Endometriosis Stages | Understanding The 4 Critical Stages

Endometriosis (endo) is described as having four distinct stages.

The endometriosis stage you are diagnosed with doesn’t necessarily correlate with how severe your symptoms are.

Many clinicians are choosing to move away from these categorizations.

This article looks at the four stages in more detail, so you can better understand your diagnosis.

It’s important to remember the stage of your endo doesn’t dictate how lousy you will feel.

Some women with stage 1 find it negatively affects their everyday life, while others with more advanced endo might have few to no symptoms.

What is endometriosis?

Endometriosis is an inflammatory gynaecological condition. Tissue similar to the lining of the uterus (endometrium) starts to grow in other places, such as the ovaries or fallopian tubes. These growths are called endometriosis implants.

The endometrial tissue outside the uterus thickens and bleeds, just like the normal endometrium in the uterus does during your menstrual cycle.

In very rare cases, the lining has been found in the lungs or brain.

Endometriosis is a common condition affecting 1 in 10 women. Many experts, however, believe the real number to be much higher.

It’s a long-term condition that can affect women of any age.

Endometriosis implants can be debilitating and can have a huge impact on sufferers, affecting both their physical and mental health.

Symptoms of endometriosis

The main symptoms of this condition are:

• Heavy periods
• Period pain
• Pain during or after sex
• Pelvic pain
• Ovulation pain
• Chronic fatigue
• Symptoms similar to those of IBS (Irritable Bowel Syndrome)
• Bladder problems.

Some sufferers find themselves badly affected, both physically and mentally, and others may behave with no symptoms (asymptomatic).

Unsurprisingly, a chronic pelvic pain condition such as endo can be associated with depression. Endo can be a debilitating condition and some sufferers struggle with their mental health as a result.

If you are suffering from mental health problems, please talk to your healthcare advisor. Counseling might help to improve your mental health.

Endometriosis is often misdiagnosed or dismissed by healthcare providers. Often sufferers are prescribed birth control pills or implants that do little to treat endo.

The condition can go undiagnosed for years and many women struggle because healthcare providers dismiss their pain.

If you think you’re suffering from endo, it’s important to find a supportive doctor who understands the condition.

Your healthcare provider can provide medical advice, diagnosis, and endometriosis treatments.

When to seek medical help for endometriosis

If you think you are suffering from symptoms of endo, you should speak to your healthcare provider. Untreated endo can lead to chronic pain, bladder problems, ovarian cysts, and infertility.

Many women don’t realize they have endo until they seek medical help for fertility problems.

Endometriosis stages

There are four stages of endometriosis, ranging from mild to severe. These stages are categorized based on the location, amount, and depth of the endometrial tissue.

The stages don’t take into account the amount of pain or symptoms which might be present.

Many experts are moving away from classifying the condition in stages because it is seen as an outdated tool.

How do you know what stage of endometriosis you have?

In order to give you a full diagnosis, your healthcare provider will perform a surgical procedure called a laparoscopy.

Laparoscopy is carried out under general aesthetic, so you’ll be asleep during the procedure. A small camera is inserted into your abdomen to identify signs of the condition, such as lesions.

There are four stages of endometriosis.

Endo is sometimes diagnosed using a point system:

• 15 points or fewer indicates mild endometriosis to moderate endometriosis
• 16 points and above is indicative of severe endometriosis.

Stage 1 Minimal Endometriosis

Stage 1 endometriosis are often missed because symptoms tend to be minimal. The early stages are categorized by small patches or lesions on or around the organs in the pelvis. There is little or no scar tissue present, you may notice some pelvic pain, cramping during your period, or minor stomach issues.

What Pregnant Women Should Know About Stage 1

When you’re first diagnosed with endo, the likelihood is it’s still considered minimal. Stage 1, the endometrial-like tissue has only begun to spread outside the uterus. The minimal spread means pregnancy is still possible for many women with stage 1 endometriosis.
However, you have a slightly higher chance of an ectopic pregnancy, when the fertilised egg implants outside the uterus.
Even though the endo is considered minimal, it can continue to grow and spread without appropriate treatment. Some women are able to manage symptoms for years with over the counter pain relievers and heat pads during their period.

Most women with stage 1 endometriosis go on to have very normal pregnancies and deliver healthy babies. Early diagnosis and management is key to minimising problems and maximising your chances of getting pregnant when the time is right for you.

Stage 2 Mild Endometriosis

As conditions progress into second stage endometriosis symptoms may be mild. This would be categorized by painful periods, pain during sex, lower back ache, and occasional nausea or diarrhea. The endometrial tissue might be found deeper.

Exams may reveal larger endometrial lesions or scar tissue in the pelvic are. For some women, infertility becomes an issue. Damage to the pelvic organs will be limited with a stage 2 diagnosis. Adhesions and scar tissue are minimal.

Impact on Fertility and Pain in Stage 2

At stage 2, your fertility may be slightly impacted, as the larger lesions distort the anatomy of the reproductive organs like the ovaries and fallopian tubes. Many women are still able to get pregnant during this time without assistance. The key to success is to conceive sooner rather than later, before the endometriosis progresses further.

To manage symptoms, some medical practitioners may prescribe birth control pills or an IUD to slow the growth of lesions. Over the counter pain relievers can also provide intermediate relief from discomfort.

In some cases, laparoscopic surgery may be recommended to remove endometrial implants, restoring the reproductive anatomy to some level of normality to all for improved fertility.

Stage 3 Moderate Endometriosis

With a stage 3 diagnosis, symptoms are more disruptive, they include chronic pelvic pain, painful bowel movements, urination, and heavier bleeding during your period.
Scar tissue and thick adhesions are present. Exams will show endo tissue lesions found deeper as they begin to infiltrate organs in the pelvic region, small cysts are present on one or both ovaries and there will be significant scar tissue. Fertility may be impaired.

Treatment Options for Mothers in Stage 3
Surgery

For many women, surgery is necessary to remove endometrial lesions, scar tissue, and cysts. A laparoscopy uses small incisions to locate and excise the endometrial tissue while preserving fertility. In some severe cases, a hysterectomy to remove the uterus and ovaries may be recommended as a last resort.

Hormone Therapy

Hormone therapy aims to slow the growth of the endo tissue. Birth control pills, patches and rings contain estrogen and progestin to suppress menstruation and reduce pain.
Research shows that gonadotropin releasing hormone (GnRH) agonists may help stop menstruation and ovulation altogether by altering hormone levels. These drugs often induce menopause- like side effects but can be used short-term before surgery.

Pain Management

For chronic pelvic pain, over the counter drugs such as ibuprofen or prescription painkillers may provide temporary relief. Nerve blocks can interrupt pain signals, while pelvic floor therapy helps relax and strengthen pelvic muscles. Acupuncture and massage therapy are alternative approaches some women find soothing.

The treatment for moderate to severe endometriosis often requires a multi-pronged approach. Most women are able to find significant relief from their symptoms and improve their fertility and quality of life.

Stage 4 Severe Endometriosis

In the most advanced and final stage of endometriosis, symptoms are considered severe. By stage 4 endometriosis you are experiencing debilitating pain, infertility, and impacts quality of life. The tissue is now affecting several organs in the pelvic region, lesions, thick bands of adhesions and scarring will be more pronounced. Large cysts will be present on one or both ovaries.

In some cases, organs like the ovaries, fallopian tubes, intestines, or bladder may be fused together or stuck to pelvic walls. Surgery may be recommended to remove growths, relieve symptoms, and increase fertility odds.

Endometriosis symptoms

Stage 4 endometriosis symptoms vary from woman to woman. The symptoms of stage 4 endo aren’t necessarily more severe than the symptoms of a woman with stage 1.

The symptoms seem to vary from woman to woman rather than from stage to stage.

Treatment Options

Treatment namely focuses on managing pain and improving quality of life.
Hormone therapy with birth control pills or GnRH agonists may be options, but surgery is typical.
A laparoscopy can remove lesions, adhesions and scar tissue. A hysterectomy with the removal of ovaries may be recommended as a last resort.

Endometriosis surgery recovery

Endometriosis surgery is usually performed via a laparoscope and has a short recovery time. After a laparoscopic procedure to remove the adhesions, you should be able to resume normal activity within a couple of days.

Endometriosis life expectancy

Endometriosis is a chronic condition that can be debilitating. Although it can affect your quality of life, it isn’t considered to be a fatal disease.

Endometriosis is associated with a small number of potentially fatal conditions, such as small bowel obstruction and ectopic pregnancy.

Endo is also associated with an increased risk of miscarriage and infertility.

For these reasons, it’s important to seek medical help if you think you might be suffering from this condition.

Does endometriosis get worse over time?

Endometriosis doesn’t necessarily worsen over time. Some women with endometriosis find the condition remains the same even if it’s left untreated. However, this isn’t the case for all.

It isn’t yet understood why the severity of endometriosis varies between women. More research is needed to understand more about this condition.

Make sure you check out BellyBelly’s article about endometriosis treatment options by our Women’s Health and Reproductive Medicine expert, Dr. Andrew Orr.

Endometriosis surgery

If endo is affecting your daily life, the endometrial tissue needs to be removed. Your healthcare provider will talk to you about the benefits and risks of surgery and you’ll be able to ask any questions you might have.

Dr. Andrew Orr has recorded a video that explains more about endometriosis surgery.

You can watch it on his website.

Can endometriosis be cured?

Although there’s no known cure for endo, it’s possible to treat the condition.

For chronic endometriosis that’s affecting your daily life, you will need surgery. A qualified gynaecologist, who is experienced in laparoscopic surgery, can perform the procedure to remove visible endometriosis lesions.

After the surgery, a multimodality team approach will help you get the best results. Acupuncture, Chinese medicine, lifestyle management, and a healthy diet (paleo or low carb are ideal) can all help to manage your ongoing symptoms.

Your treatment plan should be tailored to your specific needs and symptoms. It’s important to work with healthcare providers who understand your symptoms and who take a proactive approach to this condition.

If you’re struggling with the emotional toll of ongoing pain, counselling will be beneficial. It’s important to talk about how you’re feeling.

There are support groups where endo sufferers can share their experiences and hear from others who are battling the same condition.

Will a hysterectomy cure endometriosis?

There are a lot of unknowns when it comes to women’s health. Unfortunately, even some doctors are misinformed as to the best treatment options for endometriosis.

A hysterectomy will stop you from having periods, so this will end your period pains. However, if the endometrial lining has spread outside of the uterus, hysterectomy isn’t a cure.

If your endo is affecting only your uterus, a hysterectomy could be a treatment option. If it’s reached other parts of the body, such as the fallopian tubes, a hysterectomy might not provide much relief.

BellyBelly has an informative article about hysterectomy and endometriosis that covers this topic in much more detail.