It’s Time We Talk About Endometriosis

Endometriosis—when the uterine lining grows outside of the uterus, resulting in severe pain, swelling and bleeding—is thought to affect more than 11 percent of all American women between the ages of 15 and 44. This condition impacts 6.5 million U.S. women, and 176 million women worldwide. Yet, it is still not easily recognized. It takes about 10 years from when women experience their first symptoms to receive an endometriosis diagnosis—half that time to recognize and bring up symptoms to a doctor and the other half for the doctor to diagnose it. For Endometriosis Awareness Month this March, we as obstetrician-gynecologists must do our part to raise awareness about the condition with our patients, strive to improve our understanding of the disease, and ensure more timely and accurate diagnoses.

Improving awareness and timely diagnosis of endometriosis helps women avoid unnecessary pain, and decrease infertility rates. Around 40 percent of all women with infertility have endometriosis and, of women diagnosed with endometriosis, about 40 percent experience fertility challenges. Many women struggling with infertility remain undiagnosed; others won’t be diagnosed with endometriosis until they start to experience problems conceiving. It falls to ob-gyns to reverse this trend, particularly as 63 percent of general practitioners feel uncomfortable diagnosing and treating patients with endometriosis, and as many as half are unfamiliar with the three main symptoms of the disease.

Early endometriosis diagnosis and treatment lead to better outcomes. Careful listening and discussion are integral to early detection, as many common symptoms are not so obvious, such as chronic lower back pain and intestinal problems like diarrhea, constipation, bloating and nausea. We can also look for indicators that a woman is at greater risk of having endometriosis, including if she’s in her 30s and 40s; has a close relative who has been diagnosed with endometriosis (which increases risk by five to seven times); and has a higher body mass index (which is thought to promote the development of endometriosis because fat increases estrogen levels).

Raising awareness about endometriosis and increasing its timely diagnosis improves women’s lives. While symptoms may range in terms of severity, nearly all of them take a physical toll on a woman’s day-to-day life—from increasing tiredness to limiting her physical capabilities. It’s time to talk with our patients more regularly about endometriosis, and ensure more women are getting the care and support they need.

We Cannot Afford to Have the Clock Turned Back on Women’s Health

As we begin a new year, a lot is at stake for Americans’ health. Our nation’s leaders have promised substantial changes to the Affordable Care Act, from partial to full repeal, without the certainty of a replacement plan. While it can be easy to get caught up in the politics of health care, as ob-gyns our focus has always been on our patients and ensuring that they have access to safe, high-quality health care. That is why a critical part of our work here at ACOG is to advocate for the health of women, and as millions of people face the possibility of losing health insurance coverage in the coming months or years, ACOG’s work has never been more important.

Earlier this month, ACOG partnered with three leading medical organizations—the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Physicians—to urge Congress to avoid repealing the ACA without an immediate replacement which would protect and retain the landmark women’s health provisions in the law.

The ACA is not perfect. In fact, ACOG didn’t endorse it originally because we felt it didn’t meet the needs of our physician members. However, while there’s lots to improve, the ACA does include really important protections for our patients’ health. Insurers must now cover maternity and preventive care and contraceptives. It stops insurers from charging women more than men for the same coverage, prevents insurers from denying coverage to women who were victims of domestic violence or who had a Cesarean delivery in the past. The ACA also guarantees women direct access to their ob-gyns without any limitations.

The coverage provided under the ACA allowed many women to schedule routine doctor’s appointments for the first time in their lives. We all know that when people have insurance, they’re more likely to use preventive care like mammogram and diabetes screenings that prevent more costly and life threatening health problems down the line.

Whatever one’s reservations may be about the law, as physicians we know how devastating it would be for a cancer patient to suddenly lose her coverage or for a pregnant woman to go without prenatal care and deliver a baby preterm because she could no longer afford health coverage. The fact is, low-income women are more likely to suffer from often preventable pregnancy complications and, unfortunately, that is the very population that stands to lose the most unless Congress protects these important benefits, including Medicaid expansion.

Today, 31 states and D.C. have expanded their Medicaid programs, offering coverage to 11 million newly eligible individuals. The most important part of the expansion to women is that those Medicaid programs cover low-income women even if they’re not pregnant. Regular Medicaid programs routinely only cover pregnant women through delivery and a few weeks after.

But speaking more broadly, all women stand to lose essential preventive care if the ACA is repealed. Access to breast cancer screenings decreases women’s likelihood of dying from the disease by up to 50 percent. Routine cervical screenings decrease the odds of late-stage cancer diagnosis by 60 percent. Finally, when women have access to more choices of affordable and effective contraception, including IUDs and implants, rates of unintended pregnancy, unplanned birth, and abortion drop dramatically.

In 2016 alone, 6.8 million girls and women gained health insurance coverage. If the law is repealed, those gains will likely be lost. We cannot turn back the clock on women’s health. The care we provide doesn’t stop in our exam or delivery rooms. It’s our responsibility to advocate on our patients’ behalf and protect their access to affordable, comprehensive health care. So let’s mobilize and use our collective community’s influence and expertise to ensure access to health care in this country.

To become involved in ACOG’s advocacy efforts, join us at the 35th Congressional Leadership Conference, The President’s Conference in Washington, D.C., in March.