What Is Endometriosis?
Endometriosis happens when tissue similar to the uterine lining grows outside the uterus — on the ovaries, fallopian tubes, or pelvic lining — where it responds to your hormonal cycle the same way, but has nowhere to go. That’s what drives the inflammation and pain. Historically, a definitive diagnosis required surgery, which meant years of delay for a lot of women. That’s changing: updated ACOG guidance from February 2026 now supports a clinical diagnosis — based on your symptoms, history, and a physical exam — as enough to start treatment, without requiring surgery first. Surgery still has a role, but it no longer has to be the gatekeeper before you get help.
Recognizing the Signs of Endometriosis
No two women experience endometriosis identically, but the pattern our providers look for includes:
- Painful Periods (Dysmenorrhea): Pain that goes beyond typical cramping and doesn’t respond well to over-the-counter pain relievers.
- Pain During or After Sex (Dyspareunia): Pain with intimacy, often described as deep within the pelvis rather than at the entrance.
- Pain with Bowel Movements or Urination: Discomfort with digestion or urination, especially around your period.
- Chronic Pelvic Pain: Ongoing pain that isn’t confined to your period at all.
- Heavy or Irregular Bleeding: Unusually heavy or unpredictable cycles.
- Difficulty Getting Pregnant: Trouble conceiving, which for some women is the first sign that brings endometriosis to light.
The severity of your pain doesn’t necessarily match how much tissue is actually there — some women with extensive disease have mild symptoms, and some with a small amount have debilitating pain. That mismatch is part of why this condition gets dismissed for so long, and it’s exactly why your description of your own pain matters more than trying to guess a “score” for it yourself.
How We Evaluate Endometriosis
A visit typically starts with a detailed conversation about your pain — when it happens, how it’s changed, and what’s already been tried — followed by a pelvic exam. Per current guidance, that’s often enough to start treatment. When more information is useful, a pelvic ultrasound can look for endometriomas (endometriosis-related ovarian cysts) and help rule out other causes of pelvic pain, like fibroids. Blood tests like CA-125 aren’t reliable enough to diagnose endometriosis on their own and generally aren’t part of the workup. Surgery (laparoscopy) remains an option — both to confirm the diagnosis directly and to treat it at the same time — but it’s a choice you and your provider make together based on your goals, not an automatic first step.
Your Treatment Options
There’s no cure for endometriosis, but there’s a real difference between “living with it” and having it actively managed. Treatment is built around your symptoms and what you’re hoping to achieve—whether that’s pain control, fertility, or both—and most women land on a combination of these approaches:
- Hormonal Therapy: Usually the first-line medical option — combined birth control pills, progestin-only methods, or an IUD can all suppress the tissue growth driving your pain.
- Pain Management: Including anti-inflammatory medication used strategically around your cycle rather than only after pain has already started.
- GnRH Agonists or Antagonists: Medications that create a temporary, controlled low-estrogen state to shrink endometriosis activity, typically reserved for more significant symptoms or as a step before surgery.
- Surgical Treatment (excision or ablation): Used for women whose symptoms don’t respond to medical management, who are trying to conceive, or who prefer a surgical approach.
- Fertility-Focused Care: Specialized support and treatment options, since endometriosis is a common contributor to infertility.
When to Call Us: Symptoms That Shouldn’t Wait
Most endometriosis symptoms build gradually and can be discussed at a scheduled visit. A few things are worth calling about sooner:
- Sudden, severe pelvic pain, which can occasionally signal a ruptured or twisted ovarian cyst rather than typical endometriosis pain.
- Fever alongside pelvic pain, which points toward a different cause needing prompt evaluation.
- Pain that’s escalated sharply from your usual pattern, rather than gradually worsening.
- New difficulty getting pregnant alongside your other symptoms, especially if you’re over 35.
Choose the Women Who Know: Care From Providers Who Specialize in Endometriosis Management
Years of being told your pain is normal isn’t something our providers accept, and it isn’t something you have to accept either. Drs. Mironda Williams, Deanna Guthrie, and Karen Greene, along with nurse practitioners Mary Corbitt, APRN and Brittany Bulger, APRN, take your pain seriously from the first visit, woman to woman. Call us today at 770-487-9604 to schedule your evaluation.
