Evidence of meeting #92 for Health in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was surgery.
A video is available from Parliament.
Professor Emeritus, Department of Obstetrics and Gynecology, University of Ottawa, As an Individual
No, the 40% was 40% of infertility patients—
Professor Emeritus, Department of Obstetrics and Gynecology, University of Ottawa, As an Individual
—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.
Conservative
Anna Roberts Conservative King—Vaughan, ON
Will women with endometriosis, if it's curable or treatable, be able to have children?
Professor Emeritus, Department of Obstetrics and Gynecology, University of Ottawa, As an Individual
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. The treatment can be as simple as an intrauterine device, a Mirena. You don't get pregnant with this, but hopefully between pregnancies you are maintaining a milieu for the endometriosis that is suppressing estrogen. The same thing can be done with a low-dose birth control pill. These are both easily obtainable. If the endometriosis is more severe, then you have to bring out the bigger guns, and funding is a problem with that.
You need to have an understanding that endometriosis can rear its head anytime before menopause, so you need to follow that patient. You need, in this case, to do a pelvic examination, because that is the easiest. The pelvic examination includes a rectovaginal examination because that's where endometriosis flourishes, in nodules that cause pain.
There is a follow-up procedure to endometriosis, and unfortunately, in the countries that we mentioned, it is not perfect either because it is not a one-stop thing. It is something that goes on until your periods stop.
Liberal
The Chair Liberal Sean Casey
Thank you. I am sorry, but that is your time.
The last round of questions for this panel will come from New Brunswick—Fredericton or Oromocto.
Mrs. Atwin, please go ahead for five minutes.
November 29th, 2023 / 9:25 p.m.
Liberal
Jenica Atwin Liberal Fredericton, NB
Thank you very much, Mr. Chair.
Thank you to the witnesses for being with us this evening.
I was at a different committee. I just popped in for the second half, but, my goodness, I've learned a lot in this short period of time. I think that speaks to just how important the awareness piece is and how there is such lack of awareness, in general, in Canada about this.
I'm struck by the first time I was ever introduced to the issue of endometriosis. It was through a friend of the family—a Mi’kmaq woman here in New Brunswick—and her journey in finally receiving an endometriosis diagnosis, after years of that denial we talked about. I'm thinking particularly of the mental health impacts of not being believed. Then, of course, add that to the layer of being a Mi’kmaq woman.
I wonder if any of our witnesses this evening would like to address this topic—how we need to look at the issue with a lens of intersectionality, as well, in order to understand some of the systemic barriers and discrimination within our health care system, and how much harder it is for indigenous and, in particular, racialized women to receive this diagnosis.
This is for anyone and everyone who would like to comment on that.
Professor Emeritus, Department of Obstetrics and Gynecology, University of Ottawa, As an Individual
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. Black women have that.
There certainly needs to be some idea of what the incidence is.
Liberal
Executive Director, EndoAct Canada
Thank you, Mr. Chair.
Something we hear from women with endometriosis is that the very first step is believing them when they say they're in pain. We know people from different underserved groups are believed less commonly in the health care system. We know, for example, that Black women talk about the narrative of “the strong Black woman”—that they feel pain differently or don't feel pain. A lot of folks with endo talk about being accused of drug-seeking when they go to the emergency room looking for care.
We already know those biases exist in the system, and they just stack up with endometriosis. Already, if you're a woman, there might be a feeling that you're being “hysterical”. You might then also be considered to be drug-seeking.
There are so many biases that pile up for this population. We have a good sense of what they are. I think the next step is to start addressing them in different ways in the health system.
Liberal
Jenica Atwin Liberal Fredericton, NB
Excellent. Thank you very much.
If any other witness would like to add to that, please feel free to do so.
I certainly have another question, as well.
Liberal
The Chair Liberal Sean Casey
Dr. Mattatall is applauding, but I'm not sure if that means she wants in.
Obstetrician-Gynecologist, As an Individual
No, I was just impressed with Ms. Wahl's comment.
Liberal
Jenica Atwin Liberal Fredericton, NB
Thank you very much.
Dr. Zakhari, my time is wrapping up, but you mentioned some of your experiences, I believe, in the European health care system.
I'm wondering if you can pull from that experience and draw on some of the things we could be focusing on with regard to a national action plan. You mentioned models exist and there are some things we can learn from them.
In our final minutes here, what are some key things we need to focus on for a national action plan that perhaps could be pulled from some of those European models?
Co-Director, Endometriosis Centre for the Advancement of Research and Surgery, McGill University Health Centre
While I completely agree with Dr. Allaire that the Australian model is probably our best bet of what we can emulate, I think the key thing is this: The first step is bringing together a working group of people who have a vested interest and the expertise, and to have patient advocates on board who can help us identify their priorities, as well. I don't think we need to completely reinvent the wheel. We have, as we said, good models that we can work off to create something unique for Canada that fits our structure and system, and that fills in all the gaps we've discussed at this meeting today, among others.
Then, make sure that, if Canada sets forth endometriosis as a priority.... I'm sure that, if we lead, the provinces will follow. Every province will find a way to structure their care, incentivize hospitals to make endometriosis a priority, identify key centres that have expertise, and invest heavily in them. That way, patients and resources will know where to go to keep building our endometriosis framework in Canada. A lot of it comes from gathering data and statistics, and from understanding our population. The second part of that is going to be action, of course.
If there's more time, I'm happy for anyone to jump in and throw in their two cents.
Liberal
The Chair Liberal Sean Casey
Dr. Zakhari, you got the last word. Thank you so much.
Colleagues, just before we wrap-up, this is a reminder that when we get together on Monday, it's going to be for three hours. In the first two hours, we will begin our study of the opioid epidemic with departmental officials, and at one o'clock, we'll be hearing from witnesses for the study of the advance purchase agreements with Medicago.
To our panel with us this evening, your expertise, your experience and your passion are evident. We thank you so much for being with us. I think absolutely everybody here—even the medical doctors—learned a lot. It will be of significant value as we go forward with this study on women's health.
Thank you so very much for being with us.
Is it the will of the committee to adjourn the meeting?