Raj K. Syal, M.D., F.A.C.O.G.    |    Jenna A. Everson, M.D., F.A.C.O.G.    |    Holly Westmoreland, M.D., F.A.C.O.G.    |    Kellyn Rielly D.O.   

What is Endometriosis?

The American Congress of Obstetricians and Gynocologists defines endometriosis as a condition in which the type of tissue normally found on the inside lining of the uterus (the endometrium) is found outside the uterus.

Endometriosis is a disease that can affect woman from the time of her first period to menopause. Sometimes, the disease can even last after menopause.

Woodlands endometriosis

Endometriosis most commonly involves the uterus, ovaries, the small bowel, and the tissue lining the pelvis. Endometrial tissue acts just like the normal uterine lining in that it thickens, breaks down, and sheds or bleeds with each menstrual cycle.

However, because the displaced tissue has no way to exit the pelvic cavity, it becomes trapped and can cause pain, scar tissue, and adhesions. As a result, fertility problems may arise. Effective treatments are available.

What are the symptoms of endometriosis?

The primary symptom of endometriosis is pain, mostly in the lower abdomen, lower back, and pelvic area. Pain associated with endometriosis is usually in tandem with a woman’s monthly menstrual cycle, but in more severe cases, can occur more frequently. The amount of pain a woman feels is not linked to how much endometriosis she has. Some women have no pain even though their disease affects large areas, or there is scarring. Some women, on the other hand, have severe pain even though they have only a few small areas of endometriosis.

General symptoms of endometriosis can include, but are not limited to:

  • Extremely painful (or disabling) menstrual cramps; pain may worsen over time
  • Chronic pelvic pain (includes lower back pain and pelvic pain)
  • Pain during or after sex
  • Intestinal pain
  • Painful bowel movements or painful urination during periods
  • Heavy menstrual periods
  • Spotting or bleeding between periods
  • Infertility
  • Gastrointestinal symptoms that are like those of a bowel disorder
  • Fatigue

How do I know if I have endometriosis?

If you think you might have endometriosis, talk with your OB/GYN. There are a number of tests we can perform to determine if you have endometriosis. Sometimes, imaging tests are used to create a “picture” of the inside of the body, which allows a doctor to locate larger areas of endometriosis. The two most common imaging tests are ultrasound, a machine that uses sound waves to create a picture, and magnetic resonance imaging (MRI), a machine that uses magnets and radio waves to create a picture.

The only way to know for sure if you have endometriosis is to have a laparoscopy. This is a surgical procedure performed under general anesthesia in which a tube with a light is placed inside your abdomen. The surgeon can then check your organs to see if any growths or tissue from endometriosis exists. This procedure will show the location, extent, and size of the growths and help you and your doctor make better treatment decisions.

What causes endometriosis?

No one knows for sure what causes this disease. One theory is that during menstruation some of the menstrual tissue backs up through the fallopian tubes into the abdomen, where it implants and grows. Another theory suggests that endometriosis may be genetic, or runs in families.

What is the treatment for endometriosis?

There is no cure for endometriosis, but there are many treatments, each of which has pros and cons. It is important to build a good relationship with your doctor, so you can decide what option is best for you.

Pain Management

Talk to your doctor if you are experiencing pain. A pain management program may be right for you.

Hormone Treatment

For patients who do not wish to become pregnant, but need treatment for endometriosis, your doctor may suggest hormone treatment. Hormone treatment is most effective when growths are small.

Birth control pills control the growth of the tissue that lines the uterus and often decrease the amount of menstrual flow. They usually contain two hormones: estrogen and progestin. Once a woman stops taking them, the ability to become pregnant returns, but the symptoms of endometriosis may also return. Some women take birth control pills continuously, without using the sugar pills that signal the body to go through menstruation. When birth control pills are taken in this way, the menstrual period may stop altogether, which can reduce pain or get rid of it entirely. Some birth control pills contain only progestin, a progesterone-like hormone. Women who can’t take estrogen use these pills to reduce menstrual flow. With these pills, some women may not have pain for several years after stopping treatment. All birth control pills might cause some mild side effects like weight gain, bleeding between periods, and bloating.


Surgery is usually the best choice for women with extensive endometriosis, or those with severe pain. Your doctor will be happy to discuss the different surgical options available to you.