Health committee  In British Columbia, I think we're probably unique in Canada in having probably the most pelvic physiotherapists. Our physiotherapist told us there was a certificate she had to do to get that designation, although some may choose to call themselves that without the designation and without the certificate, because there's no governance of that, I believe.

Health committee  Will my answer be interpreted into English?

Health committee  As you said, not all countries can be directly compared to Canada, of course. That said, we looked carefully at the program in Australia. We even met some people from Australia who came to spend some time with us and talked with them a lot. Their political system is quite similar to ours, including federal health transfers.

Health committee  The first line medical therapy that family physicians would start with would be something simple: oral contraceptive pills, even taken continuously, progestin-containing IUDs, which can help quite a bit with dysmenorrhea, or sometimes progestin-only therapies, which is the next level of therapy.

Health committee  Thank you. That's a very important problem considering the size of our country. Having centres of excellence is one thing, but having access for the whole community and the whole province is very important. I think there are basically the frontline providers. We have to mention the family physicians, who will be the ones who have to be educated to recognize the possibility of endometriosis, to initiate first-line treatment and then to really promptly make a referral once the first-line treatment doesn't work.

Health committee  I would be pleased to answer in French if you wish. Let me get back to your question, which is similar to what someone else asked about access to care. Access to surgeons was mentioned, among other things. Many surgeons have received excellent training in Canada. Fourteen research grants have been awarded in laparoscopy and endometriosis, but the surgeons end up working in the communities and no longer have operating time.

Health committee  Everyone knows that the pandemic was devastating to the medical system. All non-urgent cases were set aside during the pandemic. Only cases of cancer and trauma were treated. This created major problems in health care, and we are struggling to get back to normal. We are trying to catch up, but are not there yet.

Health committee  I'd be happy to. I think your points are very well taken, and certainly the teenager who has abnormal periods may not know they're abnormal. There is certainly a difficulty with sharing that information. Sometimes there is still a certain mystery and certain taboo about discussing menstruation.

Health committee  I'll speak to the national action plan, because that's certainly something EndoAct has put forward as something that can be emulated following the example that Australia has set for us. They have been very successful so far with their plan at obtaining funding. The three arms are always awareness education, access to quality care or for evidence-based care, and research funding.

Health committee  Thank you, Mr. Chair and members of the committee for the opportunity to provide evidence today about endometriosis for the women’s health study. We are grateful to the committee for prioritizing this issue. I am Dr. Catherine Allaire. I'm a gynecologic surgeon. I'm also head of the UBC division of gynecologic specialties and medical director the B.C. women's centre for pelvic pain and endometriosis, an interdisciplinary centre we have in Vancouver for endometriosis care.