Endometriosis: Chronic, Progressive, Inflammatory
Endometriosis is a chronic progressive inflammatory condition which, if left untreated, can cause significant sequelae with a profound effect on quality of life. Approximately 10% of women worldwide are affected. It can begin as early as adolescence, and residual inflammatory effects may persist for decades after menopause.
Because it is inflammatory and progressive, early diagnosis with curative and preventive intervention is crucial to halt ongoing damage to pelvic organs.
Why Early Diagnosis Matters
Progressive inflammation can involve reproductive organs and cause long-standing effects on fertility. It can also damage the autonomic pelvic nerve network, leading to hyper-excitability and dysfunction (pelvic neuropathy).
- Protect fertility and reproductive organs
- Reduce risk of chronic pelvic pain & pelvic floor dysfunction
- Prevent urinary, bowel, and sexual dysfunction linked to nerve inflammation
- Shorten the average 7–11 year delay to diagnosis
How Endometriosis Affects Multiple Systems
The lower urinary tract, reproductive organs, lower gastrointestinal tract, and pelvic floor muscles share the pelvic space. Inflammation around pelvic nerves can disrupt signaling and result in organ dysfunction.
Common Presentations
1) Lower Urinary Tract
- Urinary urgency & frequency
- Difficulty emptying bladder
- Nocturia (waking at night)
- “Phantom” recurrent UTIs unresponsive to antibiotics
2) Lower GI Tract
- Constipation / diarrhea
- Fecal urgency & bloating
- Difficulty emptying the bowel
3) Reproductive System
- Irregular & painful menses
- Pain with intercourse
- Heavy menstrual bleeding
- Infertility
4) Pelvic Floor & Nerve
- Pelvic nerve hyper-excitability → reflex contraction
- Vaginismus & pain with penetration
- Chronic pelvic pain & dysfunction
The Cost of Ongoing Inflammation
Inflammatory neuropathy can reduce quality of life through pain and urinary/bowel/sexual dysfunction. Break the cycle early to prevent long-term, sometimes irreversible damage.
Why Diagnosis Is Delayed (7–11 Years)
- Normalization of symptoms: many consider menstrual pain “normal.”
- Dismissive culture: band-aid therapy (NSAIDs, OCPs) without root-cause treatment.
- Over-reliance on imaging/labs: no specific/sensitive test for early disease.
- Hesitation with surgery in youth: laparoscopy is still the only confirmation.
- Limited surgical expertise: lesions near ureter/bowel/rectum/pelvic nerves are challenging → residual disease if incomplete.
Result: delayed detection, reduced quality of life, higher downstream costs.
Systemic Barriers to Early Detection
- Update guidelines with early-detection pathways
- Broader training in advanced excision & pelvic nerve surgery
- Validated diagnostic tools with high sensitivity/specificity
Advanced Robotic Excision & Nerve-Focused Care
Exploration should be paired with complete excision of lesions/nodules. Because disease often involves ureter, bowel, rectum, and pelvic nerves, it requires high-level expertise.
The PelviQuest Project
Dr. Shakiba (20+ years, NJ & NYC) leads PelviQuest to address the key missing first step: early diagnosis.
- Universal database linking questionnaires/exams with intraoperative findings
- Use analytics & AI to boost diagnostic precision and staging
- Dual apps (patient & provider) for evaluation, planning, outcomes
- Collaborate globally to improve sensitivity/specificity
- Long-term, self-correcting research platform
Fully funded by Dr. Shakiba; open to collaboration/investment for global expansion.
Suspect Endometriosis? Get Answers Sooner.
Book with our specialists in Hackensack, NJ or the Upper East Side, NYC.
Key Reference
Shakiba K, Bena JF, McGill KM, Minger J, Falcone T. Surgical treatment of endometriosis: a 7-year follow-up on the requirement for further surgery. Obstet Gynecol. 2008;111(6):1285-92. PMID: 18515510. PubMed
