Gynecologic Surgery Delayed for Up to 3 Years in Canada

For many women facing the debilitating effects of gynecologic conditions like endometriosis and uterine fibroids, access to timely treatment in Canada is sorely lacking.

Wait times for gynecologic care are remarkably long. According to a report from the Women’s Health Coalition of Ontario, some tertiary centers have wait-lists of 800-1500 patients. A growing number of women are traveling to the US, Mexico, and India to access basic gynecologic healthcare.

While the commonly quoted prevalence of endometriosis among Canadian women is roughly 1 in 10, Sony Singh, MD, chair of Obstetrics and Gynecology at the University of Ottawa, Ottawa, places the figure at 20%-50% among women with menstrual pain or infertility. An estimated 50%-80% of women have fibroids, depending on their racial and ethnic background.

Major delays occur at every point in the patient journey, from imaging and diagnosis to surgery. Before the COVID-19 pandemic began, the average period from diagnosis to treatment in Ottawa was 7-10 years. Since then, wait times have increased by 2 years, and some patients report a 12-year delay for an initial assessment.

Women with complex cases can wait 2 or 3 years for surgery. Often, the condition is so far advanced by that time that it requires more serious intervention. Untreated endometriosis can lead to kidney death and bowel obstruction, and fibroids can grow into 2- and 3-pound tumors, thus resulting in massive bleeding and infertility.

Sexism in Medicine

Physicians and patients are using the term “gaslighting” to describe the dismissive attitude that women frequently encounter in their search for proper medical care. “There is clear sexism in medicine. The prevailing thought is, “It’s not cancer; therefore, it’s not important.” Delays in care adversely affect women’s wellness and cause overutilization of the healthcare system,” Singh told Medscape Medical News.

“The surgical bottleneck is due primarily to economic factors,” Singh continued. “Unlike orthopedic, cardiac, and cataract surgeries, for example, urogynecology and complex gynecologic procedures are being deprioritized, as they aren’t revenue-generating for hospitals. Imaging in women’s pelvic health is terrible because it hasn’t received the attention it deserves. What pays well is large volumes of imaging, so it’s easier to process imaging quickly rather than paying proper attention to accurate evaluation. Many technicians interpreting ultrasound results don’t have adequate expertise to interpret them, and results frequently are reported as normal or not significant.”

Jonathon Solnik, MD, head of Gynecology at Sinai Health and Women’s College Hospital, both in Toronto, explained that women with pelvic organ prolapse, urinary incontinence, and especially endometriosis have some of the longest surgical wait times. “This is a multifactorial issue. Ontario has a shortage of surgeons skilled at treating these types of conditions in relation to the population’s needs. We have a growing baby boomer population with increasing health needs. This [situation] is compounded by too few facilities [being] available to provide the needed surgical care. Surgeons are working at or beyond capacity, and our ability to recruit new surgeons is limited, in part, because we don’t have anywhere to put them,” said Solnik. Women’s College Hospital has received additional funding from Ontario Health to optimize the number of available operating rooms in Ontario.

In 2024, four Toronto Academic Health Science Network hospitals — Women’s College Hospital, Sunnybrook Health Sciences Centre, Mount Sinai Hospital, and Humber River Health — launched a collaboration to reduce the backlog of gynecologic surgeries through resource sharing.

Several Ottawa regional hospitals have created capacity to increase access to noncomplex women’s health surgery, but it’s the older and most vulnerable women requiring complex surgeries who experience the longest wait times. Comorbidities in this population make these delays even more serious.

Gynecologic Pain Normalized

Flora Kestin had extreme pain, blood clots, and exhaustion resulting from endometriosis and adenomyosis for 14 years before she received a diagnosis. She waited nearly a year for an exploratory laparoscopy for endometriosis and then another year for a hysterectomy. Kestin became bedbound, unable to function and take care of her two young boys. Like many women, Kestin felt ignored and invalidated when doctors repeatedly told her, “It’s all in your head. See a psychiatrist.” Kestin felt as though she was living in a vacuum. “When you return home from hospital, you’re left with no support or guidance.”

Nam Kiwanuka, co-host of The Agenda on TVO Today, has openly discussed her ordeal with fibroids and adenomyosis. In 2022, Kiwanuka began having severe menstrual bleeding and pain that led to near-weekly visits to hospital emergency rooms. A laparoscopic hysterectomy was discussed, but by the time she had surgery 2 years later, her fibroids were so advanced that some of her organs had fused together, requiring an open hysterectomy. “I was in terrible pain and couldn’t function normally as a result. People take cancer seriously, but pain from conditions like fibroids and endometriosis has become normalized. It’s unacceptable that women are still begging to be heard, begging to be helped,” said Kiwanuka.

“We’ve seen hundreds of years of dismissal, and our healthcare system needs a major correction. You can’t just say you want to improve women’s health. You have to be active and aggressive to push the agenda forward,” Singh concluded.

Singh, Solnik, Kestin, and Kiwanuka reported having no relevant financial relationships.