Stages of Endometriosis

Endometriosis is a condition in which the tissue that typically lines the uterus during the menstrual cycle, grows in places outside the uterus. It can be quite painful and lead to serious side effects including widespread scar tissue, lesions, and pain during sex and urination.

Unfortunately, there is no cure for endometriosis, but treatments are available to relieve symptoms and address infertility caused by the condition. In this article we shall discuss the stages of endometriosis, from minimal to severe, as well as the symptoms, treatment options, and their impact on health and fertility.

What Is Endometriosis

In a typical menstrual cycle, a lining of soft tissue, known as the endometrium, grows on the inner wall of the uterus and gradually thickens over time until, in the absence of a pregnancy, it is shed through bleeding during a menstrual cycle.

For people with endometriosis, the menstrual cycle occurs in a very similar way, but the endometrium then grows in other places, typically around the ovaries, fallopian tubes or other parts of the pelvic region. Occasionally, it can grow in other parts of the body and around other organs.

Whereas in a typical menstrual cycle this tissue starts to break down and leaves the body through menstruation, with endometriosis, it is unable to leave the body. Instead, it remains in place, causing a wide variety of painful complications if left untreated.

The World Health Organization estimates that nearly 200 million girls and women worldwide are affected by endometriosis. Although very common, endometriosis currently has no cure. There are treatments available to address some of its symptoms though. 

Types of Endometriosis

There are three general categories into which endometriosis can be grouped. This is based on the severity and location in the body that the disease is found.

Superficial Peritoneal Endometriosis 

This is the most common form of endometriosis. More than half of all the endometriosis cases worldwide are of this type. Sometimes it is simply referred to as superficial endometriois. This form of the disease is characterized by shallow lesions along the thin lining of the inner abdomen, called the peritoneum. Additionally, painful menstruation and urination, discomfort during intercourse, and infertility are other symptoms of this variant.

Ovarian Endometriosis 

As suggested by the name, this type of endometriosis occurs on the ovaries. It results in the development of cystic lesions inside the ovaries, which contain dark brown endometrial fluid known as endometriomas, or “chocolate cysts.” Symptoms of endometriomas are similar to superficial endometriosis, but are often more severe and may also include back pain, vomiting, bloating, and nausea.

Deeply Infiltrative Endometriosis 

This is the most severe form of endometriosis. It occurs when endometrial tissue grows in other parts such as the bowel, bladder, or other organs outside the reproductive system. Symptoms often include increasing frequency of urination, urine with blood, pain in the pelvic area and lower back, and loss of kidney function. This form of endometriosis does not typically respond to medication-based treatment in the same way other forms of the disease do. Often the only way to successfully treat it is through surgery.

Symptoms of Endometriosis

Symptoms of endometriosis can vary, depending on the type and severity, as well as the location of the condition. Many of the side effects of endometriosis are common to a large portion of individuals affected by the disease.

Some of the more common symptoms of endometriosis 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

If left untreated, endometriosis can cause serious complications as it progresses. One of the main long-term issues that can arise from endometriosis is infertility, and research has shown links between endometriosis and certain types of cancer.

Stages of Endometriosis

Endometriosis typically progresses through four stages. It is important to note that the different stages do not necessarily correlate to the symptoms experienced by a patient. It is possible to have very mild symptoms resulting from very advanced endometriosis, or conversely, experience severe symptoms in a relatively mild case.

Having said that, below are the main stages of endometriosis:

1. Stage 1 Endometriosis: In this small implants or lesions are found on the surface lining of the peritoneum, with little to no scar tissue.
2. Stage 2 Endometriosis: This stage is slightly more severe, with the lesions being deeper and the scar tissue present is more than in stage 1.
3. Stage 3 Endometriosis: This stage is characterized by multiple deep lesions, as well as ovarian cysts, and adhesions, which are bands of scar tissue in the pelvic area.
4. Stage 4 Endometriosis: This is the most severe stage, with large ovarian cysts, and dense adhesions. Additionally, multiple organs are attached to each other by scar tissue.

Endometriosis and Fertility

A study on the connection between endometriosis and fertility found that  30 to 50 percent of women who are diagnosed with endometriosis also experienced infertility. The exact mechanism by which this connection is formed is unclear. However, the effects of endometriosis on the organs and tissue found in the reproductive system likely causes complications with their normal function.

The good news is that infertility caused by endometriosis does not completely eliminate the chances of having a child. Depending on the severity of the condition, there are several treatment options for couples and individuals wishing to start a family despite being diagnosed with endometriosis. 

Intrauterine Insemination (IUI)

For cases of stage 1 and 2 endometriosis, intrauterine insemination (IUI), also known as artificial insemination, can be a viable option for many people, if their fallopian tubes and egg quality are unaffected. This option is less invasive and less expensive than other options, although less effective.

In-vitro Fertilization (IVF)

If IUI is unsuccessful, it may be possible to become pregnant through the use of in vitro fertilization (IVF). This process involves retrieving eggs directly from the patient’s ovaries and fertilizing them with sperm in a lab setting, before implanting the fertilized embryo into the uterus.

Surgery

For certain advanced forms of endometriosis, surgery is sometimes required to remove scar tissue and cysts prior to attempting these assisted reproductive technology (ART) treatments. This is necessary in order to increase the likelihood of their success, as well, reduce complications related to advanced endometriosis.

When to Cconsult a Doctor

If you are experiencing severe menstrual pain or other symptoms that could be related to endometriosis, it is important to contact a healthcare professional to get a diagnosis of the cause of these issues. There are blood and urine tests that can rule out many of the other likely causes of the symptoms. 

In Conclusion

The only way to definitively diagnose endometriosis is through a laparoscopic procedure to inspect the pelvic cavity. While there is no cure for endometriosis, steps can be taken to mitigate its symptoms and reduce discomfort for those experiencing them. 

In addition to surgical treatments, many patients benefit from the use of non-prescription pain medication, as well as hormonal treatments like birth control pills or progesterone medications. Hormonal treatments, aim to stave off ovulation and the production of endometrial tissue, while newer medications help by suppressing the hormones that stimulate endometriosis. 

Contact Us

Working with an accredited fertility center can help you determine the best steps for family planning with an endometriosis diagnosis. To learn more about women’s reproductive health, visit Nevada Fertility Center. We have locations across the country to help navigate the diagnosis and treatment of endometriosis.