The 4 Different Stages of Endometriosis Explained

According to the World Health Organization, endometriosis affects 190 million reproductive-age girls and women worldwide. Endometriosis is a health condition where tissues similar to the uterine lining grow in different body areas. 

Healthcare professionals classify the condition according to the type and different stages of endometriosis. The stage and type of endometriosis vary based on different factors. 

This guide will discuss the different stages and common sites of endometriosis

What Are the Different Stages of Endometriosis?

Have you wondered, "what are the different stages of endometriosis?" The American Society of Reproductive Medicine has created the most commonly used scale. Your healthcare professional will assign different points during the course of your diagnosis based on different factors regarding the tissue. 

These factors include:

  • Depth
  • Location 
  • Amount 
  • Size

The point system allows healthcare professionals to classify and scale the disease numerically. Remember that the endometriosis stage doesn't always reflect how many symptoms or how much pain you have. 

Stage 1: Mild (1 to 5 Points)

Stage one is minimal or mild. An individual in this stage would have superficial and small lesions. 

Their lesions won't deeply penetrate their body. Most of the lesions in stage one are found in the abdominal cavity or peritoneum. 

Stage 2: Minimal (6 to 15 Points)

Stage two includes more implants than are found in stage one. There might also be scar tissue, and the lesions penetrate deeper into the person's tissue. Ovarian endometriomas, or ovarian cysts, are also present. 

These cysts form when endometrial tissues get attached to the ovary. The tissue sheds during the individual's normal menstrual cycle. 

Stage 3: Moderate (16 to 40 Points)

Stage three includes deep implants. The individual might also have small cysts on their ovaries. 

They could also experience adhesions. According to MedlinePlus, adhesions are thick pieces of scar tissue. 

The adhesions form as the body tries to protect itself from inflammation caused by endometriosis. The adhesions result in organs sticking together. This can cause sharp pain. 

Stage 4: Severe (40 or More Points)

Stage four endometriosis is more widespread throughout the body. Endometriosis in this stage could be found in the following:

  • Bowel
  • Lungs
  • Bladder

The individual might have thick adhesions and deep implants. They could also have large cysts on their ovaries, getting up to the size of a grapefruit.

Some ovarian cysts go away over time on their own. The cysts that are caused by endometriosis typically need to be surgically removed. 

A person in stage four endometriosis might also have small cysts on the rectum and back wall of their uterus. They could experience additional symptoms, such as:

  • Constipation 
  • Abdominal pain
  • Painful bowel movements
  • Vomiting
  • Nausea 

If the endometrial cysts, scar tissue, or lesions block the fallopian tubes, a person in stage four might have difficulty conceiving. 

For more information read First Signs of Endometriosis: Look Out For Early Symptoms.

How Are Stages Assigned?

The stages of endometriosis aren't determined like the stages of cancer are. Endometriosis doesn't grow and spread the same way that cancer does. 

Cancer typically starts in one area of the body and spreads to other areas. A person might experience more pain or feel sicker as their cancer progresses. 

On the flipside, endometriosis can be widespread in the early stages. The stage of endometriosis that a person is in doesn't always correlate with their pain levels, complications, or symptoms. 

Endometriosis also won't progress through the four stages as other diseases do. The health condition can worsen, stay the same, or improve over time. There's no sound method to determine how endometriosis will progress. 

The stage of endometriosis you're in is determined by how many points you receive during your diagnosis. As we mentioned earlier, your healthcare professional will look at different things when assigning points. 

According to WebMD, your doctor will conduct various examinations to diagnose you with endometriosis. These tests include:

  • Pelvic exams
  • Ultrasounds
  • Magnetic Resonance Imaging (MRI)
  • Laparoscopy

During these examinations and tests, your physician will assign you points to determine the stage you're in. 

Common Sites of Endometriosis

There are multiple areas where endometriosis can occur. Some endometriosis sites are 

more common, while other sites typically occur for individuals who are in stage three or four. 

Endometriosis on the Peritoneum

Superficial peritoneal endometriosis is one of the most common sites of the health condition. The peritoneum is the lining of your pelvis and abdomen. You can also find this lining on the outside of most of your organs in the abdominal cavity. 

With this type of endometriosis, the tissue gets attached to the peritoneum. While common, peritoneal endometriosis is difficult to diagnose. It doesn't show up on ultrasounds or other imaging. 

Healthcare professionals typically have to perform a laparoscopic procedure to locate peritoneal endometriosis. However, it can vary in appearance. Unskilled surgeons might miss peritoneal endometriosis if they're not experienced in the area. 

Endometriosis in the Ovaries

Another site where endometriosis can form is cysts on the ovaries called endometriomas. The cysts can also be located within the ovaries as well. Deep ovarian endometriosis will form fluid-filled cavities called "chocolate cysts." They can form into many different sizes. 

Healthcare professionals can diagnose ovarian endometriosis with a pelvic ultrasound. However, most doctors will want to remove the cysts to examine them. 

Endometriomas can be a serious reproductive health threat. The cysts don't respond well to medical treatment.

They can also destroy healthy ovarian tissue. That could result in a variety of issues, such as:

  • Premature ovarian failure
  • Decreased functionality of the ovaries
  • Difficulty ovulating 

Endometriosis in Organs in the Pelvic Region

Endometriosis can also spread to organs in your pelvic region. The organs don't have to be related to reproduction to get affected. 

Some of the organs in the pelvic region that can get affected include:

  • Bladder
  • Rectum
  • Ovaries
  • Fallopian tubes
  • Bowels
  • Vagina 
  • Cervix
  • Uterus 

Endometriosis usually stays in the pelvic region of your body. There are times when it can spread to your chest cavity, but that's rare. 

For additional information read Top 12 Endometriosis Questions Answered.

Get the Right Endometriosis Support for You

Every case of endometriosis is different. What treatment works for you might not work for other people. It's important to find the right support and treatment to help your body through the different stages of endometriosis

Knowell can help. Learn more about how our hormonal supplement can help regulate your endometriosis symptoms. 

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