Endometriosis is a chronic, often painful condition in which tissue similar to the uterine lining grows outside the uterus — on the ovaries, fallopian tubes, bowel, bladder, and other pelvic structures. Like the uterine lining, this tissue responds to hormonal changes each month: it thickens, breaks down, and bleeds. Because it has no way to exit the body, it becomes trapped — leading to inflammation, scar tissue, and adhesions that can bind organs together.
Endometriosis affects an estimated 1 in 10 women of reproductive age. Despite its prevalence, the average woman waits 7 to 10 years between symptom onset and confirmed diagnosis. At Hackensack CMIGS, Dr. Adam Shoman provides expert evaluation, precise imaging, and minimally invasive surgery — helping women in New Jersey get answers and relief.
| Women Affected | Diagnosis Delay | Endometriosis & Infertility | Surgical Approach |
|---|---|---|---|
| 1 in 10women of reproductive age — approx. 11% of the female population | 7–10 yrsAverage between symptom onset and confirmed diagnosis | 30–50%Present in women experiencing infertility | LaparoscopicExcision — same-day discharge; return to work in 5–7 days |
Pain severity does not always correspond to disease severity. A woman with Stage I endometriosis may have excruciating pain, while another with Stage IV may have minimal symptoms. Comprehensive evaluation by an experienced specialist is essential.
| Symptom | Description |
|---|---|
| Pelvic Pain | Cramping or aching in the lower abdomen, often worsening during menstruation |
| Painful Periods (Dysmenorrhea) | Severe menstrual cramps that disrupt daily activity |
| Pain During Intercourse (Dyspareunia) | Deep pain during or after sex |
| Pain with Bowel or Urination | Especially during menstrual periods; may signal bladder or bowel involvement |
| Heavy or Irregular Bleeding | Menorrhagia or spotting between periods |
| Infertility | Endometriosis found in 20–40% of women struggling to conceive |
| Fatigue & Bloating | Chronic tiredness around menstruation; severe abdominal bloating ("endo belly") |
| Bladder Symptoms | Frequent urination, urgency, or pain — signs of bladder endometriosis |
Endometriosis cannot be diagnosed by symptoms alone. The only way to confirm a diagnosis is through laparoscopic surgery with biopsy. However, pelvic exam, ultrasound, and MRI can provide strong clinical evidence before surgery.
The exact cause remains under scientific investigation. Leading theories include:
Risk factors include: early onset of menstruation (before age 11), short cycles (less than 27 days), heavy periods lasting more than 7 days, never having given birth, and a family history of endometriosis.
Endometriosis is classified into four stages by the American Society for Reproductive Medicine (ASRM), based on lesion number, location, depth, size, and the presence of adhesions or endometriomas.
| Stage | Description | Severity |
|---|---|---|
| Stage I — Minimal | Small, shallow implants on the pelvic lining or ovaries. Little to no scar tissue. | Mild |
| Stage II — Mild | Deeper implants, small areas of scar tissue. Lesions may appear on the ovaries. | Mild–Moderate |
| Stage III — Moderate | Multiple deep implants, endometriomas on ovaries, and adhesions connecting pelvic organs. | Moderate–Severe |
| Stage IV — Severe | Extensive deep implants, large ovarian cysts, dense adhesions. May significantly affect bowel or bladder. | Severe |
Staging is performed during laparoscopic surgery and guides treatment planning. However, staging alone does not dictate treatment — symptoms, fertility goals, and overall health are equally important factors.
Diagnosis begins with a thorough conversation. Dr. Shoman reviews your symptom history, menstrual patterns, pain profile, and fertility goals. The diagnostic process includes:
The right approach depends on symptom severity, disease stage, age, fertility goals, and prior treatment history. Dr. Shoman develops an individualised treatment plan for every patient.
| Treatment | Details | Best For |
|---|---|---|
| Pain Medications | NSAIDs (ibuprofen, naproxen) to reduce inflammation and menstrual pain | Mild symptoms; short-term relief |
| Hormonal Therapy | Combined oral contraceptives, progestin-only therapy, GnRH agonists/antagonists to suppress estrogen and slow lesion growth | Not yet ready for surgery; post-surgical maintenance |
| Laparoscopic Excision | Minimally invasive surgery to cut out endometriosis lesions completely including root — gold standard surgical treatment | Moderate–severe symptoms; definitive surgical treatment |
| Robotic-Assisted Surgery (Da Vinci) | Robotic precision for complex or deeply infiltrating lesions involving bowel, bladder, or dense adhesions | Deep infiltrating endometriosis; reoperative cases |
| Ablation | Laser or electrosurgical destruction of superficial lesion surfaces | Superficial lesions; less preferred — higher recurrence than excision |
| Hysterectomy | Removal of the uterus — considered only when other options have failed and childbearing is complete | End-stage; failed prior treatments |
The preferred surgical technique at Hackensack CMIGS is excision — cutting out endometriosis lesions completely, including their root — rather than ablation, which destroys only the surface and leaves the root intact. Excision offers more complete removal, lower recurrence rates, tissue samples for pathological confirmation, and the ability to treat lesions on the bowel, bladder, and ureter. Most patients return home the same day.
For deeply infiltrating endometriosis or cases involving the bowel, bladder, or dense adhesions from prior surgery, Dr. Shoman uses Da Vinci robotic-assisted laparoscopy. Benefits include 3D high-definition visualization, tremor-free wristed instruments for precise dissection, reduced blood loss, and return to normal activity within 1–2 weeks.
Endometriosis is one of the leading causes of female infertility, affecting 30–50% of women experiencing difficulty conceiving. The condition interferes with fertility by distorting fallopian tube and ovarian anatomy, creating an inflammatory environment affecting egg quality and embryo implantation, forming adhesions that block the tubes, and causing endometriomas that reduce ovarian reserve.
Surgical excision of lesions and removal of endometriomas can improve natural conception rates. For women pursuing assisted reproductive technology (ART), treatment planning is tailored to preserve ovarian reserve while managing disease. Dr. Shoman works with reproductive endocrinologists to optimise outcomes for patients with endometriosis-related infertility.
| Hoboken Office | Hasbrouck Heights Office |
|---|---|
| Address: 104 Hudson St, Suite 2C, Hoboken, NJ 07030 Hours: Mon–Fri: 8:00 AM – 5:00 PM | Sat: 9:00 AM – 3:00 PM Serving: Jersey City, Weehawken, Union City, Kearny, Manhattan | Address: 777 Terrace Ave, Suite 302, Hasbrouck Heights, NJ 07604 Hours: Mon–Sat: 8:00 AM – 5:00 PM Serving: Hackensack, Lodi, Wallington, Little Ferry, Ridgefield |
How do I know if I have endometriosis?
Common signs include severe menstrual cramps, chronic pelvic pain, pain during intercourse, heavy bleeding, and difficulty conceiving. Definitive diagnosis requires laparoscopic surgery with biopsy. Schedule a consultation with Dr. Shoman for a thorough evaluation.
Can endometriosis be cured?
There is currently no cure, but symptoms can be very effectively managed. Surgical excision offers the most complete treatment, with hormonal therapy used post-operatively to extend symptom-free periods.
What is the difference between excision and ablation?
Excision removes lesions entirely including their root — more complete removal, lower recurrence. Ablation destroys only the surface of lesions, leaving the root intact. Excision is the preferred technique at Hackensack CMIGS.
Can endometriosis cause infertility?
Yes — endometriosis is present in 30–50% of women with fertility challenges. It affects conception by distorting pelvic anatomy, blocking fallopian tubes, and diminishing ovarian reserve. Surgical treatment can significantly improve natural conception rates.
How long is recovery after laparoscopic endometriosis surgery?
Most patients return home the same day and resume desk work within 5–7 days. Full physical activity is typically possible within 2–4 weeks, depending on the extent of the procedure.
Will endometriosis come back after surgery?
Endometriosis can recur, but excision has significantly lower recurrence rates than ablation. Many patients remain symptom-free for years, particularly when surgery is followed by hormonal management.
Does endometriosis affect only the reproductive organs?
No — while most common in the pelvis, endometriosis can involve the bowel, bladder, ureters, appendix, and in rare cases the diaphragm or lungs. Extra-pelvic cases require a specialist experienced in complex excision.
How do I schedule a consultation at Hackensack CMIGS?
Visit hackensackcmigs.com or call our Hoboken or Hasbrouck Heights offices, available Monday through Saturday. Dr. Shoman accepts most major insurance plans and our staff will verify your coverage before your visit.
Dr. Adam Shoman | Hackensack CMIGS | Hoboken & Hasbrouck Heights, NJ
hackensackcmigs.com | Mon–Sat
Adam Shoman, MD, FACOG, MBA, is an obstetrics and gynecology specialist with over 15 years of experience in medicine, fibroids, and surgical treatment.