Endometriosis

Endometriosis is a condition that can cause significant pelvic pain, painful periods, and sometimes fertility challenges. It occurs when tissue similar to the lining of the uterus grows outside the uterus, where it does not belong. This tissue may affect the ovaries, fallopian tubes, pelvic lining, bowel, bladder, or other nearby areas.

Because endometriosis can respond to monthly hormone changes, it may lead to inflammation, scarring, irritation, and pain that can worsen over time. For some patients, symptoms are mild. For others, endometriosis can interfere with school, work, relationships, intimacy, exercise, and everyday activities.

At The Medical Group of New Jersey, our gynecology specialists provide careful evaluation and personalized treatment for women with suspected or confirmed endometriosis. The goal is to reduce pain, improve daily function, protect reproductive health, and support long-term quality of life.

Symptom Onset & Initial Evaluation

Endometriosis symptoms often begin during the teen years or early adulthood, but many women are not diagnosed right away. Painful periods are sometimes dismissed as “normal,” even when the pain is severe, worsening, or interfering with daily life.

Symptoms may become more noticeable over time, especially if pain occurs outside the menstrual period or if a woman has difficulty becoming pregnant.

Common symptoms include:

• Painful menstrual periods
• Pelvic pain before or during periods
• Pelvic pain between periods
• Pain during intercourse
• Pain with bowel movements or urination, especially around the time of the menstrual cycle
• Heavy or irregular bleeding
• Bloating or digestive discomfort
• Difficulty becoming pregnant

During your visit, your gynecologist will take time to understand your symptoms, when they occur, how severe they are, and how they affect your daily life. They will also review your menstrual history, pain pattern, prior treatments, family history, medical history, and reproductive goals.

A pelvic examination may be performed to check for tenderness, ovarian cysts, pelvic floor muscle discomfort, or other signs that may help guide the next steps in evaluation.

Diagnosis

Endometriosis can be challenging to diagnose because symptoms may overlap with other conditions, including ovarian cysts, uterine fibroids, irritable bowel syndrome, bladder pain syndrome, pelvic inflammatory disease, and pelvic floor dysfunction.

Evaluation may include:

• Pelvic examination
• Pelvic ultrasound
• MRI in selected cases
• Laboratory testing when needed to rule out other causes
• Trial of medical therapy in some patients
• Laparoscopy when a surgical diagnosis is needed

Pelvic ultrasound or MRI may help identify ovarian endometriomas or other pelvic findings, but smaller areas of endometriosis may not always show up on imaging.

A laparoscopy is a minimally invasive surgical procedure that allows the gynecologist to look inside the pelvis. In many cases, endometriosis can be treated during the same procedure.

Treatment & Ongoing Management

Treatment depends on symptom severity, age, medical history, fertility goals, and whether endometriosis is affecting other organs. The right plan may look different for each patient.

Management options may include:

• Pain relief medications
• Hormonal birth control to reduce menstrual cycling
• Progesterone-based therapies
• Hormonal IUDs
• Medications that temporarily suppress estrogen activity
• Pelvic floor physical therapy
• Minimally invasive surgery to remove endometriosis lesions
• Fertility evaluation or treatment when pregnancy is desired

Treatment is individualized. Some patients do well with medication and monitoring, while others benefit from surgery or coordinated care with fertility, gastrointestinal, urology, pelvic floor therapy, or pelvic pain specialists.

Your gynecologist will review the benefits and risks of each option and help you choose a treatment plan that fits your symptoms, goals, and quality-of-life needs.

Follow-Up Care

Endometriosis is often a long-term condition, so follow-up care is important. Symptoms may improve with treatment, but they can also change over time, especially with medication changes, pregnancy planning, or hormonal transitions.

Follow-up may include:

• Monitoring pain and menstrual symptoms
• Adjusting medications when needed
• Evaluating fertility goals
• Repeat imaging if cysts or other findings are present
• Follow-up after surgery when performed
• Coordination with pelvic floor therapy or other specialists

With proper care, many women experience meaningful improvement in pain, function, intimacy, fertility planning, and overall quality of life.