Ask the Physician: How do I know if I have endometriosis?

Ask the Physician: How do I know if I have endometriosis?

  Monday, July 11, 2016   Comments (0)

Plaza OB/GYN presents the "Ask the Physician" series, where our nationally recognized physicians answer patients' most common questions about obstetrical care and gynecological conditions and procedures.

Endometriosis is a disease in which the tissue that lines the canal of the uterus, contributing to the menstrual flow, develops in other locations in the body. Since no one knows what causes endometriosis (although there are many theories), it is difficult to tell who is at risk. Approximately 10 million women have endometriosis. Unfortunately, it is one of the most misdiagnosed diseases by doctors. Many studies have noticed that endometriosis could be familial, so a positive family history for the disease (mother or sister) should alert the physician. Since an exact etiology is not yet established, preventative measures to take against this disease are still elusive. 

Endometriosis Symptoms and Complications

The most common symptom is pain before and during the periods. Others have a dull ache and discomfort in the lower abdomen. Other symptoms include: heavy bleeding, painful intercourse, a lower back ache, and infertility. Endometriosis can cause heavy bleeding with secondary anemia and disabling pelvic pain. It also contributes to infertility by causing physical and hormonal changes in the pelvis. It can also invade the rectum and cause painful bowel movements, as well as compress and/or invade the bladder, cause pain during urination and blood to be present in the urine. 

Endometriosis Diagnosis

Pelvic Exam

The first step to check for endometriosis include pelvic exams with a detailed history. Asking the right questions about the intensity, distribution, and type of pain are also important in the pelvic exam. An indication of thickening of the utero-sascial ligament, which is a tissue band behind the cervix, could be significant. Any thickening or tenderness while feeling the ovaries and sidewalls of the pelvis should be noted.


An ultrasound of the pelvis will not reveal small implants of endometriosis. However, when endometriosis implants inside the ovary, it bleeds month after month. It will end up with a large cyst filled with old blood, which will show on an ultrasound. This type of cyst is called a chocolate cyst. Also, when the endometriosis spreads inside the muscles of the uterus, bleeding here will cause the muscle wall to get thicker and larger. An ultrasound of the uterus will show the uterus to be enlarged in a general fashion. This condition is called adenomyosis (endometriosis of the muscle wall of the uterus). This is usually noticed on ultrasounds and often mistaken for fibroids. Patients usually present history of heavy periods with this condition.

Blood Test

As of yet, there is no blood test that is specific of endometriosis. CA126, which is a marker for ovarian cancer can be slightly elevated with endometriosis.


Outpatient diagnostic laparoscopy is the only test to confirm endometriosis. Laparoscopy is a surgical procedure done under anesthesia where a telescope is inserted into the abdomen through a small incision in the navel. Under direct vision, the pelvis and abdomen will be explored for endometriosis.

About the Physician: Dr. Balat

Dr Isam BalatWith almost 40 years of experience, Dr. Isam Balat, M.D. has long been recognized as one of the top OBGYNs in the greater Houston area. A UTMB medical school graduate, he started private practice in 1976 and founded Plaza OB/GYN in 1998.

As a lifetime member of the Endometriosis Association, Dr. Balat is considered an "endometriosis specialist" treating women in the Houston area. He also conducts minimally invasive surgeries for the management of endometriosis. Dr. Balat also specializes in infertility and minimally invasive surgeries, including operative laparoscopy, micro laparoscopy, outpatient hysterectomy, outpatient tubal reversal, and fibroid surgery.

endometriosis treatment

Suffering from Endometriosis?

As a lifetime member of the Endometriosis Association, Dr. Balat's expertise as a Houston endometriosis specialist has helped women manage, treat, and overcome the symptoms of endometriosis.

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