Endometriosis occurs when tissue similar to the lining of the uterus grows outside the uterus. During a normal menstrual cycle, the tissue inside the uterus thickens and sheds as part of a period. With endometriosis, similar tissue is found in places where it does not belong, such as the ovaries, fallopian tubes, bladder, bowel or other areas in the pelvis.
Because this tissue still responds to monthly hormone changes, it can become irritated, bleed and cause pain. Over time, endometriosis can lead to ongoing inflammation, scarring and fertility challenges.
Endometriosis most often affects women during their reproductive years and can begin as soon as menstrual cycles start.
The exact cause of endometriosis is not fully understood. One possible explanation is retrograde menstruation, which happens when some menstrual tissue flows backward through the fallopian tubes and into the pelvis instead of leaving the body during a period.
Researchers also believe endometriosis may begin when certain cells grow in the wrong place and start acting like endometrial tissue. In rare cases, tissue similar to the uterine lining may even appear outside the pelvis. Although the exact cause is not always clear, the symptoms and impact of endometriosis are very real.
Endometriosis symptoms can look different from one woman to the next. One of the key signs is cyclical pain, meaning pain that returns around the same time each month before, during or after your period.
Additional symptoms may include:
Because endometriosis can affect different areas of the pelvis, symptoms may vary based on where the tissue is located. For example, endometriosis involving the bowel may cause pain with bowel movements, while endometriosis near the bladder may cause urinary discomfort or bladder spasms during the menstrual cycle.
Some women experience constipation or recurring pelvic discomfort that may be dismissed as something else, without realizing endometriosis could be part of the picture.
Symptoms do not always reflect how much endometriosis is present, and pain can be significant even when imaging appears normal or the disease is not extensive.
An experienced OB/GYN can often make an informed clinical assessment based on your symptoms, health history and a detailed conversation during your visit. Endometriosis may be strongly suspected before surgery is even considered.
Imaging such as MRI may help, especially in more extensive cases, but it does not always detect endometriosis. A normal scan does not necessarily rule it out. That is one reason it is so important to talk with an OB/GYN who is familiar with the condition and knows what questions to ask.
Treatment may also begin based on symptoms and a strong suspicion of endometriosis alone. If symptoms improve with treatment, that can further support the diagnosis.
Ultimately, the only way to definitively confirm endometriosis is through a minimally invasive procedure called laparoscopy. During this procedure, a surgeon uses a small camera to look inside the abdomen and pelvis for signs of endometriosis. If needed, tissue can be biopsied or treated during the same procedure.
Many women live with painful periods for years because they have been told their symptoms are normal or that other women in their family had the same experience. However, painful periods are not something you should assume are normal.
You should consider seeing an OB/GYN if you have:
Left untreated, endometriosis can continue causing pain for years and may contribute to scarring that affects fertility. Many women are not diagnosed until they begin seeking answers for infertility or have already spent years living with symptoms they assumed they had to tolerate.
For teens and younger patients who have started having periods, it is especially important to pay attention to early symptoms. If painful cycles are already becoming a pattern, families should consider bringing their daughter to an OB/GYN instead of assuming those symptoms are simply part of growing up. Early conversations can lead to earlier answers, evaluation and relief.
Endometriosis treatment depends on your symptoms, your goals and whether pregnancy is something you hope to pursue in the near future.
Treatment options may include:
Treatment most often begins with hormonal medication aimed at reducing or stopping the menstrual cycle. Because endometriosis tends to flare with hormonal cycling, this approach can help manage symptoms over time. Some patients begin to notice symptom relief after one to three cycles of treatment, though finding the right medication plan can take time.
Pain management strategies may also be part of treatment to help reduce day-to-day discomfort while you and your doctor determine the right long-term approach.
Dietary and lifestyle changes can also play a role in symptom management. Reducing heavily fried or fatty foods may help as part of a broader treatment plan.
Laparoscopic surgery may be recommended for women who do not want hormonal treatment, whose symptoms persist or who need a more definitive diagnosis. During surgery, physicians can identify, biopsy and remove visible endometriosis tissue, which can provide meaningful symptom relief.
Because endometriosis may affect the fallopian tubes or pelvic anatomy in ways that make conception more difficult, treatment planning also takes fertility into account. That is why treatment decisions often depend not only on current symptoms but also on future pregnancy goals and timing.
Every woman’s treatment journey with endometriosis is different. Some patients respond quickly to medication, while others need time to find the right approach. Endometriosis can also recur, which is why follow-up care and ongoing conversations with an OB/GYN remain important.
At Memorial Hermann, patients with endometriosis have access to affiliated OB/GYN specialists experienced in recognizing, diagnosing and treating this often-overlooked condition. Care is centered on two important goals: relieving symptoms and preserving or supporting fertility when possible.
Patients benefit from:
Women with endometriosis often come to us after years of unanswered questions, ongoing symptoms or treatment that has not fully helped. Our team is here to listen, evaluate your symptoms carefully and help you move toward care that is thoughtful, individualized and aligned with your goals.
Memorial Hermann is committed to enhancing health care for women of all ages and at every stage of life. We offer a full spectrum of specialized services, from adolescent gynecology and maternity care to midwife services, breast care, pelvic floor health, menopause care and more. Across Greater Houston, our affiliated women’s health specialists work together to provide convenient, comprehensive care close to home within one connected network. We also work to increase access to care and support efforts to close the health equity gap for women and children in the communities we serve.
You do not have to keep wondering whether your pain is normal. If you are experiencing symptoms tied to your cycle or have fertility concerns, the first step is talking with an OB/GYN who understands endometriosis. Reach out today to schedule an appointment.