Stages of Endometriosis

The tissue that lines the uterus is called the endometrium. When a person has endometriosis, the endometrium grows in other parts of the body outside the uterus. Since there is no outlet for this tissue, it can cause discomfort and pain, and lead to widespread scar tissue and lesions.

Endometriosis has no known cure, but treatments are available to relieve its symptoms, and address the infertility that it sometimes causes. To understand this condition better, we shall be discussing the types of endometriosis, symptoms of the condition, treatment and management options, and the impact endometriosis has on a person’s health and fertility.

What Is Endometriosis

In a typical menstrual cycle, the endometrium gradually thickens in anticipation of pregnancy, but when this does not occur, it is shed and a person is said to be having their period.

When a person has endometriosis, the endometrium also grows in other parts of the body. This tissue is then found on the ovaries, the fallopian tubes or different parts of the pelvic cavity. Occasionally, it grows around other organs.

Almost 200 million women and girls all over the world are affected by endometriosis. What makes endometriosis complicated is that the endometrium outside the uterus cannot break down and leave the body as it does in menstruation, causing many painful complications, if it is not treated.

Types of Endometriosis

Endometriosis is categorized into three main types based on the location it is found in the body, as well as how severe it is. 

Superficial Peritoneal Endometriosis 

Superficial peritoneal endometriosis gets its name from the location in the body it is typically found in. In this case, the surface of the peritoneum - the peritoneum is the thin lining of the inner abdomen. It is also referred to as superficial endometriosis, and is the most commonly occurring form of endometriosis. In fact, over 50 percent of all the cases of endometriosis are superficial endometriosis. 

Superficial endometriosis is characterized by shallow lesions along the peritoneum. People who have this type of endometriosis also experience painful menstruation, pain or discomfort when they urinate, and discomfort during intercourse, as well, they may struggle with infertility.

Ovarian Endometriosis 

Ovarian endometriosis affects the ovaries. It is characterized by cystic lesions inside the ovaries, which contain dark brown endometrial fluid. These lesions are called endometriomas, and because of their coloration, they are also referred to as “chocolate cysts.” 

People who have endometriomas tend to experience similar symptoms as those with superficial endometriosis, the difference is that the symptoms are more severe. In addition, they may cause back pain, bloating, vomiting, and nausea. 

Deeply Infiltrative Endometriosis 

As the name suggests, this form of endometriosis is quite severe, because endometrial tissue grows around other organs outside the pelvic cavity. In this case, endometrial tissue will be found in the bowels, or the bladder.

People who have deeply infiltrative endometriosis experience symptoms such as an increase in the frequency of urination, blood in their urine, pain in the lower back and pelvis, and sometimes a loss of their kidney function. Because this type does not usually respond to medication-based treatment, it is often treated through surgery.

Symptoms of Endometriosis

The symptoms of endometriosis depend on the location where endometrial tissue is found, the type of endometriosis, and how severe or widespread it is. Most people experience similar symptoms, with the more common ones being:

• Bleeding between periods, or extremely heavy bleeding during a period,
• Severe cramping before and/or during a period
• Pelvic and stomach pain 
• Pain in the lower abdomen during and/or after having sex
• Experiencing bloating, constipation, or  diarrhea, particularly around the time of a monthly period
• Pain in the pelvic area when peeing or having bowel movements, especially during a period

Endometriosis continues to cause even more severe complications as it progresses, if it is not treated. Some of these include infertility and certain types of cancer.

Stages of Endometriosis

The progression of endometriosis is observed in four main stages, although the symptoms experienced by a patient may not necessarily reflect the severity. A patient could have advanced endometriosis and experience mild symptoms, or on the other hand, they could have mild endometriosis and experience severe symptoms. Thus, the stages of endometriosis are:

1. Stage 1 Endometriosis: At this stage, a patient will have small implants or lesions on the peritoneum. They will also have little or no scar tissue.
2. Stage 2 Endometriosis: This stage is more severe, where the lesions a patient has are deeper into the peritoneum and amount of scar tissue has increased
3. Stage 3 Endometriosis: At this stage patients will have a combination of multiple deep lesions in the peritoneum, ovarian cysts, as well as bands of scar tissue in the pelvic area. These bands of scar tissue are also known as adhesions.
4. Stage 4 Endometriosis: This is the most severe stage of endometriosis. The ovarian cysts will be quite large, the scar tissue will not only be dense, but will attach multiple organs to each other.

Endometriosis and Fertility

30 to 50 percent of women who have been diagnosed with endometriosis also face challenges with infertility. This is because when the endometrium grows on the organs and tissue found in the reproductive system, it interferes with their normal function.

That being said, infertility that is caused by endometriosis does not typically obliterate the chances one has of having a child. There are treatments available to manage the endometriosis, giving couples or individuals a chance at building a family. 

Intrauterine Insemination (IUI)

IUI is a viable option for people with endometriosis at stage 1 and 2. As long as the quality of their eggs and their fallopian tubes are unaffected, patients will find intrauterine insemination less invasive and more affordable. As 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)

If IUI is not successful, in vitro fertilization (IVF) may be a better option. IVF is a much more expensive treatment. It is also quite invasive, but it has had high success rates in the majority of cases, particularly in cases of infertility.

Surgery

If a patient has very advanced endometriosis, the scar tissue and cysts may inhibit the success of assisted reproductive technology (ART). Therefore surgery targeting the removal of both the scar tissue and cysts increases the chances that ART will be successful. Surgery also reduces the complications caused by advanced endometriosis.

When to Consult a Doctor

If you repeatedly experience severe menstrual pain or symptoms similar to those of endometriosis, contact your healthcare provider for proper diagnosis. 

Be Proactive; Seek Care

There are urine and blood tests that are done to rule many likely causes of symptoms that seem similar to those of endometriosis. However, inspecting the pelvic cavity through a laparoscopic is the only way to definitively diagnose endometriosis. 

Once endometriosis is positively diagnosed, there are measures that can then be taken to manage the symptoms and reduce discomfort. Some patients manage with non-prescription pain medication, while others benefit from hormonal treatments such as birth control pills and progesterone medications. Still others benefit the most from surgical treatments. 

While surgery removes existing endometrial tissue, hormonal treatments prevent the tissue from developing by keeping the body from ovulating. In addition, there are newer medications that have been helpful in suppressing the hormones that stimulate endometriosis. 

Contact Us

If you have been diagnosed with endometriosis do not be discouraged. Contact a fertility center such as Ivy Fertility to help you chart the way forward toward building your family. We are available at various locations across the country to respond to any other queries regarding your reproductive health.