For generations, Black women with debilitating pelvic pain have been dismissed and disregarded. They have been told it’s just cramps or to take Ibuprofen. They have been instructed to lose weight, eat better, or reduce their stress. They have been labeled as dramatic or difficult. Their pain has been attributed to everything, but what it so often is: endometriosis.
Endometriosis is a chronic condition traditionally associated with period pain, but it doesn’t just live and grow around the uterus, tubes, and ovaries. It can affect the bowels, bladder, diaphragm, lungs, and even the brain. It is a leading cause of infertility and can cause daily, life-altering pain. And yet, it takes an average of seven years to diagnose. That’s seven years of inflammation, seven years of frustration, and seven years of wondering if the pain is somehow your fault.
As an OB/GYN, I know how this happens. Because I was trained inside the system that helped create it. In medical school, I was never explicitly told that endometriosis was a White woman’s disease. But I didn’t have to be. The pattern was clear as day. In case studies and exam questions, when a young Black woman presented with chronic pelvic pain, the answer was often pelvic inflammatory disease. When a White woman of the same age presented with the same symptoms, the answer was often endometriosis.
You see, medical training relies heavily on pattern recognition. You learn to identify clues quickly. And when you’re studying for an exam with thousands of facts competing for space in your brain, you follow the pattern that gets you to the right answer. But I recognized the bias even then. And I wondered how many generations of physicians never even questioned it. I also shuddered at the thought of how many patients paid the price for it.
The price of bias in medical education isn’t theoretical. It looks like Black women returning to emergency departments repeatedly without getting answers or relief. It looks like being labeled as “drug seeking” or “non-compliant” when the medicine doesn’t help. It looks like delayed options for fertility treatments because the diagnosis came far too late. It also looks like depression, missed days from work, strained relationships, and unnecessary procedures and tests.
I’ve known this for years, which is why when I saw this announcement on Instagram, I stopped scrolling. The American College of Obstetricians and Gynecologists (ACOG) released new endometriosis guidelines with a stated goal to “speed up diagnosis and reduce barriers to care.” ACOG is the leading professional organization for OB/GYNs in the United States. Its practice bulletins shape how med students are taught, how residents are trained, how physicians practice, and how patients are counseled. When ACOG updates guidance, it reverberates through exam rooms across the country. And this update is significant.
The new guidelines redefine endometriosis as a “chronic, inflammatory, estrogen-dependent disorder” that “can affect multiple systems in the body.” That may sound like a minor wording shift, but it marks a profound departure from older descriptions that framed it primarily as a “gynecologic condition” defined by pelvic pain and infertility. This matters because definitions inform perceptions, and perceptions shape diagnoses.
The new guidelines also recommend moving away from requiring surgical confirmation before making a diagnosis. Historically, patients were told that endometriosis could only be definitively diagnosed through surgery, a barrier that contributed to delays and limited access to care. The new guidance supports symptom-based clinical diagnosis, acknowledging that while it may not be perfect, reducing delay and increasing access to treatment matters more. That alone is major progress. But tucked within the section on barriers to timely diagnosis was something I have waited more than a decade to see in writing.
The guidelines acknowledge that marginalized and minoritized individuals experience greater barriers to diagnosis. They reference data showing that Black women are significantly less likely to be diagnosed with endometriosis and go on to clarify that this disparity does not necessarily reflect lower prevalence. Then they say what many patients (and quite a few of us inside the profession) have known for years, that racially biased and erroneous beliefs about biological differences between Black and White individuals, perpetuated in medical education and clinical practice, contribute to inequities in diagnosis. But that’s not all.
They go further, naming the dangerous perceptions that endometriosis is a disease of White women and that Black women experience pain differently or have a higher pain tolerance, two beliefs that can lead clinicians to dismiss or underestimate pelvic pain and fail to consider endometriosis in the differential diagnosis. I have never seen guidelines with language like that from a national medical organization in my field. For the first time in my career, what was always hidden was finally brought into the light.
Now let me be clear, this acknowledgment does not undo generations of harm. It doesn’t automatically eliminate the diagnostic delay. It doesn’t magically ensure that every Black woman who walks into a clinic tomorrow will be believed. But it removes the excuse, the justification allowed by ignorance, or the defense of “I didn’t know.” It also sets a new standard for training. It signals to residency programs that this bias must be addressed explicitly, intentionally, and repeatedly. It gives physicians the permission and responsibility to interrogate the patterns we were taught. And it gives patients validation.
If you are a Black woman living with severe period pain, pain with intercourse, chronic pelvic pain, painful bowel movements, pain with urination, or unexplained infertility, this moment matters. The leading organization in women’s health has acknowledged that bias plays a role in delayed diagnosis. So you deserve a thorough evaluation. And you deserve a clinician who considers endometriosis as an initial possibility, not as an afterthought.
In a time when Black women are fighting to be believed in labor and delivery rooms, emergency departments, and exam rooms across the country, this shift isn’t minor. It’s part of a larger reckoning within medicine. Systemic harm improves only when the system changes. The new guidelines will not fix everything, but they do change the narrative. And medical narratives shape how care is given and how it is received.
Maybe the next generation of physicians won’t subconsciously associate endometriosis with a patient of one race over the other. Maybe the next Black girl curled up in the fetal position from menstrual pain won’t spend her twenties searching for answers. Yes, the average diagnostic delay has been seven years. But for too many Black women, it has been far longer.