Beyond the Blade: Navigating Surgical Inequities and Treatment Truths

Many of us enter the operating room feeling like our bodies are in a “battle”—fighting both a chronic inflammatory disease and a system that often fails to protect us during our most vulnerable moments. To navigate this, we must understand the landscape of surgical disparities and the critical importance of specialized excision. We are moving beyond the “blade” as a tool of medical trauma and reclaiming it as a tool of precision and restoration.

REVEAL: The Data of Disparity

The numbers tell a story that we can no longer ignore. Even when we access high-level surgical environments, Black women face significantly higher risks than our White counterparts. Research analyzing over 11,000 patients through the National Surgical Quality Improvement Program revealed that Black women have an adjusted odds ratio (aOR) of 1.71 for surgical complications. This means we are 71% more likely to experience complications within 30 days of an endometriosis surgery.

The disparities are even more stark regarding hysterectomies. Black women have a 64% higher chance of major complications when undergoing a hysterectomy for endometriosis. These outcomes are not the result of biological differences or “innate” fragility; they are the result of structural inequities, the quality of care provided by generalist surgeons, and the “diagnostic delay” that allows the disease to reach more advanced, complicated stages before intervention.

OFFER: Conservative vs. Radical Options

There is a concerning and unapologetic trend in how Black women are treated: we are frequently offered “radical” procedures—like hysterectomy (removal of the uterus) or oophorectomy (removal of the ovaries)—at much younger ages than other groups. In fact, research shows that Black women in their 20s have three times higher odds of undergoing an oophorectomy compared to their White peers, and twice the odds in their 30s. This is often done without offering minimally invasive, fertility-preserving alternatives.

For many, the Excision Model is the gold standard:

• Ablation (The “Burn” Method): Often performed by generalists, this method destroys only the lesion’s surface, leaving the “roots” intact. It is like mowing the lawn instead of pulling the weeds; the pain almost always returns.
• Excision (The Gold Standard): Surgical removal of the entire lesion, including the underlying tissue. It is the superior method for long-term pain relief and is the vital path to fertility preservation.

Before agreeing to a hysterectomy in your 20s or 30s, you must ask why minimally invasive excision is not being prioritized. Your reproductive future is yours to hold, not for a biased system to discard.

OUTLINE: Vetting Your Surgical Team

Finding a “safe space” for surgery means finding a specialist who understands the nuances of the disease and respects your autonomy. Do not assume every gynecologist is an endometriosis expert. Use these “Must-Ask Questions” to vet your surgeon:

• “How many excision (not ablation) procedures do you perform weekly?” High-volume specialists (MIGS) typically have better outcomes.
• “Do you use a shared decision-making model?” Your personal goals—whether that is fertility preservation or avoiding hormonal therapy—should be the foundation of the surgical plan.
• “What is your plan for addressing co-existing conditions like fibroids or adenomyosis during the same surgery?”
• “Will you provide a detailed surgical report and photos of the lesions you removed?”

TAKE NOTE: The Power of Informed Consent

Medical management often involves powerful hormonal drugs, such as GnRH antagonists like Elagolix (Orilissa). While these are FDA-approved for pain, they come with significant risks that are often downplayed during the “informed consent” process. Lack of transparency regarding side effects is a clinical red flag. You must be informed of potential risks, which can include:

• Severe bone density loss (often requiring “add-back” therapy).
• Suicidal ideation and significant mood disturbances (depression affects up to 86.5% of endometriosis patients).
• Hair loss and issues with depth perception.

If a provider pushes these treatments without a thorough discussion of the risks and a plan for monitoring your mental health, they are failing you. You have the right to say no to medications that threaten your quality of life.

Conclusion & Call-to-Action

You have the right to demand surgery that is safe, effective, and protective of your future. We are ending the era where Black women are pressured into radical surgeries because a provider lacks the skill to perform precise excision. Your body is a temple, not a battlefield.

Take control of your surgical journey.