The Methow River, along with its tributaries the Twisp River, Cedar Creek, and Early Winters Creek, originates in a cluster of high mountains including
Golden Horn,
Tower Mountain,
Cutthroat Peak,
Snagtooth Ridge,
Kangaroo Ridge,
Early Winters Spires, and
Liberty Bell Mountain. Several mountain passes are associated with the Methow River and its tributaries, such as Methow Pass and Twisp Pass.
State Route 20 utilizes
Washington Pass and
Rainy Pass, also in the general areas of headwater streams. The
Pacific Crest Trail follows the uppermost reach of the Methow River, until the river turns east, flowing into the Methow Valley near
Mazama. Along the way, it collects the tributary streams of Robinson Creek and Lost River. In the Methow Valley, between Mazama and
Winthrop, the Methow River is joined by Early Winters Creek, Cedar Creek, Goat Creek, and Wolf Creek. The
Chewuch River joins at Winthrop. One of the Methow's larger tributaries, the Chewuch River, and its many tributaries drain large parts of the Pasayten Wilderness to the north. One of its headwater streams, Cathedral Creek, reaches nearly to
British Columbia,
Canada. The Methow Valley continues below Winthrop to
Twisp, where the Methow River is joined by another important tributary, the
Twisp River. Flowing from the west, the Twisp River drains the mountains south of Washington Pass as well as the eastern slopes of Sawtooth Ridge, a major mountain range with some of Washington state's highest peaks (such as Star Peak and Mt Bigelow). Downriver from Twisp, the Methow River passes by the communities of Carlton and Methow, receiving several minor tributaries, before joining the Columbia River at
Pateros. This part of the Columbia is the impoundment of
Wells Dam, a lake known as
Lake Pateros. ==Ecology and conservation==