New endometriosis guidelines: A smoother path to effective treatment
June 2, 2026
If you’ve been living for years with heavy periods, pelvic pain, or bloating and bowel problems that disrupt your daily life, you’re not alone. An estimated one in 10 women of reproductive age worldwide have endometriosis, which causes excess, often-painful tissue growth in the abdomen.
Despite endometriosis being so common, it takes an average of four to 11 years for women to get a diagnosis, which for decades has required exploratory surgery.
Many women come to our clinic after years of missing out on school, work, and intimacy due to symptoms and adjusting their lives around the pain. Often, they’ve been told that their symptoms are normal or that there isn’t an effective treatment and just to “live with it.” Some go through multiple surgeries, including hysterectomy, only to have their symptoms resurface.
But there is hope for endometriosis management. And now there are better, clearer guidelines to help doctors shorten the time to diagnosis and help women get effective treatment sooner.
The American College of Obstetricians and Gynecologists (ACOG) recently released updated guidance for endometriosis diagnosis. The recommendations reflect how specialists in women’s health at UT Southwestern have approached endometriosis care for years: listening to women and providing treatment options based on their symptoms – without exploratory surgery.
What is endometriosis?
Endometriosis occurs when tissue that is similar to the lining of the uterus (endometrium) grows outside the uterus in the pelvic area, on the ovaries, and in other areas of the abdomen. These lesions respond to hormones during your menstrual cycle – they can swell, cramp, and bleed. But instead of getting flushed out of the body with your period, the blood gets trapped instead. This can cause inflammation and scar tissue that adheres to the surrounding organs, generating intense pain and nerve damage.
To date, there is no clear data on what causes endometriosis. Research suggests that immune system conditions or hormones may play a role, along with retrograde menstruation – a backflow of period blood through the fallopian tubes and pelvis instead of out of the body.
How is endometriosis diagnosed?
Historically, endometriosis could only be definitively diagnosed with laparoscopic surgery to visualize the excess tissue. This caused delays in care; the disease had time to get worse while costing women more money and reducing their quality of life.
The new ACOG guidelines take the surgery requirement away. Instead of doing exploratory surgery, doctors can make a diagnosis based on a woman’s symptoms, a physical exam, and visualization from imaging such as transvaginal ultrasound or pelvic MRI.
Endometriosis should be suspected when a woman has at least one of these symptoms:
- Chronic pelvic pain
- Painful periods (dysmenorrhea)
- Pain with sex (dyspareunia), urination (dysuria), or bowel movements (dyschezia)
- Infertility
Additional signs can include fatigue, bloating, diarrhea, constipation, or a family history of endometriosis. Some symptoms overlap with other common conditions, such as fibroids, adenomyosis, and inflammatory bowel disease.
Endometriosis is classified in four stages, ranging from minimal with few lesions to severe with deep lesions, large cysts, and thick adhesions. The amount of pain someone has with endometriosis doesn’t always indicate how much disease is present. A woman with minimal active disease may have a lot of pain, while another woman with deep endometriosis or even bowel disease may hardly notice the effects.
No single symptom confirms endometriosis, so getting an accurate diagnosis may require a few visits and conversations with your doctor. It’s like peeling an onion – we’ll go one layer at a time until we reveal the core cause of your symptoms. For women, this means you can get a more effective treatment plan earlier, and you can start feeling like yourself again sooner.
What are the treatments for endometriosis?
While there is not yet a cure for endometriosis, getting the right treatment can significantly improve your symptoms and quality of life.
Treatment for endometriosis depends on your symptoms, goals, and priorities. Many women start with medical management, often using hormone therapies such as birth control pills and over-the-counter pain relievers to manage symptoms.
If medication isn’t sufficient after six months, or if you have more complex disease, you may benefit from surgery. A key point in the new ACOG guidelines is that surgery should be done by an expert who can diagnose and treat endometriosis during the same procedure. This can reduce the need for repeat surgeries and improve outcomes.
UTSW gynecologic surgeons are fellowship-trained in traditional and robotic surgery techniques, including:
- Endometrial ablation: Using heat, cold, or energy to destroy the uterine lining or destroy superficial lesions.
- Excisional surgery: Laparoscopic procedure to remove scar tissue, adhesions, and implanted endometrial tissue. This option provides the best long-term symptom control and preserved fertility.
Patients often ask whether a hysterectomy is required. In most cases, the answer is no. Treatment decisions will be individualized based on your symptom severity, fertility goals, and overall health.
Pelvic floor physical therapy can help
After years of chronic pelvic pain from endometriosis, the muscles and nerves in your pelvis can become overly tight and sensitive, so relief doesn’t typically happen right away. The ongoing pain and inflammation can also change how the pelvic floor muscles function, which can lead to ongoing discomfort, pain with sex, and bowel or bladder symptoms.
Pelvic floor physical therapy helps retrain these muscles to relax and work normally again. Your doctor and therapist team will pinpoint exercises and techniques to improve muscle control and provide better long-term symptom relief.
Depending on your goals and needs, your plan may include:
- Biofeedback, a form of muscle retraining
- Injections of muscle relaxers
- Home exercises
- Electrical stimulation to rehab weakened muscles
- Counseling to work through the emotional challenges of endometriosis
- Medications for bladder or bowel symptoms
Improving endometriosis care
Endometriosis is complex, and for many women, the disease and its symptoms change over time. Proper evaluation and treatment require an experienced team with a thoughtful, patient-centered approach. Our gynecologic surgeons and women’s health specialists collaborate with colorectal, urologic, thoracic, and physical therapy experts to give every patient the best outcome.
The new ACOG guidelines are a meaningful step toward listening to women and supporting their health needs. If you’ve been living with symptoms or have been dismissed by doctors about endometriosis symptoms in the past, you aren’t alone. We hear you, we believe you, and we can offer effective strategies to help you feel better, starting on day one.
To talk with an expert about endometriosis, make an appointment by calling 214-645-3838 or request an appointment online.
