Endometriosis is a disease of the female reproductive system that is characterized by endometrial tissue, tissue lining the uterus — growing elsewhere. These abnormally implanted tissue deposits go through the same cycle as the normal endometrium, but cannot be shed and expelled. This leads to Endometriosis symptoms such as pain and infertility.
How is endometriosis staged?
According to the American Society for Reproductive Medicine (ASRM), up to 10 percent of all women have endometriosis. However, not all women with endometriosis stages experience the same endometriosis symptoms, and symptom severity does not correlate with the extent of the disease. To classify the disease, physicians evaluate patients using a system of staging that takes into account the location, extent, and depth of the endometrial lesions, as well as the presence and severity of adhesions and the presence and size of ovarian endometriomas.
What are the Stages of Endometriosis?
There are four stages of endometriosis. But it is important to remember that the severity of endometriosis does not necessarily directly equate to the level of pain or endometriosis symptoms experienced. The symptoms of endometriosis can be seen here.
The first stage of endometriosis is Minimal Stage. In this stage, there are usually small endometrial implants on or around the ovaries, some inflammation in the pelvis and small lesions or wounds. These implants are still superficial at this point and aren’t yet deep in the body.
The second stage of endometriosis is Mild Stage. In this stage, the implants are spread further in the ovaries and pelvic lining. There are more lesions and wounds in the pelvic region now, including in the area between the uterus and the rectum. Black spots also appear over these lesions, which cause more irritation during ovulation and/or pelvic pain.
The third stage of endometriosis is Moderate Stage. Endometriomas, also called chocolate cysts begin to grow. There is a presence of cysts, dark red or brown in color, and when these rupture, they cause extreme pain and inflammation in the pelvic region. The endometrial implants are now deeper into the organs i.e. ovaries, tubes and very possibly some other organs within the pelvis such as bladder, bowel, colon etc. More lesions are formed and now scars have begun to form as well.
The fourth and final stage of endometriosis is Severe Stage. At this stage, the implants are deep within the organs in the pelvis. Many of the surrounding organs have lesions and adhesions on them and these bleed during the menstrual period just like the cells within the uterus. Sometimes, the scars cause these organs to stick together and as a result, not function properly. Many women with this stage of endometriosis may experience problems such as constipation, nausea/vomiting, abdominal pain and painful bowel movements.
After Stage 4
Even though Stage 4 is seen as the final stage of endometriosis, some patients have been diagnosed with a medical condition known as a ‘Frozen Pelvis as a result of Severe Endometriosis’. This is also seen as ‘End Stage Endometriosis’ or ‘Terminal Endometriosis’ in the pelvis. It is the most advanced form of deep infiltration where pelvic organs are firmly fixed to each other and to the pelvic bones. Sometimes they might extend to deeper tissues including nerves, muscle layers and even lymph nodes, hardening soft tissues and organs in the pelvis. Surgery for this stage of endometriosis involves very experienced surgeons who are experts in the various affected organs in order to excise the endometriosis and separate the different affected organs.