(Photo by Ang Tek Gie via Catalyst Planet/CC BY-NC-SA 4.0 DEED)
Note: This article discusses violence against Indigenous women, including forced sterilization.
Although endometriosis affects millions of people who menstruate, the health condition remains widely misunderstood and routinely dismissed. Globally, around 190 million people live with the condition. In Canada, endometriosis affects about “1 in 10 women, along with an unmeasured number of transgender, non-binary, and gender-diverse people.”
Despite its prevalence, endometriosis is rarely diagnosed. A national survey from 2020 found that only 7 percent of women in Canada with endometriosis received a clinical diagnosis, while many wait an average of five years (often far longer) for diagnosis and treatment.
Still, Indigenous women face a greater risk of undiagnosed and untreated endometriosis. Unequal access to care, ongoing systemic barriers, and a long history of gynaecological violence under colonialism prevent many Indigenous women from receiving adequate and necessary treatment.
What is Endometriosis?
Endometriosis is a chronic health condition in which tissue similar to the lining of the uterus grows outside the uterus in other parts of the body, such as the ovaries or fallopian tubes. During the menstrual cycle, endometriosis tissue behaves like the uterine lining and bleeds. Because it grows outside the uterus, the bleeding tissue cannot “leave the body.” As a result, many people experience inflammation, scarring, and pain.
While many people experience discomfort during menstruation, people with endometriosis often experience pain that is far more severe and can worsen over time. Symptoms can include intense menstrual cramps, ongoing pelvic pain, fatigue, bloating, and pain during sex.
Beyond physical pain, endometriosis impacts people’s daily lives. Many people with endometriosis struggle to work or attend school because of frequent debilitating pain. This can lead to lost income and increased financial stress, especially when people have to pay for medical care. Stigma and the common dismissal of menstrual pain make these challenges even worse, leaving many to suffer in silence.
The exact cause of endometriosis remains unknown. There is also currently no permanent cure for it. Treatments aim to manage symptoms and limit long-term impacts, using pain medication, hormone therapy, or surgery. However, many people with endometriosis struggle to access early diagnosis and effective treatment.
Facing Endometriosis: Challenges for Indigenous Women in Canada
Although many people praise Canada for its publicly funded and “free” healthcare, access to adequate treatment remains uneven. Indigenous communities face the largest gap, shaped by historical and ongoing systemic inequities.
In 2015, the Truth and Reconciliation Commission created a series of “Calls to Action” after investigating the lasting effects of residential schools on Indigenous communities in Canada. Calls 18-24 specifically focus on health, urging the federal government and healthcare providers to “identify and close the gaps in health outcomes” between Indigenous and non-Indigenous communities. Ten years later, Indigenous People continue to face major barriers to accessing health services as many federal and provincial healthcare providers minimize Indigenous health in practice.
A 2020 review in British Columbia, involving 2,780 Indigenous participants and 5,440 healthcare workers, confirmed widespread anti-Indigenous racism across the province’s healthcare networks. Indigenous patients reported how healthcare staff dismissed their health concerns and refused to believe their pain, resulting in fewer referrals for diagnostic imaging and specialist care.
Doctors may use imaging tests like ultrasound or magnetic resonance imaging (MRI) to look for endometriosis. However, imaging alone often cannot definitively detect the disease, and doctors usually need to perform a laparoscopic surgery for diagnosis. Referrals for laparoscopic surgery can be difficult to obtain. Thus, patient-reported pain plays a critical role in identifying endometriosis and providing support for a surgery referral.
Both Endometriosis Network Canada and Health Canada acknowledge that Canadian healthcare systems have historically neglected Indigenous People with endometriosis and continue to overlook their needs. For a condition like endometriosis, which already lacks a simple diagnostic test, the absence of validation and care for Indigenous patients from healthcare providers can delay diagnosis and treatment for years.
Invisibility in Medical Research
Early flawed medical literature framed endometriosis as a disease that primarily affected wealthy white women, leading to the under-diagnosis of non-white patients. As a result, endometriosis research and literature fail to reflect the experiences of non-white populations, contributing to poorer health outcomes for Indigenous women.
As awareness of endometriosis increases, researchers and advocacy organizations recognize the need for “diverse representation in clinical research”, highlighting that studies must include patients from undeserved and underrepresented communities to improve care. At the same time, Indigenous women remain largely invisible in endometriosis research. This absence of research limits understanding of how endometriosis affects Indigenous communities and reinforces harmful myths that the disease is rare among Indigenous women, rather than under-diagnosed and overlooked.
The Endometriosis Network Canada has acknowledged the need to reach undeserved and historically excluded communities through outreach efforts such as its Endo Ambassador Program. While this represents a starting point, awareness initiatives must be matched with sustained funding and accountability to Indigenous People to avoid preformative inclusion. Without data, advocating for resources and endometriosis specialists becomes increasingly difficult.
Diagnostic Delay and Limited Access to Specialists
As of January 2026, Endometriosis Network Canada reports that fewer than 100 surgeons across Canada specialize in endometriosis, with no surgeons listed in northern regions. Most endometriosis specialists work in large cities such as Toronto, Vancouver, and Montreal, forcing many Indigenous women to travel long distances for care. For example, Indigenous women from the Kwanlin Dün First Nation in the Yukon, a region in northern Canada, can seek endometriosis treatment at Whitehorse General Hospital, but often need to travel out of the Yukon for laparoscopic surgery. This often means flying four to six hours to the BC Women’s Centre for Pelvic Pain and Endometriosis in Vancouver.
Travel can be exhausting and expensive. Recovery from an endometriosis laparoscopic surgery requires at least 1-2 weeks of rest due to limited mobility and 4-6 weeks for full internal healing. Patients often must wait at least a week until they can travel again.
Indigenous women with endometriosis face additional delays because federal and provincial healthcare systems often disagree over who covers tests, specialist referrals, or medical travel. This discrepancy frequently results in inconsistent and denied financial access to care.
These barriers make it clear that diagnostic delays are more than clinical issues—they stem from systemic inequalities in Indigenous health.
Colonial Impact on Menstrual Health Care
Before colonization, many Indigenous communities maintained community-based knowledge systems and practices that supported menstrual health.
Among Inuit communities, menstruation was understood as more than a physical process, but part of a broader “physical and mental connection” between a woman’s body, mind, and environment. Menstruating women could also “possess unique powers of intuition and connection to the spiritual realm”, which needed to be supported and treated with respect. Thus, it was a time to rest and retreat.
In Cree communities, menstruation was similarly recognized as a sacred phase of life connected to creation and renewal. The “moon time,” referring to a woman’s period, was considered a time for women to focus and renew their spiritual well-being.
Colonization violently disrupted these systems, replacing them with medical practices that re-framed menstruation as a shameful problem and took away Indigenous women’s control over their bodies. As Iqaluit artist Laakkuluk Williamson asserts, “colonization has made a taboo and a financial tariff of menstruation.”
The lack of menstrual equity in Canada continues to disproportionately affect Indigenous communities, particularly in remote and northern regions. Indigenous-led grassroots organizations such as Moon Time Connections are working toward menstrual equity by providing menstrual products and education in northern Indigenous communities. These efforts aim to address long-standing stigma and colonial legacies around menstruation by centering on Indigenous cultural practices and perspectives on menstrual health.
History of Colonial Gynaecological Violence
Generations of abuse have left many Indigenous women wary of accessing healthcare. This mistrust is rooted in centuries of colonial gynaecological violence and forced sterilization.
In the 1970s alone, approximately 1,200 Indigenous women were coerced and forced into sterilization. In British Columbia, the Sexual Sterilization Act gave the B.C. Board of Eugenics the right to make decisions to sterilize Indigenous women without their consent and knowledge in order to “purify” society.
Sterilization is a form of sexual assault and state violence against Indigenous women, and consequently deprives Indigenous women of their fundamental right to reproduction and bodily autonomy.
Although British Columbia repealed its Sexual Sterilization Act in 1973, coerced sterilization of Indigenous women has persisted well into the present in Canada—including in British Columbia, Manitoba, Saskatchewan, and Quebec. In 2019, more than 100 Indigenous women came forward saying they were sterilized without informed consent, including one reported case as recent as 2018.
The psychological and physical consequences of forced sterilization are profound. Survivors have described lasting trauma, painful menstrual cycles, chronic pain, and a sense of lost identity. For many Indigenous women, repeated gynaecological exams and invasive diagnostic procedures, which are common in endometriosis care, can be re-traumatizing. This trauma can lead to avoidance of medical care and worsening of their symptoms.
Moving Towards Culturally Safe Care and Indigenous Body Sovereignty
Although there is currently no cure for endometriosis, earlier diagnosis and access to culturally safe care may slow disease progression and reduce long-term impacts.
Canada requires a fundamental shift in how health-care systems understand, deliver, and evaluate care for Indigenous women. Culturally safe care, a concept rooted in Indigenous health scholarship, goes beyond cultural awareness or sensitivity and instead focuses on disrupting power imbalances and colonial structures rooted within medical institutions.
In practice, this means healthcare providers must acknowledge the historical and ongoing impacts of colonialism and reflect on how these histories shape Indigenous women’s interactions with health systems today. It also requires trauma-informed, consent-based care that prioritizes listening and respect, particularly in gynaecological settings where Indigenous women have experienced profound harm.
For Indigenous communities, culturally safe care for endometriosis can take many forms. In some communities, this may involve integrating cultural healing practices and traditional medicines into care models. In others, it may mean ensuring access to Indigenous health care providers, women-only clinical spaces, and “Indigenizing” menstrual education.
Central to all approaches is Indigenous body sovereignty, which upholds the right of Indigenous women to make informed, uncoerced decisions about their bodies and health. In the context of endometriosis, body sovereignty is critical. Indigenous women must have agency over how their pain is evaluated and what treatment options are appropriate for them. Respecting this sovereignty is essential to counteract a long history of gynaecological violence and reproductive control under colonialism.
Edited by Lubaba Mahmud
