Endometriosis Specialist

Your Pain Is Real. You Are Not Alone.

Endometriosis is a chronic, often painful condition that affects millions of women — yet it is frequently misunderstood, dismissed, or diagnosed years late. At Haven OBGYN, we believe your symptoms deserve to be taken seriously, and you deserve answers, validation, and compassionate, expert care.

As a board-certified OB-GYN and minimally invasive gynecologic surgeon (MIGS) with a strong focus on pelvic pain and endometriosis management, Dr. Nikita Mishra provides comprehensive evaluation, advanced imaging, individualized treatment plans, and minimally invasive surgical options when appropriate.

What Is Endometriosis?

Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus, which can lead to:

  • Inflammation
  • Pain
  • Scarring & adhesions
  • Fertility challenges
  • Chronic symptoms that impact daily life

It is NOT just "bad cramps" — it is a complex medical condition that requires thoughtful, individualized care.

Endometriosis Can Affect:

Ovaries

Fallopian Tubes

Uterus

Pelvis

Bowel or Bladder (in advanced cases)

Common Symptoms of Endometriosis

If your symptoms disrupt your daily life, work, relationships, or emotional wellbeing — we're here to help evaluate and support you.

Pain Symptoms
  • Severe period cramps
  • Chronic pelvic pain
  • Pain during intercourse
  • Pain with bowel movements
  • Painful urination
  • Lower back or ovulation pain
Bleeding Symptoms
  • Heavy periods
  • Irregular bleeding
  • Spotting before periods
Digestive Symptoms
  • Bloating
  • Constipation
  • Diarrhea
  • Nausea around menstruation
Fertility & Other
  • Difficulty conceiving
  • Recurrent pregnancy loss
  • Fatigue
  • Pain that worsens over time

Why Endometriosis Is Often Missed

Many women go years without a diagnosis because:

Symptoms overlap with other conditions
Pain is normalized or dismissed
Pelvic exams may be normal
Standard ultrasound may not detect many lesions
Hormonal birth control can mask symptoms
Not all OB-GYNs specialize in laparoscopic evaluation

We take a thorough, patient-centered approach to understanding your symptoms and concerns.

Our Diagnostic Approach

Endometriosis requires a careful, multi-layered evaluation.

Comprehensive Medical History

We explore:

  • Pain patterns (cyclic vs non-cyclic)
  • Bowel and bladder symptoms
  • Sexual discomfort
  • Family history
  • Prior treatments
  • Fertility goals and concerns
Trauma-Informed Pelvic Exam

Only when appropriate and always with your comfort first. We prioritize consent, privacy, and respect at every step.

Advanced Ultrasound (2D + 3D)

While ultrasound cannot "diagnose" endometriosis definitively, it can help evaluate and sometimes suggest:

  • Ovarian endometriomas
  • Features of deep infiltrating disease in some cases
  • Adhesion patterns
  • Uterine abnormalities
  • Coexisting conditions
  • Subtle structural changes
Learn About Our Ultrasound
Gold Standard
Diagnostic Laparoscopy (If Needed)

Laparoscopy is the gold standard for definitive diagnosis and surgical treatment of endometriosis.

Treatment Options for Endometriosis

There is no single approach that works for everyone. We tailor treatment to your symptoms, goals, medical history, and reproductive plans, and we make decisions together through shared decision-making.

1
Medical Management

Medical therapy can help reduce symptoms and inflammation and is often a first step for pain relief:

Birth control (pill, patch, ring)
Progestin therapy
Hormonal IUD
GnRH analogs
Pain management strategies
Anti-inflammatory regimens

These treatments do not remove endometriosis but can help manage symptoms for many patients.

2
Minimally Invasive Surgery (MIGS)
Core Strength

If symptoms are severe, persistent, or impacting fertility or quality of life, surgery may be recommended after careful discussion.

Laparoscopic Endometriosis Excision

This approach aims to:

Remove visible endometriosis lesions
Improve pelvic anatomy where possible
Reduce inflammation
Support long-term pain improvement
Support fertility potential in some patients

Excision is generally preferred over ablation for long-term management, although outcomes can vary based on individual factors.

Hysteroscopy

Useful when evaluating uterine abnormalities or abnormal bleeding that may coexist with endometriosis.

Adhesiolysis

Releases areas of scarring that may contribute to pain or restrict organ movement.

3
Fertility-Focused Care

For patients trying to conceive, we design a personalized plan that may include:

Ovulation induction
Ultrasound monitoring
Laparoscopy to remove endometriosis when appropriate
Hysteroscopy to optimize the uterine cavity
Timing strategies for conception
Referral to REI when needed

Our goal: support your reproductive goals and, when feasible, natural conception, while also coordinating care with fertility specialists when appropriate.

Learn About Fertility Care
4
Holistic Support

Endometriosis affects the whole person. We address:

Pain management
Sleep and energy
Nutrition and lifestyle
Stress and emotional wellbeing
Sexual function and intimacy concerns
Bowel and bladder health
Hormonal stability

We may collaborate with pelvic floor physical therapists, GI specialists, pain management, and mental health professionals to create a comprehensive support network. You deserve a multidisciplinary approach.

Coexisting Conditions

Endometriosis often overlaps with other conditions. We evaluate and treat the broader picture, not just one diagnosis.

Adenomyosis Fibroids Ovarian Cysts PCOS IBS Bladder Pain Syndrome Pelvic Floor Dysfunction

What Makes Haven Different

MIGS Surgical Expertise

A MIGS-forward practice with training in advanced laparoscopic care for complex pelvic pain and endometriosis.

On-Site 2D & 3D Ultrasound

Convenient, detailed imaging that can support evaluation and treatment planning.

Trauma-Informed Care

Your comfort, trust, and consent matter deeply at every step.

Fertility-Sensitive Approach

We integrate your reproductive goals into both medical and surgical decision-making.

Comprehensive Pain Evaluation

We look beyond the uterus — including pelvic floor, bowel, bladder, hormones, and overall wellbeing.

Unhurried Visits

A thorough endometriosis evaluation takes time. We ensure visits are thoughtful and not rushed.

When to Seek Help for Endometriosis

Your pain deserves to be understood and taken seriously.

Severe period pain
Pelvic pain lasting 6+ months
Pain that interrupts daily life
Pain during intercourse
Pain with bowel movements/urination
Difficulty getting pregnant
Cyclic digestive symptoms
Heavy or irregular bleeding
Bloating or pelvic pressure

Frequently Asked Questions

Common questions about endometriosis, answered by Dr. Nikita Mishra

The gold standard for diagnosing endometriosis is laparoscopy — a minimally invasive surgical procedure that allows direct visualization and biopsy of endometrial implants. However, a thorough clinical evaluation including your symptom history, pelvic exam, and advanced 2D/3D ultrasound can strongly suggest endometriosis before surgery and guide appropriate treatment planning.

There is currently no permanent cure for endometriosis, but symptoms can be effectively managed with medical therapy, minimally invasive excision surgery, or a combination of both. Excision surgery — which removes endometrial tissue rather than simply burning it — is associated with better symptom control and lower recurrence rates than ablation alone. Menopause often (but not always) leads to symptom improvement.

No. Many women with endometriosis conceive naturally. However, endometriosis can affect fertility through multiple mechanisms — including inflammation, adhesions, distorted anatomy, and impaired egg or embryo quality. The impact on fertility depends on disease severity and location. Early evaluation and individualized treatment can meaningfully improve fertility outcomes.

Excision surgically removes endometrial implants in their entirety, including deeper tissue. Ablation uses heat or laser to destroy the surface of visible lesions, but does not address deeper tissue. Research consistently shows that excision is associated with more complete pain relief and lower rates of symptom recurrence. At Haven OBGYN, Dr. Mishra performs excision surgery as the preferred surgical approach.

Yes. While endometriosis most commonly affects pelvic organs, it can involve the bowel, bladder, appendix, and in rare cases even the lungs. Bowel and bladder involvement may cause symptoms such as painful bowel movements, bloating, diarrhea around the period, urinary urgency, or blood in the urine. These symptoms are often mistaken for IBS or bladder conditions, which can delay the correct diagnosis.

Clinically reviewed by Nikita Mishra, MD, FACOG

Board-Certified OB-GYN & Minimally Invasive Gynecologic Surgeon
Haven OBGYN · Folsom, CA

Published: November 2025  ·  Last reviewed: May 2026

References

Understanding Endometriosis

Find Clarity, Support & Expert Care

We're honored to support your journey toward relief, healing, and hope. Schedule an endometriosis evaluation at Haven OBGYN to explore your options with a team that listens and cares.

Request Appointment (916) 269-8865