Pamela Price vividly remembers her distress.

She had endured debilitating menstrual cramps, heavy bleeding and irregular cycles throughout her 20s – pain that only became more excruciating when trying to complete daily workload – carrying loads weighing 20 pounds or more at times. When seeking medical assistance at medical clinics she would receive a prescription of Ibuprofen and be sent away again.

Price would later learn she was suffering from endometriosis, a pelvic pain condition caused when tissue that normally lines the uterus proliferates outside it and forms growths called endometrial implants. While most people take seven years before receiving an endometriosis diagnosis, Black women like Price are significantly less likely to receive one at all due to implicit bias from healthcare providers (HCPs) who tend not to recognize pain on Black patients than when treating white ones.

Price’s diagnosis was also delayed by her time spent serving in the U.S. Army; while healthcare coverage is available, accessing appropriate care can often be more challenging for service members and veterans than civilian counterparts. Studies have also indicated that women serving in these branches experienced higher rates of pelvic inflammatory disease, fibroids, endometriosis and heavy or prolonged menstrual bleeding compared to civilian counterparts.

Not much is known about why women in the military are more likely to experience uterine conditions, but Price suspects the pressures imposed by military service could trigger or worsen health issues. Environmental and physical demands placed upon soldiers as well as being taught to disregard symptoms could all play a part.

Care is also a concern. Female soldiers will typically begin receiving care at their Troop Medical Clinics, Price explained. Unfortunately, our TMCs do not have adequate resources available to address issues beyond headache and exhaustion; thus they might give out medication, telling the soldier to go home, drink some fluids and come back ready to serve when possible.

Price noted how this structure places an extra burden on servicewomen and those assigned female at birth (AFAB), particularly as there’s no other access point to care; often visiting multiple times before finally being referred to a gynecologist or healthcare specialist for their complaint – often leading to lost duty time and jeopardizing their military careers; Price served seven years, and said physical limitations due to her condition had an enormous influence in dictating her decision to leave.

Price has over 20 years of healthcare and public health experience, working at clinics, major healthcare systems, hospitals, correctional facilities and serving in the U.S. Army Nurse Corps. She currently holds the position of deputy director at The Balm In Gilead (TBIG) – a non-profit that collaborates with churches and faith-based communities to address health equity. Previously she held positions within clinics, major healthcare systems, hospitals correctional facilities as well as military nurse corps.

Price says her time as an Army nurse revealed to her that the military wasn’t immune from implicit biases that delayed or limited care for Black servicewomen and servicemembers in AFAB. In particular, Price saw differences not just along racial lines but also by age and rank in emergency room care provision.

“I remember several instances in which I would observe what the provider wrote as a plan of care for their patient,” she stated. “After looking into one African American patient’s history – who’d made multiple trips to the ER with similar symptoms – and her history I could see this was her fourth or fifth visit, with complaints lasting months at a time; they had also been taking 800 milligrams of ibuprofen.”

Price asked why she wasn’t provided anything different for the soldier and was told that there was concern he could abuse stronger pain medications or sell them on.

Price admits she felt powerless as someone unable to prescribe, yet wanted to at least question his decision in order to gain an understanding of where it came from. Was there something I was overlooking at the time or was she looking into this because she felt she had been there herself at some point in her life?

Price noted that bias was more often implicit rather than explicit in both active duty and Veterans Affairs (VA) settings, with many providers not receiving adequate cultural competencies training in regard to serving more diversely, with an increase in women signing up and serving. I’ve never encountered explicit forms of racism where someone intentionally wanted the soldier in pain; rather there are misperceptions along racial/ethnic lines we need to educate staff members more on. No other individual would’ve even challenged that decision not to give more than ibuprofen to that soldier in pain.”

Price’s journey took more than a year of visiting TMCs before she finally received a referral to see a gynecologist at what she refers to as the “big hospital” on post. There she underwent ultrasound imaging, CT scanning, and finally an official diagnosis, while receiving hormonal suppression treatments as well as scope removal of affected tissue.

Read: Pam’s Story: Your Period Has Returns

“Once I finally left the military, my medical records consisted of three volumes,” she noted.

Finding Solutions
Improving training of clinicians who treat veterans and active duty service members AFAB is a priority, yet Price suggested ways service members could advocate for themselves as well. Many VAs have created women’s clinics; veterans experiencing uterine or gynecological issues should request to be assigned one if appropriate – the process requires additional steps but exists for those in pain.

Veterans near VAs that don’t offer women’s clinics can work with their current providers to request seeing by a civilian OB-GYN instead. More paperwork may be involved; what matters most is understanding this route is possible.

Finding support is also essential, with organizations such as the National Association of Black Military Women and Women Veteran Social Justice Network Inc advocating on their behalf for military women. Price recommended seeking out any organizations dedicated to improving women’s health so they can have all of the tools necessary to advocate for themselves more effectively; even local networks or support groups provide resources and assistance when necessary.

Price noted the importance of sharing stories and information, with such dialogue leading to answers for uterine health conditions.

Price noted, “Though active duty seems so distant to me now, I still find myself thinking back to how I could assist the 20-year-old version of myself. Even thinking back on all of the amazing providers who worked alongside me during active duty, I still consider ways in which they could be equipped better to provide care that meets each soldier’s individual needs.”


Leave a Reply

Your email address will not be published. Required fields are marked *