Women’s health in primary care needs continuity, not visits

My wife and my daughter both have endometriosis.

I have spent nearly thirty years working in community health, much of that time leading a federally qualified health center. I know how health care works. I know how referrals work. I know how to ask questions, find resources, and push when something does not make sense. None of that shortened the road for the two women I love.

I watched appointments end with normal labs and no answers. I watched referrals lead to more referrals. I watched years of pain get treated as separate events instead of pieces of the same story.

Their experience is painfully common. A study published this February in the Journal of Women’s Health, following roughly 6,950 women, found an average delay of 10 years before an endometriosis diagnosis and 11 years for adenomyosis. One finding stood out to me. Each additional health professional a woman saw before diagnosis was associated with roughly another third of a year of delay. More appointments did not move women toward an answer faster.

Our system is filled with good people and deep expertise. What often goes missing is someone responsible for holding the whole story. One clinician sees the bleeding. Another sees the pain. Another sees anxiety, fatigue, fertility concerns, sleep disruption, or depression. The patient becomes the person expected to connect every piece and carry the history from room to room.

We see the same problem later in a woman’s life. A 2024 study in Menopause examined women in primary care with moderate to severe hot flashes. Fewer than 1 in 4 had those symptoms documented in their medical record. Among women without a contraindication to hormone therapy who had never used it, about 6 percent received a prescription.

Those women made it into the exam room. Their symptoms still disappeared inside the visit.

Women’s health unfolds over decades. Adolescence, contraception, fertility, pregnancy, pelvic pain, mental health, perimenopause, menopause, bone health, cardiovascular risk, sexual health, and the enormous amount of caregiving women often carry all overlap. When we divide that life into disconnected encounters, women pay the price.

Community health centers are in a strong position to do something different. More than 8 million women of childbearing age, roughly 1 in 8 women between 15 and 44, rely on health centers. In 2024, women of reproductive age made an estimated 6.1 million visits to health centers for maternal and reproductive care. Women are already walking through our doors.

Now look at what many health centers have built around those doors. At Heritage Health, a woman might see her primary care clinician, a behavioral health provider, a pharmacist, and a dentist in the same organization, using the same record, sometimes on the same day. Across the country, health centers served more than one million behavioral health patients last year.

That kind of integration matters when someone is living with a condition like endometriosis. Chronic pain affects sleep. It affects work. It affects relationships, mental health, sexual health, fertility, and whether someone has enough energy left at the end of the day to live the rest of her life.

Health centers also bring something else to the table. Sliding fee scales. Care regardless of insurance status. Relationships that often last years. A presence in rural communities where specialty care might be an hour or several hours away.

Forty percent of health centers operate in rural communities. For many women, especially in places like North Idaho, the local health center is the most consistent relationship they have with the health care system.

We also have work to do before we deserve to call ourselves the preferred home for women’s health.

We need to ask better questions. Pelvic pain, heavy bleeding, changes in menstrual cycles, and symptoms of perimenopause should be part of routine primary care conversations. We should document those symptoms and follow them over time instead of waiting for women to raise them after years of living with them.

We need to train our clinicians. Menopause, endometriosis, adenomyosis, and chronic pelvic pain deserve more attention in primary care education. Health centers serious about women’s health should invest in that knowledge throughout their clinical teams.

We need to own the referral. When a woman needs a surgeon, gynecologist, or specialist we do not employ, we should stay involved. We should help coordinate the care, make sure the referral happened, understand what came back, and remain responsible for the bigger picture.

And we need to measure whether we are getting better. Health centers track diabetes control, blood pressure, prenatal care, cancer screening, and dozens of other measures because measurement changes behavior. Women’s health deserves that same discipline. We should know how long women are waiting for answers, whether abnormal findings are followed up, whether referrals are completed, and whether women leave our care feeling heard and believed.

I did not arrive at this idea through a strategic planning exercise. I arrived here sitting beside my wife and my daughter.

I watched two smart, strong women spend years trying to convince a health care system that what they were feeling was real. I kept thinking about how different their experience might have been if one clinical home had held the entire story from the beginning.

Community health centers were built around continuity, access, relationships, and whole-person care. That is exactly what women need.

We have an opportunity to become the place where women bring the whole story and know someone will stay with it. We should earn that trust.

This essay is cited in the KevinMD record on primary care.

Michael Baker is a health care executive.