Still Fighting in Yellow

Every March, Denton resident Shannon Hannawald puts on yellow and walks into meeting rooms across Caroline County and beyond. She has done it for seven years, standing before town councils and county commissioners, asking for one thing: a proclamation recognizing Endometriosis Awareness Month.

For many, it might look ceremonial, even repetitive. For Hannawald, it is neither. This disease affects an estimated one in 10 women and girls worldwide.

Each proclamation represents another chance to name a disease that thrives in silence, another moment to remind her community that endometriosis is real, chronic, and far more common than most people realize.

“If I stop talking about it,” Hannawald said, “then it goes back into the shadows. And that’s where people get hurt.”

Hannawald is the founder of Endo Warriors of the Eastern Shore. As an Endo Warrior, she’s one of more than 190 million women living with endometriosis.

Despite its prevalence, endometriosis remains widely misunderstood, frequently misdiagnosed, and underfunded in medical research.

That gap between how common the disease is and how little it is discussed is what first pushed Hannawald into advocacy, and it is why she continues to expand her efforts beyond proclamations alone.

A Disease That Hides in Plain Sight

There’s this: National health data show patients typically wait seven to 10 years from the onset of symptoms to receive a diagnosis, often after being told their pain is normal or stress-related.

“A lot of self-doubt that creeps in,” Hannawald said. “When you’re hurting, and nobody has answers, you start wondering if you’re imagining it.”

Endometriosis is a chronic inflammatory condition in which tissue similar to the uterine lining grows outside the uterus, causing pain, inflammation, and, in some cases, organ damage and infertility.

Symptoms vary widely and can include severe pelvic pain, painful periods, gastrointestinal issues, fatigue, and infertility. Some people experience minimal outward symptoms, making the disease difficult to detect and often delaying diagnosis.

Diagnosis remains a significant challenge. Imaging often misses endometriosis, leaving laparoscopic surgery as the gold standard.

Endometriosis is incurable and can be managed. Treatment focuses on symptom management and may include hormonal therapies, surgical intervention, pain management, and lifestyle adjustments. Treatment plans vary, as do symptoms, and often require trial and error and long-term follow-up.

When Pain Is Not Believed
The long road to an endometriosis diagnosis reflects a deeper issue within the healthcare system: women’s pain is often minimized, normalized, or misunderstood.

Gabrielle Trulove, MSN, CNM, C-EFM, a women’s health provider with Choptank Health, said endometriosis exposes long-standing disparities in how pain is treated and believed.

“Unfortunately, I think it’s a societal issue that women are just expected to have pain and to endure that pain,” Trulove said. “And for the comfort of those around them, to do so without complaint.”

Endometriosis is particularly vulnerable to dismissal, Trulove said, because its symptoms are not always visible during an exam. Pain during menstruation or sex does not present as an acute injury, making diagnosis dependent on patient self-reporting.

“We can’t see pain with periods or with sex,” Trulove said. “There’s no bone coming through skin, no open wound to be stitched. We have to go on our patients’ reports of their symptoms, and the delay in recognizing, diagnosing, and treating endometriosis reflects the larger issue of women not being heard, or worse, not being believed.”

That delay is well documented. National health data show that patients often wait 7 to 10 years between symptom onset and a confirmed diagnosis.

The Front Line of Care
Community-based health providers often serve as the first point of contact for patients experiencing symptoms, particularly in rural areas and among uninsured or underinsured populations.

While Choptank Health does not typically manage advanced cases of endometriosis, Trulove said early recognition and intervention can still make a significant difference.

“Community-based health providers will often be the first providers to hear their patients’ complaints, and we have the responsibility to take them seriously,” she said.

By taking accurate menstrual and family histories and listening closely to symptom patterns, providers can begin first-line treatments or make appropriate referrals sooner.

“We can help lessen the average seven-to-10-year delay by listening to women,” Trulove said. “And for patients who can’t afford the out-of-pocket costs of seeing a private specialist, awareness at the community level can protect them from prolonged pain, fertility loss, financial hardship, and the mental health toll that comes with chronic pain.”

For some patients, access to specialized surgical care can be life-changing.

Stefanie DeFiglia, CRNP, FNP-BC, IFMCP, owner of Two Tree Integrative Health, said she often manages endometriosis through a combination of hormonal support and metabolic care, while also recognizing when advanced intervention is needed.

“I do some out-of-the-box management with progesterone, anti-inflammatory diets, and tight blood sugar control,” DeFiglia said. “But I send many of my patients to Baltimore to the Endometriosis Center at Mercy. If they can do the surgery, that can be life-changing.”

For DeFiglia, the goal is not long-term symptom suppression when a structural solution may exist.

“If we can fix the problem versus manage the problem, that’s my goal,” she said.

Changing the System
Both providers point to education as one of the most urgent needs in addressing delayed diagnosis and dismissal of pain.

Trulove said evidence-based public education must begin early and include clear guidance on what is normal and what is not.

“Updating health education in our schools so people know what is normal during a period or during sex, and what is an abnormal warning sign, is critical,” she said. “That’s how women are advocated for instead of being invalidated.”

Earlier awareness, she said, benefits patients and providers alike.

“The more informed people are,” Trulove said, “the harder it becomes to ignore pain that should never be dismissed.”

National Awareness, Growing Momentum

In recent years, endometriosis has gained more visibility at the national and international levels. Advocacy organizations have pushed for expanded research funding, improved physician education, and broader public awareness.

National advocacy organizations have helped bring endometriosis into the broader public conversation through education and research.

Internationally, countries such as Australia have implemented national action plans to address endometriosis care and research, efforts that U.S. advocates frequently cite as models for progress.

While federal funding and policy changes are essential, Hannawald believes awareness must also take root locally.

“National campaigns matter,” she said. “But people listen differently when the story is coming from someone they know.”

Advocacy Born From Experience

Hannawald’s advocacy did not begin with proclamations. It started with pain.

She first experienced symptoms as a teenager and spent years searching for answers. Like many patients, she encountered delays in diagnosis and treatment. When she finally received confirmation of endometriosis at age 19, the relief of having a name for her condition was mixed with fear and uncertainty.

“I didn’t know what it would mean for my future,” she said. “I just knew I couldn’t pretend anymore that it wasn’t serious.”

Rather than withdrawing, Hannawald began educating herself. Over time, she recognized a gap closer to home. While online communities existed, in-person support was limited on the Eastern Shore.

That realization led to the creation of Endo Warriors of the Eastern Shore, a grassroots organization dedicated to education, advocacy, and peer support. The group now serves individuals across Maryland and Delaware, offering meetings, online resources, and one-on-one guidance.

“It’s not about telling people what to do medically,” Hannawald said. “It’s about helping them ask the right questions and know they deserve answers.”

The Power of Proclamations

In its first year, Endo Warriors of the Eastern Shore secured 26 local proclamations recognizing Endometriosis Awareness Month. The effort later expanded to statewide recognition.

Proclamations, Hannawald said, serve as conversation starters.

“They give us a platform,” she said. “Once it’s on the agenda, people pay attention.”

Still, she understands the risk of stagnation. Repeating the same approach year after year can lead to diminishing impact, even when the message remains urgent.

That awareness has pushed Hannawald to evolve her advocacy. In addition to attending council meetings, she now speaks with nursing students, collaborates with community organizations, and encourages businesses and residents to participate in awareness activities throughout March.

Community as a Lifeline

One of Hannawald’s central messages is that managing endometriosis requires more than medical care alone. Support networks play a critical role in helping individuals cope with the physical and emotional toll of chronic illness.

Living with endometriosis often means navigating work, family responsibilities, and relationships while managing unpredictable pain. Isolation is common, especially when symptoms are invisible.

“People look at you and think you’re fine,” Hannawald said. “They don’t see what you’re pushing through.”

Community groups like Endo Warriors of the Eastern Shore provide a space where experiences are validated. Members share coping strategies, discuss how to prepare for medical appointments, and support one another through flare-ups and setbacks.

Rather than framing medical care as a point of failure, Hannawald emphasizes partnership.

“There are providers who want to help,” she said. “Patients just need support while they’re figuring things out.”

Education Without Blame

Hannawald is intentional about keeping her advocacy constructive. She avoids criticism of local medical providers and instead focuses on education, collaboration, and patient empowerment.

“Medicine is always evolving,” she said. “The more we talk about endometriosis, the better equipped everyone becomes.”

That approach resonates within the community. Local governments continue to issue proclamations, and more residents recognize the significance of the yellow ribbons and lights that appear each March.

On March 13, residents are again encouraged to participate in Go Yellow for Endo Day by wearing yellow, changing social media profile photos, or lighting their porches in yellow to spark conversation.

“Awareness doesn’t have to be loud,” Hannawald said. “It just has to be visible.”

Carrying the Work Forward

Advocacy takes time. Hannawald estimates she spends about 20 hours a week on awareness efforts, while also managing her health and family life. She does it without compensation and with no guarantee that progress will come quickly.

Still, she believes the work is worth it.

“Every person who hears the word ‘endometriosis’ and remembers it, that’s a step forward,” she said.

Her long-term hope is simple: that future generations will recognize the disease sooner, receive a diagnosis earlier, and feel supported along the way.

“I want endometriosis to be something people know,” she said. “Not something they have to explain.”

Tenaciously, Hannawald will return to council chambers this March, wearing yellow and carrying her message forward. The proclamations may sound familiar, but their purpose has not faded.

For those living with a silent illness, being seen still matters.

“You’re not alone,” Hannawald said. “And you don’t have to stop fighting.”