How diagnosis has become a barrier in Atlantic Canadian women’s health
- Judith Mendiolea Lelo de Larrea
- Apr 20
- 11 min read
From emergency rooms to specialist waitlists, female patients describe a system where uncertainty is prolonged, and care is conditional
Originally published by The Telegram Apr 16, 2026
Alondra Velasco knew her pain was not normal.
It began in early December 2025, dull and intermittent but low enough she could dismiss it.
Within days, it became a sharp, localized and persistent pain that settled on the right side of her abdomen, intense enough that she began to worry about appendicitis.
She rushed to the Queen Elizabeth Hospital emergency room in P.E.I., yet she waited nearly 12 hours before being seen.
No imaging was done to rule out appendicitis. No physician explained what they were looking for.
After some basic tests, she was sent home with painkillers and told to return the next morning for an ultrasound.
She did.
Again, she waited. Again, she was sent home with no answer in sight.
“They never called me,” Velasco said of the follow-up she was told to expect.
Her symptoms intensified.
Later that month, while travelling for the holidays, the pain escalated to the point that she required emergency assistance at the Toronto airport. Paramedics assessed her on site. She declined further treatment, choosing instead to return to P.E.I., where her medical records were, thinking this would ease her way in.
However, when she arrived home, she would spend 19 hours waiting in the emergency room.
“You were there without eating, just with a lot of medication,” she said. “I hadn’t eaten anything, just pills.”
Over the course of that wait, she was given repeated doses of painkillers, but she only continued to get worse. At no point, she said, was she told where she stood in the triage system or why the wait was so long.
“They put me on that list… like I wasn’t important,” she thought.
Read More (First two pieces of this series)
When she was finally seen, the pattern repeated.
A diagnosis of urinary tract infection was suggested. She was prescribed antibiotics, but the symptoms continued.
As months passed, the pattern kept repeating: she was given STI medication although her results were negative, she was sent for further ultrasounds and different trials, and endometriosis was even suggested.
But time and again, the diagnosis was not confirmed, nor did any test prove it. In the meantime, she continued taking more pills.
“So I was taking antibiotics without any proof of anything,” she says.
At one point, she was told additional imaging would be scheduled, but it never was.
Today, more than four months into the process and still managing her pain, she still does not know what caused it.
“I never found out what I had,” she says.
A reactive system
What Velasco described was not a single failure, but a sequence of them.
Long waits in an overwhelmed emergency department, provisional diagnosis based on the most common causes, prescriptions given before confirmation and follow-ups that never happened.
Taken together, they form a pattern: a system that manages symptoms in the moment, without resolving the condition.
In other words, a reactive system.
Across Atlantic Canada, that pattern is not uncommon, particularly in cases involving reproductive or gynecological health.
Emergency departments operate under the Canadian Triage and Acuity Scale, a national framework designed to prioritize immediate threats to life or limb. Conditions such as stroke or trauma are seen first. Others, including pelvic pain, urinary symptoms or undifferentiated abdominal pain, are often categorized as moderate or low acuity.
In practice, that means many of these cases are assigned lower priority scores, CTAS 4 or 5, placing them at the back of the line, even when the underlying cause is unclear.
The result is reflected in time.
In N.B. and P.E.I., patients spend a median of more than four hours in emergency departments from arrival to discharge. In N.L., it is closer to three. Even the time to the first physician assessment in P.E.I. approaches three hours.
For patients like Velasco, those numbers translate into nights without answers.
The research gap
Historically, women’s health has not received the same level of research attention, and the consequences of that are still showing up in clinics and emergency rooms, said Heather Creighton, vice-president of women’s strategy and partnerships at the IWK Foundation.
Health Canada’s own guidance says the federal document on the inclusion of women in clinical trials was only released in 1997, and although women’s inclusion improved after that, they remain underrepresented in early-phase trials and in some therapeutic areas.
This gap refers to the delay, uncertainty or failure in identifying a condition, even after patients have entered the system.
In the IWK Foundation’s survey and interview, evidence pointed to women not only experiencing delayed diagnosis, but learning to stop seeking care at all.
“There are still significant gaps in how women’s health is understood, researched and delivered,” said Jennifer Gillivan, president and CEO of the IWK Foundation.
Those gaps matter most in cases that do not present neatly.
“A lot of these conditions don’t present in clear or consistent ways, which can make diagnosis more difficult within the current system,” Creighton said.
That is especially true in emergency departments, which are built to identify immediate threats, not to untangle chronic or unclear conditions.
“Emergency departments are designed to deal with acute issues, not necessarily to manage ongoing or complex conditions,” Creighton said.
That distinction helps explain why patients like Velasco can move through the system repeatedly without getting closer to an answer.
CIHI reported more than 16.1 million unscheduled emergency department visits in Canada in 2024-2025, and said abdominal and pelvic pain remained among the most frequent main problem diagnoses. In the same release, CIHI noted that for patients discharged from emergency after a less urgent visit, nine in 10 completed their visit within eight hours, while admitted patients faced far longer stays.
Under the Canadian Triage and Acuity Scale, many gynecological and genitourinary complaints are not coded as top-priority emergencies unless they come with severe warning signs. In the current CTAS quick-look guide, menstrual problems are listed as level 4, while vaginal discharge, vaginal pain or itch, labial swelling and some pregnancy issues can fall into level 5 unless other risk factors are present; pelvic pain with abnormal vaginal discharge is listed at level 4.
In other words, the system is doing what it was designed to do. But that, experts say, can also be part of the problem when symptoms fall outside clear diagnostic categories.
If reproductive symptoms are triaged as less urgent unless they present with acute instability, then patients can spend hours waiting, even when something serious is unfolding.
If what they are experiencing falls into a diagnostic grey zone, not obviously surgical, not clearly infectious, not immediately life-threatening, they can leave with pain managed, but without the underlying condition identified.
“We know that delays in diagnosis are happening, and that can have real consequences for patients,” Creighton said.
Delay and misdiagnosis
Those delays extend well beyond emergency rooms.
In 2025, the Fraser Institute reported median waits from GP referral to treatment of 60.9 weeks in N.B., 49.7 weeks in P.E.I., 49.0 weeks in N.S. and 43.5 weeks in N.L.
Once again, the longest regional waits in the country.
For conditions such as endometriosis, that delay becomes part of the illness itself. Research literature has consistently documented multi-year delays to diagnosis, often measured in seven to 10 years globally.
And delay is only one part of the pattern — misdiagnosis is another.
A PubMed-indexed emergency department study of adult women with genitourinary symptoms found that providers diagnosed 66 per cent with urinary tract infections, but only 48 per cent of those diagnoses were confirmed by positive urine culture. The same study found that 37 per cent of women with a sexually transmitted infection were not treated for it within seven days, and that many of those missed infections had been diagnosed instead as UTIs.
That pattern mirrors what Velasco describes: antibiotics first, certainty later.
Research on sex disparities in emergency care points in the same direction. A 2022 U.S. cohort study of 28,332 patients from the 2013 to 2016 Trauma Quality Improvement Program found that female trauma patients experienced slightly longer delays in trauma care than male patients.
Other recent reviews have also found that women are less likely to receive adequate pain treatment in emergency settings, even when reporting comparable pain.
The risk is not only that the condition can be mistreated, but that it can be allowed to progress. And for some, that progression can take years to identify.
A system without diagnosis
Cecilia Andrade knows that trajectory.
A year earlier, when she first spoke with Postmedia, her symptoms — heart palpitations, fatigue, sudden physical decline — were repeatedly dismissed as anxiety. It took multiple requests before she was given bloodwork. When the results came back, her thyroid antibodies were nearly 10 times above normal levels.
She was diagnosed with Hashimoto’s disease. But the diagnosis did not resolve her experience of the system. Since then, she has expressed concerns about suspected endometriosis.
And once again, the barrier is not only access to care, but access to diagnosis itself.
In P.E.I., patients suspected of having endometriosis are often required to follow a stepwise treatment pathway before being referred to specialists outside the province, including the IWK Health Centre in Halifax. There is no endometriosis specialist in the province.
That pathway typically includes hormonal therapies such as birth control or intrauterine devices.
For Andrade, that requirement created a contradiction as she is trying to become pregnant.
“I can’t do those treatments,” she said. “So I can’t move forward.”
Without completing those steps, she cannot access a referral. Without a referral, there is no diagnosis. And without a diagnosis, there is no treatment plan.
Even when referrals are made, the wait continues.
She began asking about MRI techniques used in other countries for diagnosing endometriosis.
“(They) told me, ‘That’s a myth.’ Then when I explained it, (they) said, ‘We don’t have that here.’”
As she did with her first diagnosis, she is now considering travelling back home in Mexico for testing, where private care could cost her roughly $5,000, not including time away from work, plane tickets or the possibility of further treatment.
At a February appointment she had in Mexico when she was visiting family, her gynecologist told her the condition could likely be addressed surgically if she could stay for several weeks. She could not.
Back in P.E.I., she has been told to manage the pain.
“I can’t spend half of every month taking ibuprofen,” she said.
The structure of care itself becomes another barrier.
Appointments are often limited in scope, forcing patients to present one symptom at a time. Without continuity of care, each visit begins from zero. Tests are ordered in isolation. Diagnoses are made provisionally, and follow-up depends on systems already under strain.
For those without a family doctor, a reality for many across the Maritimes, the emergency room becomes the only point of access.
When patients stop seeking care
That fragmentation is made worse when patients do not have a regular provider. Statistics Canada reported that the share of Canadian adults with a regular health-care provider fell to 82.8 per cent in 2023, meaning nearly one in six did not have that continuity of care.
Women were more likely than men to report having a regular provider, but gaps remained sharper among younger adults, lower-income households and some sexual minority groups.
“Access is not always equitable, particularly for people who don’t have a regular provider or who are navigating the system for the first time,” Creighton said.
Health P.E.I. was contacted multiple times for comment on emergency department triage, diagnostic pathways and women’s health services. A spokesperson said they were working to identify the appropriate person to respond, but no interview or statement was provided by the deadline.
In 2025, the IWK Foundation surveyed 27,317 women across N.S., N.B. and P.E.I. in what the organization has described as the largest open women’s health survey of its kind in Canada.
There, they asked how women were actually experiencing their health and what was keeping them from care.
Their results reinforce those findings.
According to Gillivan, roughly three-quarters of respondents in two Maritime provinces, and 78 per cent in P.E.I., said they were effectively denying themselves access to care because they were not being listened to, not being believed, or felt the system was too overburdened to help them. The three provinces, she said, came back “almost identical.”
The published report echoes that conclusion. It found that 70 per cent of women said the current system does not meet their needs, while 86 per cent said significant change is needed. The top issues women wanted prioritized were menopause, stress, anxiety, hormonal health, depression, weight management, sleep disorders, heart disease and cancer. The report described the burden not as only medical, but also “structural, societal, and systemic.”
Policy, recognition and limits
For Gillivan, those findings point to something larger than a shortage of appointments.
“The main tenet of that bill is to put into legislation a national framework or strategy for women’s health,” she said, arguing that Canada still lacks a modern, coordinated plan for how women’s health should be researched, taught and delivered.
That is the policy change the IWK Foundation has been publicly backing in Ottawa. Bill S-243, introduced in the Senate as the National Framework for Women’s Health in Canada Act, would require the federal government to establish a national framework for women’s health in collaboration with provinces, territories, Indigenous partners and civil society.
As of March 26, 2026, the bill had been referred to committee in the Senate.
The argument behind it is not only symbolic. In a 2025 report developed with Deloitte Canada, the IWK Foundation called for a modern National Women’s Health Strategy that would close research and data gaps, strengthen education across the health system, and align policy across jurisdictions. In other words, the kind of structure that could affect what happens before a woman reaches the emergency room, while she is in it, and after she leaves without a diagnosis.
Those measures signal growing recognition that women’s health has been under-researched and under-prioritized, but they do not yet solve the diagnostic gap described by patients.
Rethinking the system
For Gillivan, closing that gap requires more than adding services. It means rethinking how care is delivered altogether.
Right now, she said, the system is structured around illness, responding when conditions become acute, rather than identifying them early.
“What we have is a system where everyone ends up in the same queue,” she said. “People who could be managed differently, people who need to be seen urgently, and people who can wait, they’re all treated the same.”
That structure, she argued, is part of what creates the very pressure the system is struggling under.
In research the IWK Foundation is currently conducting on breast health, early findings suggest that a significant portion of patients on waitlists could be supported outside of hospital settings, while others require immediate care.
But without a system designed to differentiate between those needs early, everything moves more slowly.
Gillivan pointed instead to a model built around integrated care, health hubs where patients can access multiple forms of support in one place: diagnosis, primary care, mental health, and preventative services.
“If you can get to a preventative health system, not an illness system, and actually treat people where they are,” she said, “you will take a burden off the existing system.”
Her argument is not only about improving outcomes for women, but also about the overall system, by reducing bottlenecks, catching conditions earlier, and avoiding the kind of repeated visits and delayed diagnoses that define cases like Velasco’s and Andrade’s.
The point of recognition
For Creighton, any structural change has to begin with recognition.
“You won’t know what it’s like to experience that kind of bias and burden until you are a woman going to a doctor and having that conversation,” she said.
“You’re not listened to. And you know that the doctor does not have an answer for what your issue is, because of the lack of education, the lack of research, the lack of data.”
In those moments, she said, the response shifts.
“You’re told, ‘It’s lifestyle. You need to walk more, eat better, be healthier…’ So what happens if women stop going?”
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