Doctors are learning to diagnose endometriosis earlier by recognizing its specific symptom patterns instead of waiting for surgery, according to a recent medical presentation.
Heather Appelbaum, MD, FACOG, director of Pediatric and Adolescent Gynecology at K. Hovnanian Children’s Hospital at Hackensack Meridian Jersey Shore University Medical Center, argues that clinicians should stop defaulting to surgical confirmation for every case. She presented her findings at the North American Society for Pediatric and Adolescent Gynecology (NASPAG) under the title “Multimodal Treatment for Endometriosis.” The talk focused on the distinction between a clinical diagnosis and a surgical one, and how pattern-based recognition can lead to faster treatment.
Appelbaum noted that the disease often presents in a wide variety of ways, meaning doctors must keep it on their differential list for abdominal and pelvic pain even if the symptoms don’t match the classic textbook description. The symptoms can be cyclic, appearing with the menstrual cycle, but they can also be noncyclic. Patients might experience pain during intercourse or show no symptoms at all, complicating the clinical picture.
She added that the range of issues extends beyond the pelvis to include genitourinary symptoms. These can include a frequent need to urinate, dyschezia (pain with defecation), and in some cases, infertility. Because the presentation is so broad, relying solely on surgical confirmation means many patients wait too long for relief.
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Appelbaum also pointed out the stigma that surrounds painful periods, which often leads families to accept debilitating pain as a normal part of being a woman or postmenarchal. Clinicians sometimes conflate primary dysmenorrhea with secondary dysmenorrhea, failing to treat the underlying condition when it is present. She offered a functional threshold for when to intervene: if a girl is not functioning well in her regular daily activities due to pain, whether that means missing school, work, or social events, a deeper dive is required.
While many patients suffer in silence, the medical community is slowly shifting toward a model where symptoms dictate the timeline for care rather than diagnostic certainty. The pressure to prove a diagnosis before treating it has historically delayed care, but the trend is moving toward treating the patient’s functional status and symptom profile.
The multimodal treatment approach mentioned in the presentation suggests that managing the condition effectively often requires a combination of therapies rather than a single intervention. By treating based on the observed patterns, doctors can intervene sooner and relieve symptoms more quickly, keeping the patient’s daily life and functionality in mind.
