Health committee  No, the 40% was 40% of infertility patients—

Health committee  —have endometriosis. It is one in 10 women. Ten per cent of women in Canada have endometriosis if we look at the total population, but 40% of infertility patients is quite a lot.

Health committee  To keep endometriosis under control, you have to look at this as a lifelong matter, and very often—most often—you go to a gynecologist, you have your endometriosis surgery and then you go back to your family doctor without any appropriate follow-up. The follow-up should be some treatment, especially if there are symptoms.

Health committee  We need data. We need to know what the incidence of endometriosis is in areas where we have not looked. This even includes the United States and their indigenous populations. Once you get that data—this could be commissioned by the federal government—look at what the impact is on women of aboriginal status, or on those who have an increased risk, if you wish, of endometriosis.

Health committee  Okay, I'll try. There are issues regarding cognitive function—fear, depression, anxiety, living with the fear of the pain every month and the sequelae of that. It's gritting your teeth when you have sexual intercourse and not having the ability to have a comfortable bowel movement.

Health committee  It must be nipped in the bud so that you have, with the early diagnosis, that support system from an empathetic, kind physician, who understands and doesn't normalize it and say, “There, there, that's what women have to have. Go and get pregnant and that will take care of everything.”

Health committee  Premature menopause is defined as menopause that occurs before age 40. We know that. Ages 40 to 50 is the perimenopausal range. Most of the patients with endometriosis who enter into menopause have to have ablation surgery, which means having a hysterectomy and their ovaries out.

Health committee  Well...

Health committee  Looking in Canada and abroad at some of the data we have, 40% of infertility patients have endometriosis. The endometriosis can be minimal, or it can be moderate. It's staged from one to four, and you can guess that four is the worst. If you have stage four with chocolate cysts, there's no question you need to have surgery, because it is often symptomatic.

Health committee  Well, okay, God, how did you know? It's an interesting problem.

Health committee  Well, there are mandatory programs and you get certain points for going to certain CMEs, so you have to apply for this. It's important to know that if you don't attend a certain number of CMEs, you don't get your professional points. I've not heard of anything very bad that happens if you don't get these points, but they certainly are important.

Health committee  They're so important. They are training centres as well. They are training physicians at all levels and training in medical schools. What happens is, it's a wonderful surgery. The residents love it and they want to take extra time because it's like “wow” surgery. Menopause is...not so much.

Health committee  There's other stuff, too.

Health committee  I'm not sure about that.

Health committee  There is progress being made in Ontario to fast-track individuals so that they don't have to drive cabs and don't have to wait, if they have the training and if they pass the medical exams, because the council of medicine must have Canadian participation. However, many of those people do.