Stages of Endometriosis

The endometrium is the tissue that lines the uterus during a menstrual cycle and is shed during one’s period. Endometriosis is a condition whereby this tissue grows in places outside the uterus. It can be painful and could lead to widespread scar tissue, lesions, and even pain during sex and urination.

Unfortunately, there is no cure for endometriosis. There are however a variety of treatments available to relieve symptoms, as well as address infertility that may be caused by the condition. Let us look at the stages of endometriosis, symptoms, treatment options, and the impact on health and fertility.

What Is Endometriosis

The lining of soft tissue on the inner wall of the uterus - the endometrium -  gradually thickens until, in the absence of a pregnancy, it is shed through bleeding. This is the typical course of a normal menstrual cycle.

When a person has endometriosis, the menstrual cycle occurs in a similar way, but the endometrium grows in other parts of the body, such as the ovaries, fallopian tubes or parts of the pelvic region. Once in a while, it has been seen to grow in other parts of the body and other organs.

The complication of endometriosis is that the tissue growing outside the uterus has no exit, therefore cannot break down and leave the body as in menstruation. If untreated, endometriosis causes a variety of painful complications.

Nearly 200 million girls and women globally are affected by endometriosis, according to an estimate by the World Health Organization. Common as it is, it still has no cure, but treatments to address some of its symptoms are available. 

Types of Endometriosis

Based on the location in the body, and the severity of the disease, there are three categories into which endometriosis is grouped.

Superficial Peritoneal Endometriosis 

The most common form of endometriosis, observed in more than half of all cases worldwide, is superficial peritoneal endometriosis. It is sometimes referred to as superficial endometriosis. It is typically characterized by shallow lesions along the peritoneum, which is the thin lining of the inner abdomen. Painful menstruation and urination, discomfort during intercourse, and infertility are other symptoms one may experience with this variant.

Ovarian Endometriosis 

As suggested by the name, this variant occurs on ovaries, resulting in the development of cystic lesions inside the ovaries. These lesions contain dark brown endometrial fluid known as endometriomas, earning them the name “chocolate cysts.” Endometriomas have similar symptoms to superficial endometriosis, however, they tend to be more severe and may additionally cause bloating, nausea, vomiting and back pain. 

Deeply Infiltrative Endometriosis 

This most severe form of endometriosis occurs when endometrial tissue grows in other organs outside the reproductive system such as the bowel, bladder. Symptoms such as increasing frequency of urination, bloody urine, pelvic and lower back pain, and even loss of kidney function accompany this type of endometriosis. Unfortunately, it does not typically respond to medication-based treatment the way other variants of the disease do, meaning that the only way to successfully treat it is often through surgery.

Symptoms of Endometriosis

Endometriosis symptoms vary depending on the type, severity, and location of the condition. Most side effects are common across a large segment of persons affected by the disease.

The more common symptoms of endometriosis include:

• Excessive, heavy bleeding during a period, or bleeding in between periods
• Severe cramping before and during a period, as well, pelvic and stomach pain 
• Experiencing pain in the lower abdomen during or after sexual intercourse
• Diarrhea, bloating, or constipation, bloating especially around a monthly period
• Pain in the pelvic area during urination or bowel movements, particularly during a period

Without treatment, endometriosis causes severe complications as it progresses, including long-term issues such as infertility. Additionally certain types of cancer have been linked to endometriosis.

Stages of Endometriosis

There are four main stages of endometriosis, but the stages do not correlate to the symptoms experienced by a patient necessarily. Mild symptoms can result from very advanced endometriosis, as well, severe symptoms can result from relatively mild cases.

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

1. Stage 1 Endometriosis is characterized by small implants or lesions on the peritoneum, having little or no scar tissue.
2. Stage 2 Endometriosis is slightly more severe. Lesions are deeper and scar tissue present is more than that in stage 1.
3. Stage 3 Endometriosis is characterized by multiple deep lesions, ovarian cysts, and adhesions - bands of scar tissue - in the pelvic area.
4. Stage 4 Endometriosis is the most severe characterized by large ovarian cysts, dense adhesions and multiple organs being attached to each other by scar tissue.

Endometriosis and Fertility

A study found that  30 to 50 percent of women who are diagnosed with endometriosis also had infertility. The impact of endometriosis on the organs and tissue found in the reproductive system is the likely cause, interfering with their normal function.

On the brighter side, fertility caused by endometriosis does not wipe out the chances of having a child. Depending on its severity, there are treatments for couples and individuals wishing to start a family even if they have been diagnosed with endometriosis. 

Intrauterine Insemination (IUI)

For endometriosis at stage 1 and 2, if fallopian tubes and egg quality remain unaffected, intrauterine insemination (IUI), also known as artificial insemination, can be a viable option. It is more affordable and less invasive, however it has a low success rate compared to in vitro fertilization.

In-vitro Fertilization (IVF)

In vitro fertilization (IVF) may be a better option where IUI has been unsuccessful. IVF costs more and is a little invasive, but it has high success rates. 

Surgery

When endometriosis is very advanced, surgery may be required to remove both the scar tissue and cysts before trying assisted reproductive technology (ART) treatments. Surgery increases the likelihood of success and reduces complications that are associated with advanced endometriosis.

When to Consult a Doctor

Severe menstrual pain or symptoms that seem similar to those of endometriosis are reasons to contact a professional healthcare provider for diagnosis. Blood and urine tests are available to rule out many likely causes of the symptoms. 

Be Proactive; Seek Care

A laparoscopic procedure used to inspect the pelvic cavity is the only sure way to definitively diagnose endometriosis. Steps can then be taken to mitigate symptoms and reduce discomfort as there is no available cure for endometriosis currently. 

Apart from surgical treatments, patients have found benefit in the use of non-prescription pain medication, birth control pills and progesterone medications. Hormonal treatments such as birth control pills and progesterone medication keep the body from ovulating, thus preventing the production of endometrial tissue. Other newer medications have been found to be helpful in suppressing the hormones that stimulate endometriosis. 

Contact Us

If you have been diagnosed with endometriosis and desire to have a family, it is important to work with an accredited fertility center such as Ivy Fertility to assist you in determining the best steps for family planning. For more about your reproductive health, contact us at any of our locations across the country.