Stages of Endometriosis

Key Takeaways

• Endometriosis is named after the “endometrium,”-tissue that lines the uterus. 
• Women with Endometriosis have this tissue growing outside of the uterus
• Women struggling with Endometriosis will likely have difficulty getting pregnant
• Symptoms of Endometriosis can be hard to diagnose 

What Is Endometriosis?

The WHO estimates nearly 200 million women worldwide are affected by Endometriosis, significantly decreasing these women’s quality of life due to severe pain, fatigue, depression, anxiety, and infertility. 

Assigned women at birth have a uterus lined with endometrial tissue called the endometrium. The endometrium plays a key role in the menstrual cycle as your body grows a new endometrium to prepare for implantation. If fertilization doesn’t happen, the endometrium is shed during your period. 

In endometriosis, the endometrial tissue grows outside the uterus or outside in the fallopian tubes, ovaries, pelvic region, bladder, and rectum. It can even spread to other parts of the body. Unfortunately, the endometrial tissue in endometriosis doesn’t shed but remains in the body, growing. This can lead to inflammation, scarring, and painful cysts. 

Types of Endometriosis

Endometriosis can be categorized in the following ways.

• Superficial Peritoneal Endometriosis (SPE): Many women with endometriosis have SPE. SPE is characterized by shallow lesions along the thin lining of the inner abdomen. Symptoms include painful menstruation and urination, discomfort during intercourse, and infertility.
• Ovarian Endometrioma (OMA): This type is characterized by endometrial tissue growing on the ovaries. Cysts then develop inside the ovaries and can present with dark brown endometrial fluid known as endometriomas, or “chocolate cysts.” Symptoms include back pain, vomiting, bloating, and nausea.
• Deeply Infiltrative Endometriosis (DIE): This is the most severe form of endometriosis and occurs when endometrial tissue finds its way into the bowel, bladder, or other organs outside the reproductive system. Symptoms can be increased frequency of urination, bloody urine, pain in the pelvic area and lower back, and loss of kidney function. It doesn’t respond to medication-based treatment the same way the types above and typically needs surgery.

Causes of Endometriosis

While the causes of Endometriosis are unknown, the condition has been linked to:

• Early menstruation
• Shorter periods
• Genetics especially when another female family member has it. 
• When one goes through a C-section or hysterectomy, the endometrial tissue can attach to the walls of the abdomen in a process called transplantation. 
• In some cases, blood with endometrial tissue can be transported and settle in a specific part of the body.
• Normal cells can become endometrial cells that grow outside the body.
• Sometimes the endometrial tissue goes up the fallopian tubes and the abdomen instead of exiting during a period.
• Heavy periods
• An abnormal uterus 

Symptoms of Endometriosis

Endometriosis symptoms vary among women and depend on the type, severity, and location of the endometrial tissue. Common symptoms of the condition include: 

• Pelvic pain, stomach pain, and severe cramping before and during a period
• Pain in the lower abdomen during or after sexual intercourse
• Pelvic pain during urination or bowel movements, especially during a period
• Excessive, heavy bleeding during a period, or bleeding in between periods
• Diarrhea, constipation, or bloating, especially during a period
• Research has also shown a link between Endometriosis and certain forms of cancer.

If left untreated, endometriosis can result in serious complications if left untreated like infertility. But this doesn’t eliminate the chances of having a successful pregnancy. There are several treatment options for women suffering from endometriosis. Fertility centers like Ivy Fertility can help you determine the best steps for family planning with an Endometriosis diagnosis.

Stages of Endometriosis

Endometriosis has four main stages that have been categorized by the American Society of Reproductive Medicine (ASRM). It breaks them down into a point-based system based on:

• The presence and size of ovarian endometriomas: Endometriomas are blood-filled cysts, or "chocolate cysts," that turn brown over time. The stages also take into account the presence and size of these cysts. 
• The location, extent, and depth: This refers to where and how deep the endometrial cells have spread outside of the uterus. 
• The severity of adhesions: Endometrial adhesions are clusters of fibrous tissue that form in bands. These tissues can bind organs together and can spread toward the abdominal and pelvic organs. The stages are categorized by how severe these adhesions are. 

Stage 1

It has a point score between 1-5. Endometriosis patients with stage 1 present with small superficial implants or lesions on the surface lining of the peritoneum, with little to no scar tissue. This stage is also known as minimal Endometriosis.

Stage 2

It’s known as mild Endometriosis, this stage is slightly more severe than stage 1, presents with deeper implants and mild adhesions, and has a point score between 6-15.

Stage 3

This is also known as moderate Endometriosis. Women in this stage present with many widespread and deep lesions. These adhesions are more dense than in stage 2. The point score for this stage is between 16- 40 and one might require surgery to remove them. 

Stage 4

This is the most severe stage and presents with large ovarian cysts, dense adhesions, and multiple organs attached together by scar tissue. In this stage, the disease is more widespread and is represented by any score greater than 40.

Effect of Endometriosis on Fertility

The WHO estimates nearly 200 million women worldwide are affected by Endometriosis, significantly decreasing these women’s quality of life due to severe pain, fatigue, depression, and anxiety. According to a 2012 study, 30-50 percent of women diagnosed with Endometriosis also experience infertility due to its effect on the organs and tissue found in the reproductive system. This likely causes complications during conception.

In stages 1 and 2 of Endometriosis, intrauterine insemination (IUI or artificial insemination) is a viable option if their tubes and egg quality are unaffected. This option is less invasive and less expensive than other options although less effective.

If IUI is unsuccessful, in vitro fertilization or IVF becomes the next step. Here, the eggs are retrieved directly from the woman’s ovaries and fertilized with sperm. The fertilized embryo is then implanted back into the uterus. In stages 3 and 4, surgery may be the only form of treatment before attempting any assisted reproductive technology treatments. 

Endometriosis Treatment

Endometriosis presents differently in women, and one can have the same type but differ in severity of symptoms. Endometriosis treatments are based on your age, symptoms, and how the disease presents itself. It can be managed with pain relief in some cases but in severe cases, only surgery can be done to remove the cysts and scar tissue. Doctors can offer treatments that help manage the disease. 

Bottom Line

Endometriosis causes tissue similar to the lining of the uterus to grow in other places where it doesn’t belong. This can come with pelvic pain, heavy periods, and fertility issues. Treatment for endometriosis involves management using medication, surgery, or a combination of both. You should talk with a healthcare professional when you suspect you have endometriosis. They will be able to diagnose your symptoms and guide you on the right treatment.