Endometriosis

Endometriosis is a chronic condition that affects an estimated 10% of women globally during their reproductive years, often causing debilitating pelvic pain and infertility. At Houston Methodist, our board-certified OB-GYNs and women’s health specialists combine advanced diagnostic tools with a full range of treatments, from hormone therapy to minimally invasive surgery, to help manage your symptoms and protect your long-term health.

What Is Endometriosis?

Endometriosis is a chronic, inflammatory condition in which tissue similar to the endometrium (the lining of the uterus) grows outside the uterus, often on the ovaries, fallopian tubes or other pelvic organs. It affects approximately 10% of women worldwide, and 11% in the U.S. Endometriosis can worsen over time if left untreated, but it is often manageable with a combination of medication, minor procedures and surgery, depending on the severity of your symptoms.

Why Choose Houston Methodist for Endometriosis Care

Trusting your care team matters, especially with a condition that can affect your daily life and your fertility. Gynecology specialists at Houston Methodist combine advanced surgical technology with a compassionate, whole-person approach to help you find lasting relief. 

Endometriosis can feel like an overwhelming diagnosis, but the condition is very manageable with the right care team. Look for a gynecologist experienced in minimally invasive laparoscopy who also has access to fertility specialists and pelvic floor physical therapists if you need them. At Houston Methodist, our OB-GYNs and women’s health team work together to build a treatment plan around your goals, whether that means managing pain, protecting your fertility or both.

The exact cause of endometriosis isn’t fully understood, but doctors believe several factors work together to trigger it, which may include:

• Retrograde menstruation, in which menstrual blood flows backward into the pelvic cavity instead of leaving the body
• Genetic factors, since endometriosis often runs in families
• Immune system issues that make it harder for the body to clear stray tissue
• Hormonal imbalances, particularly excess estrogen, that encourage tissue growth
• Scar tissue or adhesions from a prior C-section or other pelvic surgery, which can trap endometrial cells outside the uterus

Types of Endometriosis

Endometriosis is classified by where it grows and how far it has spread. The type you have will affect your treatment plan.

• Superficial peritoneal endometriosis: The most common type, in which tissue grows on the thin lining of the pelvis and abdomen
• Endometrioma: Fluid-filled cysts, sometimes called “chocolate cysts,” form when tissue grows on or in the ovaries
• Deep infiltrating endometriosis: A less common but more severe type in which tissue grows into deeper structures like the bowel or bladder

Signs and Symptoms of Endometriosis

Symptoms of endometriosis vary widely. Some women have severe pain while others have few or no symptoms at all. Left untreated, symptoms can worsen over time and may affect your fertility. Symptoms of endometriosis include:

• Pelvic pain: Pelvic pain is the most common symptom of endometriosis, including chronic pelvic pain that isn’t tied to your menstrual cycle.
• Painful periods: Dysmenorrhea, or severe menstrual cramps, is common with endometriosis and often gets worse over time.
• Pain during intercourse: Pain with intercourse, known as dyspareunia, is a common symptom that can affect intimacy and quality of life.
• Digestive issues: Endometriosis can cause bloating, constipation, diarrhea and nausea. Symptoms are sometimes mistaken for irritable bowel syndrome (IBS).
• Heavy or irregular bleeding: Heavy periods, heavy bleeding and bleeding between periods are all common signs of endometriosis.
• Infertility: Endometriosis is one of the most common causes of infertility, often due to scarring or adhesions that affect the ovaries or fallopian tubes.
• Fatigue: Fatigue is common with endometriosis, and it can be worsened by the chronic pain and heavy bleeding that often accompany this condition.

How Endometriosis is Diagnosed

Diagnosis usually starts with a conversation about your symptoms and your family history, followed by testing to confirm the diagnosis and rule out other conditions. Diagnostic tests may include:

• Pelvic exam: A physical exam to check for cysts, scarring or tenderness.
• Transvaginal ultrasound: A common, non-invasive imaging test that uses sound waves to look for endometriomas and other abnormalities.
• Pelvic MRI: Magnetic resonance imaging is used to get a detailed picture of endometrial tissue, especially before surgery.
• Laparoscopy: A minimally invasive procedure that uses a thin scope, called a laparoscope, to view the pelvic organs directly and take a biopsy if needed.

Treatment Options for Endometriosis

There’s a range of treatments for endometriosis, and most doctors start with a conservative approach. Surgery may be recommended for more advanced cases, or if you’re trying to conceive.

Non-Surgical Treatment

NSAIDs: Over-the-counter nonsteroidal anti-inflammatory drugs such as ibuprofen may be used to manage pain and inflammation.

• Hormone therapy: This includes birth control pills or an IUD to regulate or stop your menstrual cycle.
• GnRH agonists: These temporarily induce a menopause-like state and can shrink endometrial tissue.
• Pelvic floor physical therapy: Exercises that may ease muscle tension that contributes to chronic pelvic pain.
• Interdisciplinary pain management: An approach that combines physical therapy and psychological support for women whose pain doesn’t fully respond to medication alone.

Surgical Treatment

• Laparoscopy: This is a minimally invasive procedure to remove or destroy endometriosis lesions while preserving fertility.
• Hysterectomy: Surgical removal of the uterus is called a hysterectomy and is considered only when other treatments have failed and you aren’t planning future pregnancies.