Uruguay’s New Endometriosis Law Is What Happens When a Country Stops Telling Women Their Pain Is Normal

Valentina Hortoneda was 12 years old when the pain started, and for the next 14 years she was told it was normal. The diagnosis finally arrived at 26, during emergency surgery that revealed a 15-centimeter cyst so attached to her organs that surgeons had to remove her right ovary and fallopian tube. She has since undergone eight operations, a full hysterectomy and countless hospitalizations, and the disease is still growing. According to El País, her story is not an exception. It is the reality for thousands of women across Latin America who spend years being dismissed before anyone takes their pain seriously.

Uruguay moved to change that this year when it passed Law 20.374 in March and regulated it in April, officially recognizing endometriosis as a public health problem and requiring all providers within the national health system to guarantee access to early diagnosis and comprehensive treatment, a step that patients and specialists had been demanding for decades.

What Endometriosis Actually Is

Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus. For decades it was treated as a routine gynecological condition, but current medical understanding places it in the category of complex inflammatory disease capable of affecting multiple organs and altering daily life in ways that extend well past reproductive health. Lesions can appear on ovaries, fallopian tubes, the pelvis, intestines, bladder and in exceptional cases even the lungs or brain.

Symptoms vary widely and include debilitating pain, heavy bleeding, extreme fatigue, digestive problems, pain during sex and difficulty becoming pregnant. The average time between a woman’s first symptoms and her eventual diagnosis currently sits between seven and ten years in Uruguay, a gap that reflects both the complexity of the disease and the culture of dismissal that has surrounded it for generations. Women arrive at specialists after years of being told their pain is a normal part of menstruation, and they leave without answers because the medical system has historically lacked both the training and the institutional pressure to look harder.

Valentina’s case illustrates the outer limits of what the disease can do. Two years after her hysterectomy, during which surgeons removed her uterus, fallopian tubes and remaining ovary under the assumption that eliminating reproductive organs would stop the cysts from growing, the pain returned with equal force. A new cyst appeared and nobody could explain how. Twenty days after her eighth surgery, she was hospitalized again when another cyst had already grown back.

The Cultural Problem Behind the Medical One

Lucía Vázquez spent four years being told by specialists that she had nothing wrong with her. She was too sensitive. She had simply been dealt a difficult menstruation. She should take an ibuprofen. She found an English-language online forum for women with endometriosis at 19 years old, recognized her own experience in every post and went to a gynecologist to say she believed she had the disease. He laughed. Her diagnosis eventually came through surgery, the most common path to confirmation for women with this condition.

The problem, as Vázquez has described it through her advocacy work with Integra Endo Comunidad, extends well past individual medical encounters. It is cultural. Women across Latin America and the broader world have grown up being told that menstrual pain is something to endure rather than something to treat, and that normalization has made it extraordinarily difficult for patients to be believed even when the evidence of their suffering is impossible to ignore.

What the Law Does and What It Still Needs to Become

Uruguay’s Health Minister Dr. Cristina Lustemberg acknowledged to El País that passing the law was a beginning rather than a finished achievement. The legislation requires that studies, treatments and medications related to endometriosis be included in the national health coverage plan, meaning patients will no longer absorb extra costs for monitoring, testing or medication connected to the disease.

Lustemberg identified closing the diagnostic gap as the most pressing remaining challenge, getting women from first symptoms to confirmed diagnosis in a timeframe that allows for treatment before the disease causes irreversible damage. She also described the importance of building policy in direct collaboration with patient communities, arguing that the state has a responsibility to translate accumulated lived experience into concrete public health action.

The law Uruguay passed this year will not give back the years that women like Valentina spent being told their pain was normal. What it can do is ensure that the next young woman who starts feeling that pain will eventually be believed, and that the system she turns to for help will be legally required to take her seriously.