Thanks very much. I guess that's part of the reason why so many people are misdiagnosed or not diagnosed, because it is quite difficult to understand that. That's why I think training for doctors, for physicians, is critical. 

Endometriosis may be suspected due to an individual symptom history or through scans, but the invasive surgical procedure called laparoscopy is currently the main way to confirm that symptoms are due to endometriosis, and allows for surgical procedures to relieve symptoms and complications. Expertise and capacity are being developed across Wales to address the need for such services. There's also a clear need for further research into more rapid diagnostic approaches for endometriosis, so it can be identified sooner in its course. 

Early treatment with hormonal manipulation is highly effective in reducing pain and complications, including surgical and fertility problems, but this, of course, depends on early diagnosis. It's with regret that the health service's response to the pandemic, whilst necessary, has negatively impacted access to care in Wales and across the UK for a range of conditions, including endometriosis. Sadly, difficult decisions have only added to the protracted timescale for diagnosis and treatment already being experienced by women. Health boards are responsible for providing their local populations with high-quality care and support for the management of endometriosis. 

Wales has two fully accredited endometriosis specialist centres—University Hospital of Wales and Singleton Hospital—as well as an endometriosis specialist centre at the Royal Gwent Hospital awaiting accreditation. I understand there are some moves afoot in Betsi as well. There are, of course, areas of good practice across Wales, but not all clinicians have the confidence and expertise to correctly identify and attribute endometriosis symptoms, as well as provide ongoing care and support. So, there is a clear need for improvements in training, skills and awareness, as well as access to specialist advice and treatment, where that's required. 

In recent years, there have been several important developments here in Wales in advancing the support and care available to those experiencing endometriosis. We had the task and finish group that was established. Following the receipt of its report in 2018, the women's health implementation group was created to take forward its recommendations. That led to endometriosis nurses and pelvic health co-ordinators being appointed in each health board. They actively spent time with patients in clinics and liaised with their multidisciplinary teams to improve endometriosis service provision across Wales. 

A dedicated website has been developed for patients and clinicians. Endometriosis Cymru includes 'living with' stories from Welsh people and a symptom tracker, which has the potential to become a diagnosis tool for patients and clinicians to speed up intervention for early diagnosis and treatment of endometriosis. Additional resources have been created, such as the Bloody Brilliant website, to provide evidence-based guidance and help normalise conversations around menstrual health.

Despite these developments, the current waiting times for diagnosis and treatment and the powerful stories we all continue to hear from women right across Wales suffering from endometriosis demonstrate that much more needs to be done. I'm committed to delivering improvements for these women, and that's what we're working towards.