Endometriosis Awareness Month isn’t just about awareness of the disease. It’s also about understanding how its misogynistic, racist, and eugenic history has shaped how patients are treated today.
When the professionalization of midwifery into obstetrics and gynecology took place in the mid-19th century, women(1) were largely excluded from spaces that had once been entirely their own. Accounts of male physicians entering women’s healthcare and committing widespread abuses, while pathologizing and exploiting women's bodies, are well documented and have led to the modern medical mistreatment of women, and the diagnostic delays they face.(2) The history of endometriosis shares a similar story.
In the early 20th century, Harvard gynecology professor Joe V. Meigs described endometriosis as “the career women’s disease,” claiming it primarily affected “affluent and ambitious women who put off childbearing.”(3) This idea spawned from his observations that endometrial cysts appeared to diminish or disappear during pregnancy, and that less affluent individuals who produced multiple children were less likely to experience the disease. But instead of searching for biological causes of endometriosis, Meigs frequently suggested that young women with pelvic pain should marry and have children to stop the disease from progressing.
In a 1948 lecture at the American College of Surgeons, Meigs advised physicians to withhold contraception from their upper-class patients, arguing, “What is more pathetic than the girl who married and for economic reasons can’t have a baby, who later goes to her doctor with a sterility problem that cannot be solved?”(4) To Meigs, endometriosis posed a threat to the fertility of upper-class white women during a time of widespread concerns over “race suicide”(5) and the influence of eugenic beliefs. Instead of focusing his efforts on treating pelvic pain, he blamed working women for failing to follow “their biological laws.”(6)
Meigs also contributed to racial bias in endometriosis research and treatment. Because he believed the disease primarily affected educated, upper-class white women, he argued that lower-income women and women of color were less likely to develop it.
Today, we know that Meigs’ contributions are inaccurate. Yet the legacy of these myths still affects patients today. Many people with endometriosis continue to be told that pregnancy will cure their pain, despite evidence to the contrary.(7) And, for decades, students were taught that Black patients rarely had endometriosis. While it is estimated that endometriosis affects 1 in 10 women of reproductive age, today in the U.S. up to 72% of people diagnosed with endometriosis are white, despite the fact that there is no evidence that people of color are less prone to the disease.(8) Furthermore, even among the few people who are fortunate enough to finally receive a diagnosis, it often takes an average of five to eleven years to get there.(9)
Meigs' ideas left a lasting impact on medicine. Structural racism, diagnostic delays, failure to take patients’ pain seriously, and gaps in research funding all shape endometriosis care today.
While more funding is being allocated towards reproductive healthcare today, across both the research field and private sector, there is still a long way to go. To date, the gold standard of diagnosing endometriosis has been to primarily rely on surgical findings. Earlier this month, the American College of Obstetricians & Gynecologists (ACOG) established new clinical guidelines that expanded endometriosis diagnostic criteria to include patient history, physical examination, and imaging results.(10) This will hopefully decrease both the invasiveness of diagnostic surgery and reduce delays.
Emerging technologies for earlier detection and improved treatments provide a meaningful opportunity to improve reproductive healthcare.(11) However, these new innovations, often backed by venture capital due to their promising financial returns, must be developed and implemented with rigorous ethical care and deep sensitivity toward the patients and communities being affected, particularly those historically neglected or abused by medical systems. As we can observe from history, medical advancements can provide lifesaving care, but they can also coincide with harm towards marginalized and disenfranchised groups.
We must work together to ensure that history does not repeat itself. Technological innovations must be pursued carefully and ethically. Schools should teach students about menstrual health and conditions like endometriosis, Polycystic Ovary Syndrome (PCOS), and Premenstrual Dysphoric Disorder (PMDD). Reproductive pain must be de-pathologized as inherent to the female body. Persistent racial disparities and biases in medical research and care must be addressed, alongside support for policies such as menstrual leave that acknowledge the real impact of these conditions.
The lack of adequate care and attention given to conditions like endometriosis does not exist in a vacuum. It is a symptom of a long and deeply entrenched history of racism, misogyny, and eugenic ideologies shaping healthcare. As we recognize and celebrate Endometriosis Awareness Month, understanding this history, and recognizing the patterns and impacts of its legacy, we are able to work toward a more equitable and just future.
ENDNOTES
(1) While clinical studies and historical medical texts mainly categorized participants as "women," making it necessary to use that term to accurately describe the historical context, the medical or biological reality involves anyone with a uterus, including transgender men, non-binary people, and other gender-diverse individuals. See: Peters, Jessica R., Allison Stumper, Katja M. Schmalenberger, Andy J. Taubman, and Tory A. Eisenlohr-Moul. 2023. “Improving Rigor Through Gender Inclusivity in Reproductive Psychiatric Science.” Comprehensive Psychoneuroendocrinology 16 (July): 100194. https://doi.org/10.1016/j.cpnec.2023.100194.
(2) Cooper Owens, Deirdre. Medical bondage race, gender, and the origins of American gynecology. Athens, GA: University of Georgia Press, 2021.
(3) “The Pain That Punished Feminists.” Wellcome Collection. Accessed March 18, 2026. https://wellcomecollection.org/articles/XTg5FxAAACQAP5Ku
(4) Ibid.
(5) "Race suicide” is a 20th century eugenicist theory of a hypothetical situation in which the death rate of a particular "race" supersedes its birth rate. Its propagandic purpose was to induce fear among white populations that declining reproduction would lead to their replacement by immigrant races, often placing the blame on women. (“Encyc.” Binet-Simon intelligence test & new term “moron” endorsed by the American Association for the Study of the Feebleminded • Timeline • Eugenics Archive. Accessed March 24, 2026. https://www.eugenicsarchive.ca/encyclopedia?id=535eedb87095aa0000000250.)
(6) Meigs, J. V. “Social Ill Is Laid to Endometriosis; Women’s Ailment Restricting the Propagation of Intelligent Class.” New York Times, October 21, 1948. Accessed March 18, 2026. https://www.nytimes.com/1948/10/21/archives/social-ill-is-laid-to-endometriosis-womens-ailment-restricting-the.html
(7) Leeners, Brigitte, Fabia Damaso, Nicole Ochsenbein-Kölble, and Cindy Farquhar. 2018. “The Effect of Pregnancy on Endometriosis—Facts or Fiction?” Human Reproduction Update 24 (3): 290–299. https://doi.org/10.1093/humupd/dmy004
(8) Bougie, O., I. Nwosu, and C. Warshafsky. "Revisiting the Impact of Race/Ethnicity in Endometriosis." Reproduction and Fertility, vol. 3, no. 2, 2022, pp. R34–R41. https://doi.org/10.1530/RAF-21-0106.
(9) De Corte, Pauline, Moritz Klinghardt, Sophia Von Stockum, and Klaas Heinemann. 2024. “Time to Diagnose Endometriosis: Current Status, Challenges and Regional Characteristics—A Systematic Literature Review.” BJOG an International Journal of Obstetrics & Gynaecology 132 (2): 118–30. https://doi.org/10.1111/1471-0528.17973.
(10) “ACOG Publishes New Endometriosis Clinical Guidance, Aiming to Shorten Time to Diagnosis and Improve Access to Care.” 2026. ACOG. February 20, 2026. https://www.acog.org/news/news-releases/2026/02/acog-publishes-new-endometriosis-clinical-guidance-aiming-shorten-time-diagnosis-improve-access-care.
(11) O’Sullivan, Anna. 2026. “Endometrics Secures $600k NIH First Prize, Pushing Total Challenge Funding to $950k.” FutureFemHealth (blog). March 21, 2026. https://www.futurefemhealth.com/p/endometrics-secures-600k-nih-first?utm_source=substack&utm_medium=email.