Endometriosis affects one in 10 premenopausal women—but often goes undiagnosed. That’s because symptoms vary widely and many women think their painful periods are just a natural part of menstruation.
Adrian Balica, MD, chairman of Women’s Health, Obstetrics and Gynecology at Atlantic Health Overlook Medical Center, is raising awareness about the disease—and about the new guidelines from the American College of Obstetricians and Gynecologists (ACOG) that are helping doctors diagnose patients sooner.
What is endometriosis?
Endometriosis is a chronic condition where tissue—similar to the uterus lining—grows outside of the uterus. This tissue can attach to the ovaries, bladder or intestines and in rare cases it can even appear beyond the pelvic region.
“It is not just a pelvic condition, it’s a systemic inflammatory disease that can affect multiple parts of the body,” says Dr. Balica. “Hormonal changes affect the tissue during menstrual cycles, triggering inflammation, scarring and significant pain. Unfortunately, many women live with this pain for years before anyone connects their symptoms to endometriosis.”
Why is it so hard to diagnose?
Although endometriosis is a common, treatable gynecologic condition, many women with the disease never receive a formal diagnosis for two important reasons:
- A surgical procedure was required to confirm the diagnosis.
- Symptoms are overlooked because they vary greatly and often mimic other conditions.
A new way to detect endometriosis
Until now, the only way to confirm endometriosis was with laparoscopic surgery, which uses a small camera in the abdomen to search for abnormal tissue.
But in 2026, the American College of Obstetricians and Gynecologists (ACOG) updated their guidelines to make detection less invasive.
“Doctors can now make a clinical diagnosis based on a patient’s symptoms, medical history and imaging,” says Dr. Balica. “Using ultrasound specifically for the pelvic area, we can more easily identify endometriosis and expedite tailored treatment plans.”
Recognizing the signs and symptoms
Painful periods is the most common symptom, but endometriosis can affect different body systems, too. Some warning signs include:
- Severe menstrual cramps that worsen over time
- Chronic pelvic pain
- Pain during sexual intercourse
- Bloating and abdominal discomfort
- Painful urination
- Heavy menstrual bleeding
- Difficulty getting pregnant
“Symptoms can begin during the adolescent years and gradually worsen over time,” says Dr. Balica. “They often resemble other health conditions, so patients often end up seeing multiple specialists before they learn the underlying cause.”
Treatment options for endometriosis
Currently, there is no cure for endometriosis. But Dr. Balica explains that there are several treatments that bring relief:
- Hormone therapy, including birth control pills
- Pain management techniques
- Pelvic floor physical therapy
- Minimally invasive surgery
- Fertility support (if needed)
“Yes, endometriosis can make it more difficult to become pregnant, but it doesn’t mean pregnancy is impossible,” he says.
Bringing the experts together
Dr. Balica is developing a comprehensive program at Atlantic Health that focuses on chronic pelvic pain and endometriosis. With key experts—urologists, gastroenterologists, minimally invasive gynecologic surgeons and pain specialists— the team is looking more broadly at solutions for each patient’s symptoms.
“Complex endometriosis treatment requires a multidisciplinary team because the disease affects multiple organs beyond the reproductive system,” says Dr. Balica. “The earlier we understand the scope of it, the better we can manage and protect a patient’s quality of life.”
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