Co-authored by Paul Yong and Catherine Allaire
It has been a year of reckoning for systemic inequality and injustice that women face. In Canada, the conversation ranged from harassment and violence in the workplace to worse women's health outcomes for conditions like stroke and, most recently, gender bias in access to health research funding. Female-bodiedness, it seems, can jeopardize the ability to thrive in a country that prides itself on feminist values.
As clinicians and researchers focused on sexual and reproductive health, we see that even the biological reality of menstruation can constrain the potential of Canadians. Adolescent girls with symptoms of endometriosis — a gynecological condition that affects 10 per cent of women and can cause painful menstruation, painful sexual intercourse, chronic pelvic pain and infertility — are 28 times as likely to miss school during menstruation than their peers, creating an early barrier to the realization of their academic and extracurricular goals. This disadvantage carries into adulthood, when women with endometriosis lose six hours of work per week due to reduced effectiveness or absence.
The threat that endometriosis poses to educational attainment and workforce participation should be of concern to the federal government, which in its 2018 budget forcefully made the case that "when women have the support and opportunities they need to fully contribute to Canada's economy, the entire economy does better."
Watch: What to do if you think you have endometriosis. Blog continues below.
The first step in reducing the burden of endometriosis on Canadians should be an effort to reduce time to diagnosis, which averages between four and 10 years. Research shows that only around 30 per cent of young women have heard about endometriosis, suggesting that lack of awareness contributes to the diagnostic delay. General practitioners may also be underprepared to recognize painful menstruation as a symptom of endometriosis; one study found that 63 per cent of women who went on to be diagnosed with the condition were told by at least one physician that there was nothing wrong.
It may come as a surprise that awareness about a condition as common as endometriosis is so low. However, as in most cultures, we have a strong tradition of "menstrual etiquette" designed to conceal from others the normal, cyclical discharge of blood and tissue from the uterus (if you need evidence of this, think about the last time you saw someone head toward the washroom with a tampon or pad visibly in hand). Moreover, women who do share menstrual symptoms with health-care providers are dismissed as dramatic more often than seems conscionable almost four decades after we abandoned hysteria as a catch-all explanation for women's physical ailments.
In considering how to address the problems around endometriosis awareness, Prime Minister Trudeau and the Ministers of Health can turn to the example of Australia for guidance. Last summer, the Australian Government announced a National Action Plan for Endometriosis that aimed to increase endometriosis education, improve access to care, and support relevant research. The plan included $1 million to increase awareness of endometriosis among frontline health professionals, as well as calls to include menstrual education in school curriculums and to leverage social media, electronic resources, webinars, and face-to-face contact sessions to ensure that "endometriosis ('endo') enters into the public vernacular."
March is Endometriosis Awareness Month. If you are a parent, normalize menstruation by talking openly about periods with your daughters and sons. If you have a friend or partner who suffers from severe menstrual pain or the other symptoms of endometriosis, ask if they have heard of the condition. If you are an educator or an employer, discuss how you address menstruation-related absences with your colleagues. It is time to start the conversation. Period.
Paul Yong, MD, PhD, FRCSC, Assistant Professor Gynaecologic Specialties & Reproductive Endocrinology and Infertility Divisions, Department of Obstetrics and Gynecology, University of British Columbia, and Catherine Allaire, MD, FRCSC, Clinical Professor and Head of the Gynaecologic Specialties Division, Department of Obstetrics and Gynecology, University of British Columbia