Parliamentary Committees

Select Committee on Endometriosis

Ms HUTCHESSON (Waite) (11:03): I move:

That the final report of the committee be noted.

One year ago tomorrow, on 21 March 2024, this house supported my motion to establish a select committee to inquire into endometriosis. We resolved to investigate and report on a number of critical issues related to this condition, including the prevalence of endometriosis in South Australia, current treatment options and support, barriers to diagnosis, the impacts on employment and education, as well as research and trials. Today, I am incredibly proud to stand before you to speak to the completed report, knowing that our government has, in principle, accepted all of the recommendations.

My personal journey with endometriosis began two years after giving birth to my son. I barely remember the early days of the condition. It could be that I had it a lot longer before that, because, as we have learned through our journey in the endometriosis committee, endometriosis does not always present with pain symptoms, but I do recall the pain worsening over time. I was prescribed the pill back to back, followed by a Mirena IUD, and I underwent two laparoscopic surgeries. For a while after these I was okay, but eventually the pain returned. It was during that time that I felt I was left to navigate this condition on my own, relying only on Dr Google for answers.

My GP never mentioned or suggested multidisciplinary care, I never knew that I could have received help from physiotherapists and no-one ever asked me how I was doing in terms of my mental wellbeing. Through this inquiry, my hope is that our recommendations, especially around educating GPs, students and the public, will allow others to learn about the various ways to access care more quickly.

One of my most significant takeaways from chairing this committee was the vast amount of research being done in this space, not just here in South Australia—although we lead the way—but across the country and globally. We are leading the way, and it is essential that we continue to support our researchers in the work that they do.

It has taken a long time for women's health issues to gain the attention they deserve, and as my colleague the member for Badcoe said here yesterday, it has also taken time for there to be enough women in parliament who can not only support a motion to establish a select committee but also talk openly about their deeply personal experiences. I am so pleased that the motion to establish the committee was supported unanimously, and I am deeply grateful for the contributions of all members, whether in support of motions, whether for the committee itself or even in the corridors. Thank you.

Endometriosis is a chronic inflammatory condition that occurs when tissue similar to the lining of the uterus grows outside of it. It is a prevalent yet underdiagnosed condition affecting girls, women and those assigned female at birth. Women do not choose to have endometriosis: it chooses them. Over the course of our inquiry, the committee received 85 submissions from individuals with endometriosis or their family members, academics, researchers, government agencies, health professionals, not-for-profit organisations, advocates and sector unions. We also held 16 oral hearings where we heard from 72 witnesses, including two regional hearings in Berri and Mount Gambier, which were warmly welcomed by local communities.

Visiting the regions opened our eyes to the benefits of multidisciplinary care as well as the challenges faced by those living far from medical imaging or major hospitals. I want to thank the Berri Barmera District Health Advisory Council for their incredible work in organising local healthcare providers, who already collaborate to support their community, to come together and share with us what they are doing to continue to work in this space and support women. I also want to thank the witnesses from Mount Gambier for sharing their stories. It was worthwhile us making those trips because the stories we heard down there can be different to the ones we heard locally in the city.

One of the key findings from our inquiry was the significant impact endometriosis has on young people, particularly those in high school or those just starting their careers, university or TAFE. The emotional and social toll is immense and we were inspired by the courage of young people who spoke to us about their experiences. I am hopeful that the report and its recommendations will lead to earlier diagnosis as we know that when left untreated the pain of endometriosis can become normalised.

The Australian Longitudinal Study on Women's Health estimates that one in seven women born between 1973 and 1978—that is me—will be diagnosed with endometriosis by the age of 44 to 49, and many younger women will be diagnosed much earlier. The evidence we heard suggests that endometriosis not only affects individuals but places a strain on the health system, with frequent hospitalisations, emergency department visits and long waitlists for specialists. In the past, laparoscopy was the only way to diagnose endometriosis, leading to delays. However, new diagnostic tools like transvaginal ultrasound and MRI are now available, providing a less invasive, more timely and cost-effective approach.

We are fortunate in South Australia to have researchers leading the way in this field, and I want to acknowledge the work of IMAGENDO and the Robinson Research Institute team. It was a meeting that I had back in 2022 with them that inspired me to use my position as a member of parliament to advocate on behalf of sufferers and, in doing so, pursue the establishment of this committee. Thank you.

After all the evidence presented, the primary goal of the committee is clear: to reduce the time it takes to receive a diagnosis and improve health outcomes for individuals with endometriosis. Early and accurate diagnosis not only improves the patient's mental health but also minimises the number of doctors and medical professionals a person needs to see before getting a diagnosis. This can reduce the financial burden on both individuals and also our healthcare system. After careful consideration, the committee has made 20 recommendations to address key areas, such as education for medical professionals, information for students and the general public, the creation of multidisciplinary care teams and better support for those in regional areas.

With delay in diagnosis experienced by many we recommend that there be a focus on education, not just of the sufferers of the disease but of the healthcare professionals tasked with caring for these patients. This education should not only be delivered at the start of their careers in tertiary institutions but be ongoing for GPs, emergency doctors and nurses, sonographers and allied health professionals.

We heard from multiple witnesses that they had nowhere else to turn, and they ended up in emergency departments for care, only to be dismissed. We also were made aware that there is not a recording mechanism for those suffering pelvic pain within our EDs, so even trying to determine how many sufferers end up in emergency is difficult to quantify. We have made the recommendation that local health networks review how presentations to their emergency departments due to pelvic pain and endometriosis are clinically assessed and managed, including the specific number of presentations, so that accurate data can be collected.

Encouraging our healthcare providers to increase their education, and providing them with tools for diagnosis, will better support their patients, and it is our hope that it will reduce that time to diagnosis. Tools like checklists need to be available to determine if someone may be suffering from endometriosis. These checklists can also be provided to patients for them to monitor their own conditions. There are already some tools in this space, such as EndoZone, RATE and PIPPA. Our recommendation is that the commonwealth government work with the RACGP and researchers to assess any existing and/or develop an endometriosis symptom checklist and make it available to all GPs to assist them with addressing their patients' needs.

We also understood the need for education programs for young people. Talking more broadly about what is and is not normal through school-based programs will help identify those who need better support earlier, and stretching this to sports clubs and tertiary institutions will also capture those who may have developed symptoms after they have left school or attended schools where education was not delivered.

This is not just for those who can be or become sufferers, but the committee understands the need to educate everybody. Endometriosis may only affect 50 per cent of the population in terms of risk of becoming a sufferer, but it actually impacts 100 per cent of our population. We heard from parents, daughters and partners whose role as a support system is incredibly important. We need to be educating our boys and men about this disease as well.

Endometriosis affects many aspects of life, including a sufferer's ability to be active and play sport, yet exercise is considered helpful for treatment. Supporting and educating not only those who battle this disease but also coaches and other players will see everyone being on a level playing field, so that they can pursue their sporting dreams.

The committee made several recommendations in regard to the federal government's role in ensuring treatments and diagnostic tools are more widely available and not dependent on your bank balance, and we are very pleased to see the announcements recently made by the federal government in this space. Endometriosis does not discriminate and all sufferers need access to care.

I would like to take a moment to thank the Labor government for their commitment to better supporting women and their reproductive health with their recent announcement of half a billion dollars in investments, including a review of the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme, items used to support the diagnosis and treatment of endometriosis, and much more, and I am pleased that we are all on the same page in wanting to support women who battle endometriosis.

I remember the toll endometriosis took on my work life. For a long time I chose to suffer in silence, trying to push through the pain with ineffective treatments, often at the cost of my cognitive function. There would be days when I got out of bed only to crouch on the floor in agony when painkillers could not even attempt to combat the pain, and where I could barely see how I would be able to function.

The thing with endometriosis is that you never know what you are going to get from month to month. You can try to control what you eat, what you drink, and have exercise and do all the right things and be hit with a terrible flare-up. You can also have a month where you cannot be bothered with any of that and sail through. It cannot make up its mind what it is going to do to you from one month to the next, but the bad months most definitely outweigh the good ones, and it is very hard to explain to others why you are not your normal chirpy self.

It was not until I had an understanding boss at the Finance Sector Union that I finally opened up about my condition and it was liberating. During COVID, the ability to work from home helped me manage my condition, being able to take a break when pain was too much or until the painkillers took hold. I was fortunate to have an understanding employer who, once I explained my condition, knew they had to do more for all workers, and I was very pleased that our committee heard directly from the Finance Sector Union and other unions about the work they are doing to support their members through enterprise bargaining and discussions with employers.

We need more employers who are educated about endometriosis and who are willing to offer flexible work arrangements. We also need to recognise the impact of this disease on a person's ability to study or work, and ensure that people can access the support they need to continue to contribute to society.

By bringing together employer groups and public and private sectors and unions to discuss and exchange ideas and experiences with the aim to better support workers, it is my hope that they will see that in supporting sufferers who have reproductive health issues they will have better workplaces and more productive staff.

Early detection is also crucial in minimising the progression of the disease and potentially reducing the severity. This can make a significant difference in ongoing treatment, as many sufferers do not want to rely on medications with the side effects. Reducing the need for heavy doses of painkillers or hormonal treatments can dramatically improve someone's quality of life. One important aspect of our inquiry was recognising the link between endometriosis and adenomyosis, another debilitating condition that often coexists with endo. The committee's recommendations aim to contribute to the timely treatment of adenomyosis as well.

Finally, I would like to express my deep gratitude to all of the individuals and organisations who contributed to this inquiry. Many of you are here today. Your courage in sharing your personal stories has been invaluable. I would also like to thank my fellow committee members, the members for Dunstan, Unley, Frome and Torrens, as well as past members, the member for Mawson and also the member for Elizabeth, for their support and contributions to this inquiry. I also extend our thanks to the member for Chaffey and the member for Mount Gambier and their office staff for their assistance in our regional hearings.

Thank you to the committee staff, Alison and Jennefer, and to our Hansard staff for supporting us with our work. Of course, I must thank the Minister for Health, Chris Picton, who just walked in on time, for supporting the motion to establish this committee from the very beginning.

To all the endo warriors, endo friendos and your support crews, your stories matter. Together, we will continue working towards better outcomes for those still waiting for a diagnosis and for those yet to embark on their journey to becoming a woman. Thank you for your courage. For everyone in health care and research, keep going. You are making progress. I am optimistic that this report and its recommendations will also contribute to paving the way to a state where endometriosis is no longer a taboo subject and where women feel supported in their journey with the condition.

March is Endometriosis Awareness Month, and it is nice to see yellow everywhere. Its theme this year is Endometriosis Explained, exploring both how endometriosis must be better understood by the general public and better explained to patients by all healthcare practitioners, and I believe many of the recommendations from this report align with this theme. Thank you to everyone who has come along this morning to be here for this very important day when women's health finally commands the agenda, as it should.

Ms PRATT (Frome) (11:17): I rise on behalf of the opposition, of course, to support the report that we see being adopted by the house from the Select Committee on Endometriosis. I want to commence my remarks by welcoming all of our fantastic guests here today. It is a credit to the member for Waite and to our secretariat support that we have been able to remain in communication with you for an event like this, a moment like this, where parliament can open up the doors and share with you your very personal experience. It is remarkable to see how many women and men have been able to give time to support our contributions today, so thank you for coming. I have learnt a new phrase member for Waite: endo friendos. We welcome you.

I add my compliments and my support to the work of the committee, and I thank the member for Waite for bringing to both sides of the house an opportunity for us to really delve into the barriers and impediments but also the opportunities through policy that we are seeing delivered in the 20 recommendations today. It takes a motion, it takes an idea, it takes bipartisan support and conversations about how we are going to do this.

I share the committee work not only with the member for Unley, who joins me, but the member for Torrens and the member for Dunstan. I note that we also had early support from the member for Elizabeth and the member for Mawson. I think it is really important to share how far we have come that men and women can have these conversations, not only the clinical academic conversations but those that are often uncomfortable for the sufferer. Without that honesty and transparency and vulnerability, we probably would not be able to deliver a report like this.

Special mention to Alison and Jennefer. I can see them in the chamber and they will be known to our guests. When we embark upon select committee work like this the research and the coordination is undertaken by parliamentary researchers, and we thank them very much for the time they put into coordinating, for example, the trips that the committee took to the regions. It was really important that we did not just capture the story from sufferers who live in metro areas, but what it looks like to be an endo friendo sufferer in the regions.

I represent the Mid North. We travelled to the Riverland and also to the South-East. From a regional health perspective, it was a bit of a baptism of fire to explore what services exist in country health, but I think also refreshing to find that the regions are doing exceptionally well with fewer resources but a lot of get up and go, a lot of determination. What we see in the country is that ability to do more with less most days.

The takeaway points that struck me from being on the committee are to be summarised in the following way. Through the inquiry that was conducted over the last 12 months, we were able to highlight critical issues surrounding the diagnosis and treatment of endometriosis in South Australia. We heard from expert witnesses, including healthcare professionals and researchers who emphasised for the committee the necessity for enhanced education and awareness, particularly within the education system, to support young girls. Education was a theme from not just the primary school space but all the way through to the health workforce.

Dr Jane Chalmers noted the stigma associated with pelvic pain and the inadequacies in current healthcare pathways, such as prolonged wait times for specialist consultations and limited access to holistic treatment options. Professionals and practitioners who presented to us pointed out the chronic underfunding of psychological services, which is quite a gap in the experience, and the need for more specialised physiotherapists in pelvic pain management. It is not just one symptom, it is not just one physiological complaint, but it is a whole-of-body experience.

Our inquiry certainly revealed systemic barriers in accessing diagnostic imaging, with many women facing financial constraints and long wait times for necessary procedures. Witnesses, such as yourselves, advocated strongly for improved referral pathways, the establishment of multidisciplinary teams, and the need for a comprehensive approach that includes psychological support alongside medical treatment. I think we really need to see the two of those working in concert.

The inquiry also addressed the economic implications of endometriosis, highlighting the significant costs associated with delayed diagnosis and inadequate treatment options for many people. Participants called for reforms in Medicare billing practices and the introduction of educational programs aimed at both healthcare providers and the general public to normalise discussions around endometriosis.

Overall, the inquiry underscored a pressing need for systemic changes to improve the healthcare experience for those affected by endometriosis, advocating for increased funding, better training for healthcare professionals and a more compassionate approach to patient care. The committee has found the right balance in the recommendations that will be shared with the public going forward.

We did, I think, agree—it was certainly my experience through the witnesses that came through—that South Australia is nation-leading when it comes to research: cutting edge, innovative, bold research led by the professionals who choose South Australia as their base. I am sure that is a credit to the universities, the institutions that support that research, but we do not want to lose that edge.

While we have the minister's attention, I know this is something that the government is focused on: how do we maintain the edge we have as a state, how do we make sure that we as a state keep investing in you and your experiences, in your lived experiences and your academic research? With the research you have already gifted back to the country—rising tides support all boats—your work will support women interstate.

I felt that with the 20 recommendations and the work we did we uncovered the following themes—and this was certainly my takeaway. Education is something that is missing from the primary school system. What does that look like? Health literacy for students, better understanding of their bodies, and building confidence in our teaching workforce to bring that curriculum and that conversation back, with parents understanding.

If we can support young people to understand the changes that are taking place in their bodies or what is not normal, what they are experiencing, and how that is then communicated to GPs, that is the first stepping stone. Then there are the barriers, or the gaps perhaps, in education for some GPs who have been in the field for a long time, who are time-poor and under-resourced but who are doing their best to diagnose symptoms that perhaps they have not understood are tied to endometriosis and chronic pelvic pain.

I think workforce planning will be a really important focus for governments as they analyse these recommendations. I have spoken about research, and we needed to better understand the complications and barriers about billing, about pricing, about affordability of appointments that take you through treatment, the inequities I have observed for women who are suffering with endometriosis symptoms but also for female GPs or GPs who are prepared to provide longer consults and who are therefore financially disadvantaged compared to their peers.

I hope you can see we have dedicated a lot of time and attention to better understanding what your experience has been. You have lived with judgement, and doubt, and disbelief, and there are issues around productivity that we are working towards. With those contributions, we support the report of the Select Committee on Endometriosis.

Ms O'HANLON (Dunstan) (11:27): I rise humbly to speak on the tabling of the final report of the Select Committee on Endometriosis. I had the great honour of joining this committee midway through last year, and I have to say that it has been a profound experience to bear witness to the testimony we have heard.

I do not suffer from endo, nor do I suffer from persistent pelvic pain—and boy, do I consider myself lucky, because the testimony I have heard from those who do has been heart-rending. It has truly impacted me as a woman and as a mother of a young daughter.

From the get-go I want to pay tribute to two witnesses, two of many incredibly brave witnesses. These women are phenomenally brave, they are tough. They had to be; life did not give them a choice. These women, and all women who suffer from this cruel, horrible and debilitating disease, are warriors, and I recognise you.

The first endo warrior I want to mention is Deanna Wallis. Hers was the first testimony I heard, and I can honestly say it changed what I thought I knew about the world. Deanna gave evidence of the multiple surgeries, but worse, the multiple dismissals of her personally and—I do not think it is a stretch to say this—of her humanity.

Her desperate search for a means of having something resembling a normal life, a life free of the constant pain, led down a path of surgeries and other invasive procedures that I think anyone who does not suffer from endometriosis would simply not believe possible. Yet for endo sufferers such treatment is sadly often normal. In spite of all this, Deanna is an advocate. She is an endo ambassador with Endometriosis Australia and the director of Wallis Cinemas, of which she is extremely proud.

The second person I want to mention is Lucy Savage. What a brave, intelligent and passionate young woman you are. For anyone who feels at this point that they do not understand the impact endometriosis is having on women, young and old—but in this case far too young—I urge you to read Lucy's evidence.

The toll endometriosis wrought on what most of us would identify as an entirely normal, though impressive, teenage life was horrific but, strong—as every endo warrior needs to be—she fought her way through the fog of pain and did something extraordinary with her experience. She created a magazine, XOXO, Endo, to help raise awareness amongst young people, the wider community and health professionals because, in her words:

…if I could go back in time and speak to the GP who took my symptoms and diagnosed me as an emotional teenager, I would like to give her a copy of my magazine.

Lucy, I hope you sent a copy and I hope they gratefully received it, because you and your story will change lives.

Deanna, Lucy and all who suffer from endometriosis: I am sorry for what life has thrown at you. Thank you for your bravery, passion and advocacy. My hope is that your bravery, combined with the efforts of committees like the one we are reporting on, results in meaningful funding changes that one day—and the sooner the better—bring you and future sufferers a cure, and in the meantime, better treatment and support. To both Deanna and Lucy's mums: I salute you. I salute you and all mums and family members like you who have had to bear witness to your beautiful girls' pain, no doubt often feeling helpless. As a mum myself, I know that in itself would have been an unbearable hardship.

As we have heard in this place already, endometriosis is an issue that affects thousands of South Australians and an issue that for far too long has been ignored, dismissed or misunderstood. We know there is a huge number of people suffering, often in silence. We heard about the simply outrageous timeline for diagnosis: six years or more. Six years of struggle to work or be educated, six years of cancelled plans and six years of struggling to be taken seriously. Six years of physical pain and the emotional toll of being unheard, doubting yourself and being let down by a system that is not working as well as it should.

This is exactly why the parliamentary Select Committee on Endometriosis was formed. This was not just about gathering statistics or looking at medical studies, it was about listening to real people and their experiences. We were asked to investigate, amongst other things, treatment and supports available, barriers to getting a diagnosis and accessing care, how endometriosis affects employment, the education available for young people and health professionals, and what research is currently being done—but more than that, we wanted to give people a platform to be heard. So many people living with endometriosis feel isolated. Their pain is often invisible to the outside world and they are left to struggle through it alone.

The committee invited submissions from anyone with a story to tell or expertise to share, and the response was excellent. We received 85 submissions and heard from 74 witnesses, including individuals living with endometriosis and their family members, health professionals and researchers, advocacy groups, unions and government agencies. We went beyond the city to ensure those in regional communities were heard as well, with hearings in Berri and Mount Gambier. Time and again, what we heard was both devastating and eye-opening.

Like Deanna and Lucy, people told us how hard it is just to get a diagnosis. For years they are brushed off, told their pain is normal, or misdiagnosed with conditions like irritable bowel syndrome or—wait for it—anxiety. When they finally do get diagnosed, they are faced with another battle: actually accessing care. We heard there are simply not enough specialist clinics or treatment options available. Waiting lists are too long and even when people do get in to see a doctor, they are often given bandaid solutions instead of real, lasting care.

The financial toll is enormous. Endometriosis is expensive. Surgery, medications, specialist appointments: none of this is cheap. Many people are forced to cut back on work hours or even quit their jobs altogether because they simply cannot keep up. Sadly, there is a huge gap in education. Young people are not taught enough about endometriosis, which means they may go years without realising that their pain is not normal.

Even many doctors do not have enough training to recognise the symptoms early, leading to delayed diagnoses and inadequate treatment. The system is not working the way it should and the people suffering from endometriosis are the ones paying the price. The good news is we also heard from incredible professionals who, through their own passion and dedication to their patients, and in spite of the barriers, have created meaningful and effective solutions.

The committee has put forward a number of recommendations to improve the way we diagnose, treat and manage endometriosis in South Australia. We need to tackle the long delays in diagnosis. We need to support the professionals already providing dedicated and effective multidisciplinary care, where general practitioners work alongside specialists, nurses and allied health professionals. We need to ensure we provide the framework that enables the sorely needed additional dedicated multidisciplinary endometriosis clinics, particularly in public hospitals.

Workplaces also have a role to play. Policies like reproductive health leave and flexible work arrangements could make a huge difference. Just as important is fostering a workplace culture where people with endometriosis feel supported and understood. We need to invest in research. There is still so much we do not know about endometriosis: what causes it, why it affects some people more severely than others, and what the best treatments are. Continued research in clinical trials will be key to improving outcomes in the future. Ultimately, we want to create a healthcare system where people with endometriosis do not have to wait years for answers, do not have to fight to be taken seriously and do not have to sacrifice their jobs or financial security just to manage their condition.

I want to thank every single person who contributed to this inquiry. To those who shared their personal stories, whether through a submission or by appearing as a witness, your voices have shaped this report. We hear you and we will continue to fight for better outcomes.

I want to thank my determined colleague Catherine Hutchesson, who is herself an endo warrior and who ensured the establishment of this committee. Your dedication and passion for this issue have been invaluable. I also acknowledge all my fellow committee members across the life of this committee. A huge thankyou goes to the parliamentary staff who supported us throughout this process: Alison Meeks, who is our secretary, and Dr Jennefer Bagaporo, our research officer, without whom the work of committees like this would not be possible; and the Hansard team for ensuring every single word was recorded so that these stories can be heard long into the future.

This report is a step in the right direction, but our work is far from over. We must continue to push for better awareness, better health care and better support for those living with endometriosis, because no-one should have to fight this battle alone.

Mrs HURN (Schubert) (11:36): Welcome to all the endo warriors and the endo friendos who are joining us in the gallery. It is a real pleasure to have you here to see this conversation happening about a really important topic. I think it is really fitting that we are tabling this report in Endometriosis Awareness Month, when it is so important that we shine a light on your experiences and the challenges that you are facing on a daily basis.

I think the importance of this report is that you have probably seen enough of talking and enough of shining a light on the challenges that you are facing, and you would like to see a little bit more action to help you with your challenges. That is exactly what today is about, and that is exactly what your experiences, which you have shared with the committee, are going to ensure—that we can get some better outcomes for you.

As has been discussed in the chamber already, one in seven people suffers through endometriosis. There are so many challenges that have already been discussed, concerning diagnosis, treatment and managing support for endometriosis. I think some of the barriers that the committee went through are really important, and you would be feeling them on a daily basis: the normalisation of pain, timely access to and availability of health and medical professionals and services, the cost, professional development among health and medical providers, and education and health literacy. Through the 20 recommendations, I am really hopeful that all those areas can be addressed and that we are paving the way for a better future for you all on your journey.

I would like to give a special shout-out to a local constituent of mine, Felicity 'Fizz' Hampel, who is in the gallery today. She is an endo warrior herself, and I encouraged her to share her experience with the committee. I would like to echo comments that your submission will make a big difference for the future of not just you but everyone who is with us in the gallery and those one-in-seven people in Australia and South Australia who are suffering like you.

Felicity—or Fizz—notes that she was blessed in her workplace to be supported in her chronic illness. She notes that she is one of the very small number of endo sufferers who have the confidence to be vulnerable. She noted in her submission that balancing medical appointments and therapies and working a full-time job with chronic pain and fatigue impacts her differently on a day-to-day basis.

This year, Fizz stepped back into part-time work to focus on her health, and it has had a huge financial impact and a huge mental impact. In fact, in Fizz's submission, she said:

As a young 26-year-old single income earner, still living at home with my parents, it is hard to see the financial stability of staying part time if I want to apply for a house loan anytime soon; this, in itself, is a burden weighing down on my mental health.

As if getting a home was not challenging enough in the current environment, Felicity has had to go part-time just to deal with her mental health challenges and, of course, challenges through endometriosis.

The disappointing thing is that she is not alone. In fact, I had a look at Endometriosis Australia before coming down here to make my remarks and 70 per cent of women have had to take unpaid time off work to manage their endometriosis symptoms, with 50 per cent saying that the lack of flexibility in the workplace was a significant problem.

Whilst Fizz notes that she had a positive experience with workplace support, she did not have a positive or successful journey when it came to treatment. In fact, Fizz went to her first gynaecologist over 10 years ago and was dismissed, with the doctor only mentioning endo when Fizz had advised that there was a family history of it. In her submission, Fizz talks through the excruciating, unexplainable pain, the challenge to put the energy she needed into her work and a range of other heartbreaking realities she has faced.

I know Felicity through a range of things, including her work at Redeemer Lutheran School in Nuriootpa. She is very active in the local Nuriootpa footy club and she is a ball of energy, but to see your words written on the page speaks to the hidden element or the silent element of the illness that you are suffering.

Fizz is also an organiser of the local endometriosis support group, along with her sister, in the Barossa Valley and last year they raised $7,000 through a quiz night and I am looking forward to joining them again in a couple of weeks' time. So thank you, Fizz, for your report.

My good friend and hopefully future colleague in this place, Dr Anna Finizio, has opened up about her battle with endometriosis. Anna has written for national publications such as Women's Agenda, highlighting the gender health gap and the impact that it has had not just on women but the entire community. Her own experience with endometriosis really has made her such a fierce advocate for improving investment and awareness around women's health. I do not believe that she did provide a submission to this committee, but I wanted to share her story in this place as well. She says the following:

Like many women, my journey to diagnosis was a long one. Quite simply, it was a battle, not just with my own body but with the health system. I spent the last years of my twenties in crippling pain. I had lost control of my body. Some days I felt so hopeless that I wondered if a life like this was a life worth living.

The years it took for me to be diagnosed came at a great cost financially, professionally and personally. I was led down rabbit holes, I was poked and prodded and referred until finally, two weeks before my 30th birthday, I underwent a laparoscopy where I was formally diagnosed with endometriosis. It had attached itself to a number of my organs. But what I thought was the end of my journey was only the beginning and I had already spent thousands of dollars just to get to that point.

When the pain and other symptoms had returned not long after my surgery, I was told by my surgeon that there wasn't anything else he could do. Yes, I had the diagnosis that explained the pain that I had experienced in the past, but I had no plan to help me manage it into the future. I was left to continue to try and navigate a health system which has consistently failed women who remain understudied, underdiagnosed and undertreated. Not only had this condition taken so much from me already but my biggest fear was that it had also taken my ability to be a mum. In two weeks, I turn 39. Endometriosis has changed the course of my life.

Those are Anna's words. I think it is so powerful that women share their experiences like this and they show that vulnerability, because that is how we are going to continue to get action in this place.

More than 70 women shared their experience verbally through the committee. I commend everyone who is here or at home watching this: well done, and including more than 85 people who have made submissions to the committee, whether that be academics, endo friendos, endo warriors, yourself, health officials, health and medical professions, government agencies, and so on.

Before I wrap up, just touching on Anna, she was our Liberal candidate for the seat of Dunstan. I was out doorknocking with her and it was really hot one day, and she was hurled over the footpath in excruciating pain. I thought that it was because it was so hot, and I said, 'Maybe we should have a bit of a breather, Anna.' She said, 'No, I'll be fine.' I said, 'No, I really think that we should be taking a breather,' and she said, 'This happens every single month.'

I thought, 'How is it okay that someone is living in such pain and it has become so normalised?' It was on that day that I found out that Anna was an endo warrior and that that underpinned everything that she was fighting for, so well done Anna. Well done to all of the committee members, particularly the Chair, the member for Waite, who has obviously done a remarkable job—likewise, the members for Dunstan, Frome and Unley—in pulling together this report for the parliament to consider.

I am genuinely hopeful that through this process it is not just about collecting statistics and having another report for the parliament but about paving the way for meaningful action for you. I hope that this is just the beginning of another chapter and that we can see some meaningful action as a result. Thank you for being here in the gallery today. Thank you for sharing your stories. I look forward to working collaboratively across the chamber and across the political divide to try to get some outcomes for you.

Ms WORTLEY (Torrens) (11:46): I rise today as a member of the committee to speak on the report before us. It is no accident that we stand here in this place this morning, having yesterday tabled the report on the Select Committee on Endometriosis, during what is now known as Endometriosis Awareness Month. That is why many of us here and those in the gallery today are wearing yellow.

I know that for many of you here in the gallery this has been a very difficult journey. While I would like to say that the journey would end, that is not going to be the case, but this is going to provide opportunities for you that you have not previously had. I know that as I have family members myself who have suffered severely with endometriosis, and continue to do so. It is something that was not spoken about. When you went to the doctor you were told, 'Live with it. It's okay. You're making a bit of a fuss.' Today, that is the end.

From now on, we know from both this report and some of the work that the federal government has been doing that it will be life changing for many people who have not yet been diagnosed but are still on that journey. The implementation of the 20 recommendations will make a difference, along with the commitment by the federal Labor government to fund an additional 11 specialised endometriosis and pelvic pain clinics, which would bring the total to 33 across the country.

This demonstrates that there now exists a genuine understanding of the urgent need for access to specialised care for the almost a million Australians who are living with endometriosis. It will assist in early diagnosis, resulting in sufferers with this life-altering condition avoiding years of doctor visits and hospital presentations and being told that the days of monthly agonising pain is normal and you just have to put up with it.

It is no wonder that not only the physical but also the mental wellbeing of so many girls and women has been seriously impacted. It affects their daily life, their work life, their career, relationships, their ability to achieve some of life's goals and, sadly in many cases, their ability to achieve and maintain a pregnancy through to the delivery of a healthy baby and healthy mother. We know that having you in the chamber today is important to us and it is important to you, but shining a light on this condition is important to all of the women and girls in the future who are going to be facing these challenges.

I trust that the report before us today will take us some way to improve the journey of those facing the challenges of living with endometriosis. I want to thank all of you here today who have shared your life story, including your family members and your loved ones. In particular, I would like to do a special call-out to Deanna Wallis. I know that you have been persistent and continued along this journey. I would like to think that in some way you also will benefit through the outcome of today's report.

I would like to now just move to the committee. We have been sitting for 12 months. We have heard from so many in the medical profession, and I would like to thank those from the medical profession who have dedicated parts or all of their medical practising to assisting those with endometriosis. I know we will catch up in a little while at the morning tea. I also want to take the opportunity to thank the Chair, the member for Waite, for initiating this journey and for her passion for making a difference for endo sufferers and their families. It is also good to know that the report before us means that it also will impact on those who have not yet been diagnosed and on women and girls who come in the future.

I would like to thank my colleagues from the committee: of course, the member for Waite and Chair—excellent job—I know so much of your time and energy has gone into this; the member for Dunstan; the member for Frome for your absolute dedication and commitment; the member for Mawson; the member for Elizabeth; and, of course, our secretariat, Alison Meeks and Dr Jennefer Bagaporo—everyone, really. You start a committee and you commit to it. When you go onto a parliamentary committee, you say, 'Right, I have to dedicate that time and energy to it.' But I have to say that once this journey started, there was not just 100 per cent given but 100 per cent-plus.

I hope that today gives you some peace in knowing that the recommendations have been accepted, I understand in principle, and will now be pursued and go some way to assisting you on your journey.

The Hon. D.G. PISONI (Unley) (11:52): I rise to make some comments on the report and to thank all those who came forward and told their personal stories, those who are working to support women with endometriosis and also those who are researching the disease. I entered this select committee straight off the back of the select committee on UTI and the common theme is that women's research comes secondary to men's research; women's health comes secondary to general health.

I have a daughter who is a pharmacist—a pharmaceutical scientist with a PhD in pharmacy—and she will tell you time and time again that in health science research it is the men who are the subjects, because women's bodies are too complicated. It is not new for anybody in this audience, or their partners, as to how much more complicated women's bodies are compared to men's. The way monthly cycles interrupt the research process means we cannot have women when we are testing this drug or this drug, and consequently we see women at the end of the line.

I am very pleased that there is a recommendation in this report—it is down at No. 20, but it is there—that there be a stronger emphasis on research for women's health. I actually believe that there is also a role for the state government to weight research grants in favour of women's health, particularly those that are put aside for medical research into medical health here in South Australia. I also learnt through my participation on the committee that there is not a lot done on the pharmaceutical side of research. A lot of the work is surgical and a lot of work is pain relief, whereas we know that pharmaceutical science has come forward in leaps and bounds over the last 50 or 60 years.

It would be good if there was money to back research into developing pharmaceuticals that could stop that growth for women, for example, who are of child-bearing age but are not planning to have children at that time—perhaps a pharmaceutical product that could make those adjustments so as that growth could stop outside of the womb—or, for those who have finished the child-bearing part of their lives, they could be prescribed with a drug that could deal with the situation on a more permanent basis, rather than the very strong impact the surgical processes have on the body.

It is an area that is attacked regularly for women. There are, of course, caesarean sections for birth, there are hysterectomies and there are operations to help manage endometriosis. I would very much like to see a much stronger emphasis on research—women's research in particular. Consequently, I support the recommendations. I thank the member for Waite for the opportunity to participate in the process and learn more about this situation as a man who has not had to experience it second-hand, or with a partner but who has learnt so much from the time that you have given the committee in sharing your experiences and advising what was being done in the scientific world about dealing with this process.

The Hon. C.J. PICTON (Kaurna—Minister for Health and Wellbeing) (11:56): I am going to speak very quickly, given we are up against a hard deadline, and I want to allow the member for Waite to conclude her remarks before 12 o'clock. We, as a state government, welcome this report. This is a landmark report. This not only shines a light on this very important issue of endometriosis but also sets a path forward for how we can improve services for women. There is no doubt that there are thousands of women across this state who have been poorly served by health services, by clinicians and by medical specialties and we want to make sure that it does not happen in the future.

I thank the member for Waite for raising this, for spearheading this, and for being open about her own personal experiences as well. I want to thank all of the people who have contributed evidence towards this. We need to make sure that the discrimination that has been in place in the medical profession for too long changes. This is going to be a big part of that. We accept the recommendations in principle and now the hard work begins in terms of the implementation of those recommendations. I also thank the other members of the committee—the members for Dunstan, Torrens, Unley, and Frome—for their work as well.

Ms HUTCHESSON (Waite) (11:58): Thank you to all members for their contributions. I do want to pay special thanks to the member for Unley. This is the second women's health committee that I have been on with him, and he is a tireless advocate for equitable research and equitable care for women. It has been enlightening to always hear from him around what his daughter experiences and also his absolute advocacy for women in that space, so a big thankyou. Thank you also to the member for Frome who is always very wise and always has a lot to contribute. I appreciate that we are on opposite sides of the chamber, but this committee has been about doing it together and I appreciate all of your submissions and all of your support.

On 5 July 2022, I stood in this place doing a grievance about endometriosis for the very first time. I was a little worried, given I was about to talk about blood and guts in the houses of parliament, but I did it anyway. In that speech, I talked about research. In the last line of my speech that I would like to quickly reflect on, I said, 'With 830,000 women having endometriosis in Australia, it is time that we stood up and helped them.'

Fast-forward to March last year, when we established the select committee, and now we are here today talking about that report and its recommendations. We are all here together: our committee members, our members of parliament and all of our people who provided us with submissions, whether you are a sufferer, whether you are a researcher, whether you are a clinician, a GP, an advocate or a union. We are all here together; we are all standing together.

As we heard, the line in the sand has been drawn. From here on in, it is all about moving forward: making sure that our sufferers feel heard and also that we are doing all the things to make sure we have better health outcomes for women who are struck by this disease. As I said before, endometriosis chooses us: we do not choose it.

Thank you everybody for your comments. I look forward to now sharing some time with all of you over a Parliament House scone and a cup of tea. I commend the report to the house.

Motion carried.