Stages of Endometriosis

Endometriosis is a common disease and with diagnostic methods evolving, the number is set to increase. The World Health Organization (WHO) estimates that nearly 200 million women worldwide are affected by endometriosis, including over 11% of women in the USA. 

Women suffering from severe endometriosis can be limited in their day-to-day life, due to severe pain, fatigue, depression, anxiety, and infertility. 

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?

Endometriosis is named after the endometrial tissue found in the uterus. The endometrium in the uterus plays a key role in the menstrual cycle. Your body grows a new endometrium in every cycle to prepare for implantation. If fertilization doesn’t happen, the endometrium is shed during your period. 

With endometriosis, endometrial tissue grows outside the uterus, causing severe pain in the pelvis and potentially negatively affecting fertility. The tissue grows outside the uterus and can spread to the fallopian tubes, ovaries, pelvic region, bladder, and rectum. In extreme cases, the tissue can even spread to other parts of the body. However, unlike the endometrial tissue in the uterus, the one in endometriosis doesn’t shed but remains in the body, growing, leading to inflammation, scarring, and in some cases painful cysts. 

Types of Endometriosis

Endometriosis can be classified into three. 

Superficial Peritoneal Endometriosis (SPE)

Superficial Peritoneal Endometriosis (SPE) is the most common type of endometriosis. It presents as shallow lesions along the thin lining of the inner abdomen. Symptoms include painful menstruation and urination, discomfort during intercourse, and infertility.

Ovarian Endometrioma (OMA)

Ovarian Endometrioma (OMA) is a type of endometriosis where the tissue grows on the ovaries. Cysts known as endometriomas, or “chocolate cysts” then develop inside the ovaries that contain a dark brown endometrial fluid hence the name chocolate cysts. Symptoms include back pain, vomiting, bloating, and nausea.

Deeply Infiltrative Endometriosis (DIE)

Deeply Infiltrative Endometriosis (DIE) is the most severe form of endometriosis and is presented by endometrial tissue that has spread to the bowel, bladder, or other organs outside the reproductive system. Symptoms can be bloody urine, pain in the pelvic area and lower back, and in extreme cases, loss of kidney function. This type of endometriosis doesn’t respond to medication-based treatment and typically needs surgery.

What Causes Endometriosis

It's unclear what causes endometriosis but some doctors believe it can be linked to:

• Genetics, especially when another female family member has it. 
• Early menstruation
• Shorter periods
• A C-section or hysterectomy. 
• Heavy periods
• An abnormal uterus 

Symptoms of Endometriosis

Each case of endometriosis may show different symptoms. These symptoms depend on the type, severity, and location of the endometrial tissue. Symptoms to look out for include: 

• Excessive, heavy bleeding during a period, or bleeding in between periods
• Pelvic pain, stomach pain, and severe cramping before and during a period
• Pain in the lower abdomen during or after sexual intercourse
• Pain during urination or bowel movements, especially during a period
• Diarrhea, constipation, or bloating, especially during a period

When left untreated, endometriosis can result in serious complications like infertility, and some research has also shown a link between endometriosis and certain forms of cancer.

Endometriosis Stages

Endometriosis stages are mainly categorized according to a point-based system based on:

• The location, extent, and depth
• The presence and size of ovarian endometriomas
• The severity of adhesions

According There are different ways of staging endometriosis. In 1996, the American Society of Reproductive Medicine (ASRM) set out four stages to describe the severity of endometriosis, ranging from minimal to severe:

• Minimal endometriosis: This stage has a point score between 1-5 and presents with small superficial implants or lesions on the surface lining of the peritoneum, with little to no scar tissue.
• Mild endometriosis: This is the second stage and it has a point score between 6-15. Women at this stage present with deeper implants and mild adhesions. 
• Moderate endometriosis: This stage has a point score for this stage is between 16- 40. Symptoms present include many deep lesions that have spread in different areas. These adhesions are more dense than in stage 2, and depending on the severity, surgery may be the only option. 
• Severe endometriosis: This is the most severe stage of endometriosis with a point score greater than 40. Women at this stage present with large ovarian cysts, dense adhesions, and multiple organs attached by scar tissue. In this stage, the disease is more widespread and is represented by any score greater than 40.

Does Endometriosis Cause Infertility?

Yes, endometriosis can cause infertility. According to a 2012 study, 30-50 percent of women diagnosed with Endometriosis also experience infertility. 

For women suffering from endometriosis, intrauterine insemination (IUI or artificial insemination) is a viable fertility 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 will be the next option. In IVF,  the eggs are retrieved directly from the woman’s ovaries and fertilized with sperm. The fertilized embryo is then implanted back into the uterus.

Fertility centers like Ivy Fertility can help you determine the best steps for family planning with an endometriosis diagnosis.

Endometriosis Treatment

The severity of endometriosis can differ from woman to woman. Not only that but two women can have the same stage of endometriosis but differ in severity. The treatment is typically based on your symptoms, your age, and the location of the tissue. In some cases, the diseases can be managed with pain relief but in severe cases, surgery is the only surgery option. This is because severe cases require the cysts and scar tissue to be removed. 

Bottom Line

Endometriosis can be debilitating in some women. If you think you might have endometriosis, your doctor will give you a physical exam or order an ultrasound, MRI, or laparoscopy. The results of this test will determine the course of treatment. Treatment for endometriosis includes medication, surgery, or a combination of both.