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An Act establishing a Women’s Menstrual Health Program and ¹amending and¹ supplementing ¹[Title 26 of the Revised Statutes] P.L.2023, c.240¹.

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

¹[1. As used in this act, “endometriosis” means a systemic disease generally occurring in menstruating individuals, which may also occur in pre-menarcheal and post-menopausal individuals.]¹

¹[2. The Legislature finds and declares that:

a. According to the United States Department of Health and Human Services’s Office on Women’s Health, endometriosis may affect more than 11 percent of American women between the ages of 15 and 44, which is approximately 6.5 million women in the United States alone;

b. According to the Mayo Clinic, endometriosis is an often painful disorder in which tissue similar to the tissue that normally lines the inside of a woman’s uterus, called the endometrium, grows outside the uterus;

c. In patients who have endometriosis, the endometrial-like tissue thickens, breaks down, and bleeds with each menstrual cycle. However, since this tissue has no way to exit the body, it becomes trapped;

d. When endometriosis impacts the ovaries, cysts called endometriomas may form. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions that can cause pelvic tissues and organs to stick to each other;

e. The primary symptom of endometriosis is pelvic pain. While many women experience cramping during their menstrual periods, those patients with endometriosis typically describe menstrual pain that is much worse than typical, and this pain may increase over time;

f. Symptoms of endometriosis include: painful periods, called dysmenorrhea, pain with intercourse, pain with bowel movements or urination, excessive bleeding, infertility, fatigue, diarrhea, constipation, bloating, and nausea;

g. Ovarian cancer occurs at higher than expected rates in those who have endometriosis. Although rare, another type of cancer called endometriosis-associated adenocarcinoma can develop later in life in those who have had endometriosis;

h. According to the Centers for Disease Control and Prevention, polycystic ovary syndrome (PCOS) is one of the most common causes of female infertility, affecting six to 12 percent of women of reproductive age in the United States, or as many as five million women;

i. This life-long health condition continues far beyond the child-bearing years and involves other serious health complications;

j. Women with PCOS are often insulin resistant, which means that their bodies can make insulin but are unable to use it effectively. Insulin resistance increases a patient’s risk for Type 2 diabetes;

k. More than half of women with PCOS develop type 2 diabetes by age 40. PCOS patients can also develop gestational diabetes which puts the pregnancy and baby at risk and can lead to type 2 diabetes later in life for both mother and child;

l. PCOS patients also have higher levels of androgens which can stop eggs from being released and cause irregular periods, acne, thinning scalp hair, and excess hair growth on the face and body;

m. Women with PCOS are at higher risk of heart disease, and this risk increases with age. Those with PCOS can also experience:

(1) high blood pressure, which can damage the heart, brain, and kidneys;

(2) high LDL, or bad cholesterol, and low HDL, or good cholesterol, which increases the risk for heart disease;

(3) obstructive sleep apnea, a disorder that causes breathing to stop during sleep and raises the risk for heart disease and type 2 diabetes; and

(4) stroke;

n. PCOS is also linked to depression and anxiety; and

o. Given all of the increased health risks associated with endometriosis and PCOS and the number of women impacted by these disorders, it is imperative that the State establish a Women’s Menstrual Health Program within the Department of Health to identify and assist patients, who have displayed symptoms related to menstrual disorders.]¹

¹1. P.L.2023, c.240 (C.26:1A-131.1) is amended to read as follows:

1. The Legislature finds and declares that:

a. Menstrual disorders such as endometriosis and polycystic ovarian syndrome affect many women and can have a negative effect on fertility and overall maternal health;

b. According to the United States Department of Health and Human Services' Office on Women's Health, endometriosis may affect more than 11 percent of American women between the ages of 15 and 44, which is approximately 6.5 million women in the United States alone; endometriosis may also occur in pre-menarcheal and post-menopausal individuals;

c. According to the Mayo Clinic, endometriosis is an often painful disorder in which tissue similar to the tissue that normally lines the inside of a woman's uterus, called the endometrium, grows outside the uterus;

d. In patients who have endometriosis, the endometrial-like tissue thickens, breaks down, and bleeds. However, since this tissue has no way to exit the body, it becomes trapped;

e. When endometriosis impacts the ovaries, cysts called endometriomas may form. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions that can cause pelvic tissues and organs to stick to each other;

f. The primary symptom of endometriosis is pelvic pain. Although many women experience cramping during their menstrual periods, those with endometriosis typically describe menstrual pain that is much worse than normal cramping, which pain may increase over time;

g. Symptoms of endometriosis include: painful periods known as dysmenorrhea, pain with intercourse, pain with bowel movements or urination, excessive bleeding, infertility, fatigue, diarrhea, constipation, bloating, and nausea;

h. Ovarian cancer is more common in those who have endometriosis as compared with the general population;

i. Although rare, another type of cancer called endometriosis-associated adenocarcinoma can develop later in life in those who have had endometriosis;

j. According to the federal Centers for Disease Control and Prevention, polycystic ovary syndrome (PCOS) is one of the most common causes of female infertility, affecting as many as five million, or six to 12 percent, of women of reproductive age in the United States;

k. Polycystic ovary syndrome is a lifelong health condition that can affect the lives of people who have it far beyond their child-bearing years and involves other serious health complications;

l. Women with PCOS are often insulin resistant, which means that their bodies can make insulin but are unable to use it effectively, increasing their risk for Type 2 diabetes;

m. Women with PCOS also have higher levels of androgens, which are hormones that can stop eggs from being released and cause irregular periods, acne, thinning scalp hair, and excess hair growth on the face and body;

n. More than half of women with PCOS develop type 2 diabetes by age 40. Women with PCOS can also develop gestational diabetes when pregnant, which puts the pregnancy and baby at risk and can lead to type 2 diabetes later in life for both mother and child;

o. Women with PCOS are at higher risk of heart disease, which risk increases with age;

p. Women with PCOS can also experience: (1) high blood pressure, which can damage the heart, brain, and kidneys; (2) high LDL or "bad" cholesterol and low HDL or "good" cholesterol, which increases the risk for heart disease; (3) sleep apnea, which is a disorder that causes breathing to stop during sleep and raises the risk for heart disease and type 2 diabetes; and (4) stroke;

q. PCOS is also linked to depression and anxiety;

r. Menstrual toxic shock syndrome is a menstruation-related condition that can lead to serious adverse health symptoms, including death if left untreated. The symptoms of menstrual toxic shock syndrome generally begin with low fever, muscle aches, chills, fatigue, and headaches, but as the condition progresses, symptoms can include high fever, vomiting, rashes, redness of the eyes, lips, and tongue, low blood pressure, and mental confusion;

s. Menstrual toxic shock syndrome is generally treatable with antibiotics, but treatment relies on identifying the signs of the condition and seeking professional help. Anyone can contract menstrual toxic shock syndrome, but women using tampons and similar devices are at a higher risk; and

t. Given all of the increased health risks associated with menstrual disorders, such as endometriosis and PCOS, as well as the risks of menstrual toxic shock syndrome, and the number of women impacted by these conditions, it is imperative that the Department of Health to establish a public awareness campaign about the effects of menstrual disorders and menstruation-related conditions on fertility and overall maternal health and a Women’s Menstrual Health Program within the Department of Health to identify and assist patients who have displayed symptoms related to menstrual disorders.¹

¹[3.] 2. (New section)¹ a. The Commissioner of Health shall establish in the Department of Health a Women’s Menstrual Health Program to identify and assist patients¹[,]¹ who have displayed symptoms related to menstrual disorders.

b. The Department of Health shall, in accordance with evidence-based industry best practices, guidelines, and screening tools, as recommended by the American College of Obstetricians and Gynecologists or another nationally-recognized body ¹[as may be]¹ designated by the commissioner:

(1) provide education and training to health care providers, hospital staff who encounter patients in emergent situations, and the public concerning menstrual health, menstrual health screening, and menstrual health care; and

(2) provide on the Department of Health’s Internet website information and resources for health care providers and patients, which shall include, but not be limited to:

(a) evidence-based clinical practice guidelines for health care providers for the screening, referral, treatment, and follow-up care of patients, who have displayed symptoms related to menstrual disorders; and

(b) educational materials for health care providers and the public concerning menstrual disorders, menstruation-related disorders, and menstruation-related conditions.

¹[4.] 3.¹ The Department of Health shall, in accordance with the “Administrative Procedure Act,” P.L.1968, c.410 (C.52:14B-1 et seq.), adopt any rules and regulations as the department deems necessary to implement the provisions of this act.

¹[5.] 4.¹ This act shall take effect on the 30th day following enactment, except that the Commissioner of Health may take such anticipatory action in advance as shall be necessary for its implementation.