Stages of Endometriosis

Endometriosis is a condition where tissue that usually lines the uterus begins to develop in places outside the uterus. This lining is called the endometrium, and is where the disease derives its name. What endometriosis creates in the body is widespread scar tissue and lesions, causing a person to experience a lot of discomfort and sometimes extreme pain. At this point, no cure has been found for endometriosis. What is available though options for both treatment and management of symptoms, which serve not only to alleviate the burden borne by the body, but also address infertility that can sometimes come about due to the disease.

Endometriosis is a multifaceted condition that can sometimes be confusing to understand particularly because of the way symptoms present themselves. This article seeks to shed light on this condition by discussing the different types of endometriosis, what the typical symptoms of the condition are, the currently available treatment and management options for patients, and the impact endometriosis has on a person’s health and fertility.

What Is Endometriosis

Under normal circumstances, the uterine lining thickens in the course of a menstrual cycle and is shed as menstruation when no conception occurs. Endometriosis presents an anomaly to the body’s functions because when this lining develops outside of the uterus, it has no outlet. As a result, without any intervention, the body suffers great pain and discomfort. 

Endometriosis is often found developing on the ovaries, fallopian tubes, or the general pelvic cavity. Although it is a rare form of endometriosis, sometimes, endometriosis can develop outside of the reproductive system and pelvic cavity onto other organs such as the bladder bowels, or kidneys. This condition is quite common, affecting nearly 200 million women and girls worldwide in their reproductive years.

Types of Endometriosis

Medically speaking, endometriosis has been categorized into three main types and this is determined by the location in which it is found, as well as how severe or widespread it is. 

Superficial Peritoneal Endometriosis 

Superficial peritoneal endometriosis is the most common type of this condition and derives its name from the location it is found in. Superficial means that it is found on the surface, while the peritoneum is the thin lining of the inner abdomen. This type of endometriosis is also known as superficial endometriosis, presenting in more than 50 percent of all the cases of endometriosis. The characteristics of superficial endometriosis are shallow lesions along the peritoneum. These cause pain or discomfort during urination, discomfort during sex, painful menstruation and could also cause infertility. 

Ovarian Endometriosis 

When a person has ovarian endometriosis the disease is found inside the ovaries in the form of lesions. These lesions are called endometriomas and contain endometrial fluid that has a dark brown coloration. As a result of this coloration they are also called “chocolate cysts.” When a person has endometriomas, they experience just about the same symptoms as those who have superficial endometriosis. However, these symptoms in addition cause nausea and vomiting, as well as bloating and back pain.

Deeply Infiltrative Endometriosis 

This type of endometriosis is the most severe form of the disease. It is called deeply infiltrative because the endometrial tissue is found having ‘infiltrated’ as it were, deep into the body cavity, around other organs. Deeply infiltrative endometriosis affects the stomach or intestines, and the bladder or kidneys. 

When a person has endometriosis at this stage, they will experience pain in the pelvis and lower back, an increase in how frequently they need to urinate, and blood in their urine. Sometimes, the condition can be so severe as to cause the patient to lose their kidney function. This type of endometriosis is more often than not treated through surgery because it does not typically respond to medication-based treatment. 

Symptoms of Endometriosis

When it comes to the symptoms of endometriosis, several factors influence how they present. Typically, symptoms are based on the type of endometriosis, its location, how severe it is, and how wide spread within the body. Across the different types of endometriosis, symptoms are similar, with the below being the commonly experienced ones: 

• Pain in the pelvis and stomach 
• Painful urination and bowel movements, particularly when having a period
• Experiencing pain during or after sex - or both - in the lower abdomen 
• Diarrhea or constipation, as well as bloating, especially around menstruation 
• Irregular bleeding: heavy bleeding during a period, or bleeding between periods
• Severe cramping before and/or during a period

Stages of Endometriosis

The curious thing about endometriosis is that the intensity of symptoms is not a direct reflection of the severity of the disease. This means that a person’s endometriosis could be moderate, but cause them very intense symptoms, or they could have severe endometriosis and present very mild symptoms. The only way to determine the extent of endometriosis is through diagnostic testing. That being said, let us briefly touch on the characteristics of each stage:

1. Stage 1 Endometriosis: Stage 1 endometriosis presents with small lesions on the inner lining of the abdomen - the peritoneum. Typically a person will have very little to no scar tissue. 
2. Stage 2 Endometriosis: Stage 2 endometriosis presents with more scar tissue and lesions set deeper into the peritoneum. 
3. Stage 3 Endometriosis: At stage 3, one finds ovarian cysts, multiple lesions that are deep in the peritoneum, and scar tissue formed in bands in the pelvic area - also called adhesions. 
4. Stage 4 Endometriosis: The most severe stage of endometriosis is at stage 4. Not only will it consist of rather large ovarian cysts, it also presents with very dense scar tissue which causes multiple organs to become attached to each other. 

As endometriosis continues to progress without treatment, its symptoms become increasingly severe, causing infertility and influencing certain types of cancer.

Endometriosis and Fertility

Infertility affects between between 30 and 50 percent of patients who suffer from endometriosis. What causes this is the endometrium growing on the uterus and tissue surrounding it. Although this may sound bleak, there are treatments available for endometriosis, which give those who are hoping to build their families a chance at doing so. Let us look at them below:

Intrauterine Insemination (IUI)

A person in either stage 1 or stage 2 endometriosis can benefit from IUI treatments. What will be required at the onset tests to verify that their fallopian tubes are not blocked, and that the quality of their eggs has not been affected by the condition. IUI is also less invasive than other fertility treatments, and more affordable. It is therefore a consolation that one need not suffer more discomfort, as well, as they undergo treatment for the endometriosis, they need not break the bank to become parents. pAs a whole, IUI has lower success rates than in vitro fertilization (IVF), and patients may opt to try IVF if they are unsuccessful after several rounds of IUI.

In-vitro Fertilization (IVF)

IVF is a highly successful fertility treatment. It is also much more expensive than IUI. In general, IUI has been observed to have a lower success rate, requiring multiple treatments before parents can see any results. When IUI is unsuccessful, many patients opt for IVF. It is important to note that apart from expense, IVF is a more invasive fertility treatment. Its value has been in the success it has had in the majority of the cases of infertility, regardless of the cause.

Surgery

When endometriosis is very advanced, the build up of cysts and scar tissue may prevent fertility treatments from being successful. In such a case, often a healthcare professional will recommend the removal of scar tissue as well as the cysts. This has two benefits, the first being that it reduces general complications that advanced endometriosis causes. The second benefit is that clearing up the endometriosis increases the probability of successful fertility treatments.

See a Doctor 

Having gone through the overview of endometriosis, ensure that you see a doctor if you are experiencing painful menstruation, or symptoms that are similar to those of endometriosis, particularly when you are having your period, or if the symptoms are regular or persistent. 

A proper diagnosis will enable you to get the best course of treatment. When faced with symptoms that are similar to those of endometriosis, urine and blood tests are useful in ruling out other causes that do not point to endometriosis. The best way to diagnose endometriosis however, is through a laparoscopic procedure. 

Since endometriosis does not have a definitive cure, patients often have to manage the symptoms in different ways. Pain medication, hormone-based therapies, and surgery remain the main ways of managing endometriosis. Pain medication helps with discomfort, hormone-based therapies suppress the development of endometrial tissue, while surgery removes endometrial tissue from the body. 

Contact Us

A diagnosis of endometriosis can be discouraging, but it is manageable. If you desire to build a family, the team of professionals at Ivy Fertility are ready and willing to assist you explore options to manage endometriosis, and build your family. We have various locations across the country for your convenience and will respond to any questions you may have about reproductive health.