8)

1 40 (11.2) 355 (15.1) 20 (14.0) 71 (13.8)

2 34 (9.6) 408 (17.4) 13 (9.1) 76 (14.8)

3 19 (5.3) 107 (4.6) 2 (1.4) 23 (4.5)

4 or more 5 (1.4) 39 (1.7) 0 (0.0) 6 (1.2)

Age of onset of pelvic pain, mean (SD), years 19.1 (7.7) 21.2 (9.6) <0.001 - 19.8 (10.8) -

# missing 59 392 142 518

Previous hysterectomy, n (%) 41/366 (11.2) 223/2393 (9.3) 0.254 8 (5.6) 28 (5.4) 0.910

Post-menopausal, n (%) 0/335 (0.0) 34/2203 (1.5) 0.022 0/143 (0.0) 4/521 (0.8) 0.582

Endometriosis (suspected or confirmed), n (%) 295/366 (80.6) 1835/2392 (76.7) 0.099 107/142 (75.4) 426/520 (81.9) 0.080

Endometriosis stage, n (%) 0.017 0.351

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(n=366) Non-users

(n=143) Non-users

(n=523) P

Unknown 82 502 0 0

1 88 (41.3) 467 (35.0) 34 (31.8) 153 (35.9)

2 49 (23.0) 245 (18.4) 29 (27.1) 97 (22.8)

3 35 (16.4) 240 (18.0) 9 (8.4) 56 (13.1)

4 41 (19.2) 381 (28.6) 35 (32.7) 120 (28.2)

Abdominal wall trigger point 123/354 (34.7) 657/2293 (28.7) 0.019 45/137 (32.8) 117/513 (22.8) 0.016

Pelvic floor myalgia 149/361 (41.3) 827/2338 (35.4) 0.030 71/140 (50.7) 211/511 (41.3) 0.046

Irritable bowel syndrome diagnosis 226 (61.7) 1272 (53.1) 0.002 91 (63.6) 287 (54.9) 0.061

Painful bladder syndrome diagnosis 190 (51.9) 1079 (45.1) 0.014 75 (52.4) 233 (44.6) 0.093

Validated questionnaires PHQ-9, mean (SD)

#missing 11.3 (6.7)

4 8.5 (6.5)

20 <0.001 12.5 (7.1)

2 8.4 (6.4)

2 <0.001 GAD-7, mean (SD)

#missing 8.4 (5.7)

4 6.4 (5.6)

21 <0.001 9.6 (5.9)

2 6.4 (5.4)

2 <0.001 Pain catastrophizing scale, mean (SD)

#missing 23.4 (12.4)

4 20.0 (13.7)

21 <0.001 27.9 (12.5)

0 24.0 (13.2)

0 0.002

EHP-30, mean (SD)

#missing 57.1 (20.7)

4 49.3 (24.0)

18 <0.001 59.3 (22.2)

1 49.1 (25.6)

1 <0.001 Pain score (severity of 3 or higher)

Painful menstrual cramps when bleeding, n (%) 355 (97.0) 2234 (93.3) 0.007 140 (97.9) 511 (97.7) 0.888

Superficial dyspareunia, n (%) 191 (52.2) 1285 (53.7) 0.595 73 (51.0) 252 (48.2) 0.544

Deep dyspareunia, n (%) 312 (85.2) 1860 (77.7) 0.001 123 (86.0) 419 (80.1) 0.108

Dyschezia, n (%) 288 (78.7) 1564 (65.3) <0.001 112 (78.3) 342 (65.4) 0.003

Other pelvic pain, n (%) 339 (92.6) 2038 (85.1) <0.001 135 (94.4) 437 (83.6) <0.001

Back pain, n (%) 334 (91.3) 1918 (80.1) <0.001 130/143 (90.9) 422/522 (80.8) 0.005

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Appendix 3. Registry Characteristics Between Cannabis Users and Nonusers by Endometriosis

Without endometriosis With endometriosis

Variable Cannabis users (n=106) Non-users (n=651) P Cannabis users (n=402) Non-users (n=2261) P

Demographic

Age, mean (SD), years 33.7 (9.1) 37.0 (9.0) <0.001 31.1 (7.3) 34.9 (8.0) <0.001

Education, n (%) <0.001 <0.001

Unknown 5 22 8 47

Below or some high school 14 (13.9) 35 (5.6) 13 (3.3) 53 (2.4)

Completed high school 43 (42.6) 213 (33.9) 160 (40.6) 595 (26.9)

Completed college or university 36 (35.6) 261 (41.5) 179 (45.4) 1061 (47.9)

Completed graduate school 8 (7.9) 120 (19.1) 42 (10.7) 505 (22.8)

Household income, n (%) <0.001 <0.001

Unknown 40 151 159 737

Less than $20,000 21 (31.8) 83 (16.6) 47 (19.3) 177 (11.6)

$20,000-$39,999 15 (22.7) 65 (13.0) 48 (19.8) 255 (16.7)

$40,000-$59,999 11 (16.7) 65 (13.0) 51 (21.0) 232 (15.2)

$60,000-$79,999 10 (15.2) 83 (16.6) 33 (13.6) 233 (15.3)

$80,000-$99,999 3 (4.5) 63 (12.6) 25 (10.3) 194 (12.7)

$100,000 or more 6 (9.1) 141 (28.2) 39 (16.0) 433 (28.4)

Currently working, n (%) <0.001 <0.001

Unknown 0 8 12 36

No (not because of pelvic pain) 11 (10.4) 119 (18.5) 26 (6.7) 316 (14.2)

No (because of pelvic pain) 31 (29.2) 94 (14.6) 68 (17.4) 223 (10.0)

Yes 64 (60.4) 430 (66.9) 296 (75.9) 1686 (75.8)

Marital Status - Married/Common law, n (%) 48 (45.3) 405 (62.2) <0.001 211/402 (52.5) 1465/2260 (64.8) <0.001

Ethnicity, n (%) <0.001 <0.001

Unknown 0 1 2 4

Caucasian 94 (88.7) 476 (73.2) 330 (82.5) 1516 (67.2)

Black 0 (0.0) 5 (0.8) 1 (0.3) 10 (0.4)

Asian 1 (0.9) 68 (10.5) 8 (2.0) 390 (17.3)

Hispanic 0 (0.0) 15 (2.3) 7 (1.8) 70 (3.1)

Other 11 (10.4) 86 (13.2) 54 (13.5) 271 (12.0)

Smoke currently, n (%) 38 (35.8) 87 (13.4) <0.001 103 (25.6) 213 (9.4) <0.001

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Drink any alcohol, n (%) 76 (71.7) 369 (56.7) 0.004 309 (76.9) 1321 (58.4) <0.001

BMI, mean (SD), kg/m2 26.9 (6.8) 25.9 (6.8) 0.189 25.7 (6.3) 25.6 (6.0) 0.842

# missing 3 31 6 21

Medical

Co-morbidities, n (%)^

Chronic fatigue syndrome 3/106 (2.8) 38/633 (6.0) 0.187 17/383 (4.4) 85/2205 (3.9) 0.588

Fibromyalgia 11/103 (10.7) 48/639 (7.5) 0.270 21/392 (5.4) 138/2233 (6.2) 0.529

Migraines, chronic headaches 28/103 (27.2) 150/639 (23.5) 0.413 81/392 (20.7) 539/2233 (24.1) 0.135

Taking opioids/narcotics every day because of

pelvic pain, n (%) 30 (28.3) 91 (14.0) <0.001 53 (13.2) 232 (10.3) 0.081

Medications for pelvic pain, n (%)^

Anti-inflammatories 91/106 (85.8) 538/649 (82.9) 0.450 360/401 (89.8) 1902/2259 (84.2) 0.004

Opioids/narcotics 65/106 (61.3) 276/641 (43.1) <0.001 207/401 (51.6) 875/2217 (39.5) <0.001

Nerve medications 27/101 (26.7) 116/619 (18.7) 0.062 57/375 (15.2) 265/2142 (12.4) 0.130

Muscle relaxants 8 (7.5) 34 (5.2) 0.332 19 (4.7) 110 (4.9) 0.905

Herbal medications 17/106 (16.0) 39/650 (6.0) <0.001 101/401 (25.2) 150/2255 (6.7) <0.001

Gynecological

Parity, n (%) 0.520 <0.001

Unknown 1 22 9 35

0 59 (56.2) 318 (50.6) 306 (77.9) 1453 (65.3)

1 17 (16.2) 99 (15.7) 43 (10.9) 326 (14.6)

2 17 (16.2) 137 (21.8) 30 (7.6) 347 (15.6)

3 10 (9.5) 50 (7.9) 11 (2.8) 80 (3.6)

4 or more 2 (1.9) 25 (4.0) 3 (0.8) 20 (0.9)

Age of onset of pelvic pain, mean (SD), years 21.8 (9.3) 23.9 (11.3) 0.147 18.3 (7.0) 20.3 (8.8) <0.001

# missing 40 159 160 746

Previous hysterectomy, n (%) 20/106 (18.9) 92/650 (14.2) 0.205 29 (7.2) 159 (7.0) 0.896

Post-menopausal, n (%) 0/95 (0.0) 19/591 (3.2) 0.076 0/382 (0.0) 19/2128 (0.9) 0.064

Endometriosis (suspected or confirmed), n (%) 0 (0.0) 0 (0.0) - 402 (100.0) 2261 (100.0) -

Endometriosis stage, n (%) - 0.054

Unknown - - 82 502

1 - - 122 (38.1) 620 (35.2)

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2 - - 78 (24.4) 342 (19.4)

3 - - 44 (13.8) 296 (16.8)

4 - - 76 (23.8) 501 (28.5)

Abdominal wall trigger point, n (%) 30/95 (31.6) 158/589 (26.8) 0.336 138/396 (34.8) 616/2216 (27.8) 0.004

Pelvic floor myalgia, n (%) 48/104 (46.2) 218/632 (34.5) 0.022 172/396 (43.4) 820/2213 (37.1) 0.016

Irritable bowel syndrome diagnosis, n (%) 48 (45.3) 267 (41.0) 0.408 216 (53.7) 1043 (46.1) 0.005

Painful bladder syndrome diagnosis, n (%) 25/97 (25.8) 128/626 (20.4) 0.232 77/376 (20.5) 369/2092 (17.6) 0.188

Validated questionnaires

PHQ-9, mean (SD) 11.6 (6.9) 8.5 (6.6) <0.001 11.6 (6.8) 8.5 (6.4) <0.001

# missing 2 8 4 14

GAD-7, mean (SD) 8.2 (6.0) 6.0 (5.4) <0.001 8.9 (5.8) 6.6 (5.5) <0.001

# missing 2 8 4 15

Pain catastrophizing scale, mean (SD) 26.0 (12.7) 20.2 (13.6) <0.001 24.3 (12.5) 20.8 (13.7) <0.001

# missing 1 7 3 14

EHP-30, mean (SD) 60.3 (22.5) 48.7 (25.4) <0.001 57.0 (20.7) 49.4 (23.9) <0.001

# missing 1 6 4 13

Pain score (severity of 3 or higher)

Painful menstrual cramps when bleeding, n (%) 63 (59.4) 398 (61.1) 0.739 318 (79.1) 1714 (75.8) 0.152

Superficial dyspareunia, n (%) 61 (57.5) 337 (51.8) 0.269 203 (50.5) 1197 (52.9) 0.366

Deep dyspareunia, n (%) 86 (81.1) 480 (73.7) 0.104 349 (86.8) 1796 (79.4) <0.001

Dyschezia, n (%) 82 (77.4) 378 (58.1) <0.001 317 (78.9) 1526 (67.5) <0.001

Other pelvic pain, n (%) 100 (94.3) 550 (84.5) 0.007 373 (92.8) 1920 (84.9) <0.001

Back pain, n (%) 100/106 (94.3) 498/650 (76.6) <0.001 363 (90.3) 1841 (81.4) <0.001