A structured clinical framework for a condition that has historically received neither structure nor consistency.
Endometriosis is a condition in which tissue similar to the uterine lining grows outside the uterus. It causes chronic pelvic pain that is frequently progressive — beginning at menarche, worsening over time, and profoundly affecting quality of life. It is among the most common gynecologic conditions and among the most consistently undertreated.
There is no universally accepted standard of care for endometriosis. What exists instead is a spectrum of approaches — ranging from empirical hormonal suppression to definitive surgical excision — applied inconsistently across a patient population that is frequently underdiagnosed, undertreated, and under-informed about their options.
PelvicProtocol operates from a structured clinical framework: the Noreikaite Endometriosis Protocol — a proprietary approach developed to bring consistency, rigor, and patient-centered decision making to a condition that has historically received neither.
Every patient presenting with chronic pelvic pain undergoes a comprehensive intake. Symptom chronology, surgical history, sexual history, lifestyle, and quality of life impact are evaluated together — not in isolation. Pain that began at menarche, progressed over time, and worsens cyclically is not incidental. It is a clinical signal that warrants investigation.
From this evaluation, a plan of care is constructed around the patient's goals. Some patients want the minimum intervention necessary to achieve symptom control. Others want every diagnostic and therapeutic option on the table. Both approaches are legitimate. Both receive a structured, individualized plan.
Endometriosis can be diagnosed clinically — through symptom history, physical examination, and imaging. A thorough clinical evaluation is often sufficient to establish a working diagnosis and initiate treatment. Surgical confirmation, however, remains the only pathway to a definitive diagnosis.
For every patient in whom endometriosis is a reasonable clinical suspicion, diagnostic laparoscopy — including robotic-assisted visualization — is offered as an option. There is no obligation to proceed. There is, however, an obligation to offer it.
For patients electing the surgical route, preoperative MRI is standard. It informs surgical planning, identifies the extent and location of disease, and reduces intraoperative uncertainty. For patients managing medically, MRI remains a valuable diagnostic adjunct — the goal shifts from surgical planning to characterization and monitoring of disease.
Hormonal suppression, including oral contraceptives, has a defined role in endometriosis management. It is one tool in a clinical toolbox that also includes excision surgery, pelvic floor rehabilitation, neuromodulation, and lifestyle-based intervention. Treatment selection is driven by the patient's symptom profile, reproductive goals, and tolerance for intervention — not by the path of least resistance.
Robotic excision surgery at PelvicProtocol is performed with the precision that complex pelvic anatomy demands. Excision — the complete removal of endometriotic lesions — is the surgical approach associated with the lowest recurrence rates and the most durable symptom relief in the literature. The da Vinci robotic system offers superior visualization of endometriotic lesions and a degree of instrument control that minimizes damage to surrounding structures.
Recovery is individualized, with most patients returning to full activity within six to eight weeks.
At PelvicProtocol, every condition is evaluated within the full context of the patient — not in isolation. Surgical and medical precision, grounded in an osteopathic understanding of the whole person. Private, direct care in Austin, Texas.