Endometriosis Diagnosis: Identifying Symptoms in Black Women

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Endometriosis affects millions of women, but Black women face unique challenges in receiving proper diagnosis and treatment. A recent BDO discussion between health journalist Shameika Rhymes and Donna Adams-Pickett, PhD, MD, highlighted the critical issues surrounding endometriosis in the Black community and how healthcare providers can improve their approach.

Understanding the Diagnostic Delay

For many Black women, getting an endometriosis diagnosis can take years—sometimes decades. As Dr. Adams-Pickett explains, “I think it’s two things. I think it’s our community and our community, the medical community.”

This dual barrier stems from cultural expectations that Black women should endure pain without complaint, and medical professionals who often dismiss their symptoms.

“Our community has kinda taught us strong Black women to tap into our pain,” Dr. Adams-Pickett notes. “We are taught that ‘I just have bad periods.'” This normalization of pain means many women don’t seek help until their symptoms become unbearable.

On the medical side, Dr. Adams-Pickett points out, “In my community, the medical community, on our end, we buy into the strong Black woman trope. So if a patient comes in and is not weeping or appears very broken about it, then my colleagues will say, ‘Well, she can’t be in that much pain. It can’t be that severe.'”

Recognizing Warning Signs

Dr. Adams-Pickett warns providers to be particularly alert to these key indicators:

  1. Progressively worsening pain: “When we see the pain becoming progressively worse…if you started off with painful periods but as you get older, they’re becoming more and more painful, that’s usually an indicator of endometriosis.”
  2. Pain in unexpected locations: “If you start having other pains that are random, like leg pain, back pain, chest pain, but it exacerbates during your period, that’s an indicator of endometriosis.”
  3. Painful intercourse: “If you’re having worsening pain with intercourse, particularly with deep penetration…and you didn’t have those issues before, that can be an indicator of endometriosis.”
  4. Unusual bleeding patterns: “If you’re having bleeding in your urine and bleeding when you have bowel movements, particularly during the time of your period, those are things that can be an indicator.”

Improving Diagnostic Approaches

Dr. Adams-Pickett recommends starting with a transvaginal ultrasound as a minimum diagnostic tool. “Sometimes you may find that the endometriosis has actually coalesced into the ovary, and you have an endometrioma.”

Importantly, she notes a shift away from immediate surgical diagnosis: “We now know that laparoscopy is not the preferred method of diagnosis and treatment anymore.” Instead, doctors can often diagnose based on symptom response to treatment: “If a patient has a history that’s suggestive of endometriosis and we start you on those medications and all of the symptoms get better, that’s enough for us to say this is likely endometriosis.”

Treatment Considerations for Black Patients

Healthcare providers should approach treatment with a comprehensive plan that doesn’t immediately jump to hysterectomy. As Dr. Adams-Pickett emphasizes, “We have enough technology that we can try other things before we automatically do definitive surgery.”

Treatment options include:

  • Hormonal therapy to suppress ovulation
  • Nonsteroidal anti-inflammatory drugs on a regular schedule
  • GNRH antagonists and agonists that “tell the ovaries to go to sleep”

Supporting Patients Through the Journey

Doctors must recognize the mental health impact of chronic pain. “It is such a drain on your emotional well-being because no one wants to walk around with the background noise of pain all the time,” Dr. Adams-Pickett explains.

She encourages physicians to validate patients’ experiences: “Acknowledge that your pain and your symptoms are real. They are not in your head.”

For patients struggling to have their concerns taken seriously, Dr. Adams-Pickett recommends suggesting a pain diary: “Sometimes you actually have to walk in with a pain diary or symptom diary.”

Looking Forward

By understanding the unique challenges Black women face with endometriosis diagnosis and treatment, healthcare providers can help break the cycle of dismissal and delayed care. Through validating patient experiences, recognizing warning signs, and implementing comprehensive treatment approaches, doctors can significantly improve care for Black women suffering from this debilitating condition.

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