By Megan Kirk
Together with Women’s History Month, March also ushers in an important issue affecting more than 190 million women globally — endometriosis. Though studies show Black women are less likely to be diagnosed, the journey to the discovery of endometriosis is murky for Black women and made even more complex with a history of lack of medical access.
Endometriosis is a common gynecological condition where the endometrium, or the tissue lining the uterus, begins to develop outside of the uterus, sometimes into the Fallopian tubes, bowels, bladder, and most commonly the ovaries. Sometimes impacting reproduction, endometriosis can create circumstances that can increase the likelihood of infertility.
“Sometimes it can significantly affect the fertility, especially if the woman has endometrioma, which is ovarian cysts caused by ovarian endometriosis. Sometimes with advanced endometriosis, there will be scarring around the Fallopian tubes which can negatively impact the fertility of the woman,” said Dr. Omar Zwain, a minimally invasive gynecologic surgeon with Ascension Providence Hospital.
Black women and reproductive health have been at odds as they search for doctors they can trust. Though African American women are predisposed to several risk factors in reproductive health, endometriosis is a chronic condition that can silently impact all reproductive age women despite race. However, misinformation about the frequency in which Black women are diagnosed is beginning to spread, leading to a false sense of health security and a misconception that Black women are exempt from the illness. Despite lesser rates, Black women, too, can develop the condition.
“Generally speaking, the prevalence is not affected. There are some studies that show that white women and Asian women, when compared to Black women and Hispanic women, have a higher prevalence of endometriosis,” said Dr. Zwain.
As diagnosis is not always clear, it is expected that endometriosis affects up to 10% of women ages 25 to 40. Though some women experience no symptoms, others face painful side effects of the condition. Often confused with other pelvic conditions, endometriosis is not screened for during standard gynecological check-ups thus making it more difficult to diagnose.
“The symptoms of endometriosis can vary. The common symptoms for endometriosis are pain during menstrual cycles and also pain during sexual intercourse. Some women will have ovarian cysts and some women will have infertility,” said Dr. Zwain.
For Black women, a systemic issue rooted in race gives way to the notion that they are more tolerable of pain. For decades, Black women have faced disparities and racial discrimination in medicine. Disproportionate rates of hysterectomies in Black women have created a fear of not only the medical system, but of reproductive health in particular.
While the cause is unknown, endometriosis can form as early as puberty and takes some women years and many painful episodes before being diagnosed.
“It’s really hard to assess the prevalence of the disease because usually we’ll have a woman come with these complaints. We can’t screen everyone for it. For example, for cervical cancer, we have screening like the Pap smear. But for endometriosis, it’s hard,” said Dr. Zwain.
Unlike some reproductive conditions in women, including the development of fibroids, which impact Black women at a higher rate than other demographics, endometriosis is not believed to be affected by genetics.
“In certain situations, familial association of endometriosis has been suggested. There is a familial association of endometriosis, but [it] is not genetic,” said Dr. Zwain.
Women are encouraged to pay special attention to their bodies, particularly around their menstrual cycles as it can provide insight into uterine health. Using it as a guide to better gauge reproductive health, doctors will assess the history of the menstrual cycle to determine certain ailments within the uterus and its surrounding structures.
“Always make sure that you don’t miss your annual wellness exam and if you are experiencing any unusual symptoms, like significant pain during your menstrual cycle [or] you notice some worsening of the cramps and pain during your menstrual cycle, heavier menstrual cycles, always consult with your gynecologist and ask for evaluation for that,” said Dr. Zwain.