How does endometriosis progress?

Chronic conditions can sound like a constant state, but just like anything about the human body, endometriosis changes and develops in different ways over time. Unfortunately, a lot of the time, this means that endometriosis grows, but there are also ways to reduce its impact.

Stages of endometriosis

Endometriosis is classified into stages from stage 1 to stage 4 based on severity. The criteria that help define which stage are the size and spread of the tissue, which organs and pelvic structures are affected by the disease, the amount and size of the pelvic adhesions, and whether the fallopian tubes are blocked, and if so, how much.

The stages are defined as:

  • Stage 1: Minimal. In this stage, there may be implants (sometimes called cysts) that are only superficially deeply implanted, as well as some limited filmy-looking adhesions, which are bands of scar tissue that can get in the way of internal movement and cause pain.
  • Stage 2: Mild. In this stage, adhesions will have grown and will cover more surface area, and lesions or implants may have spread either along the uterus or into the area between the rectum and the uterus.
  • Stage 3: Moderate. In this stage, more advanced cysts, called endometriomas, or “chocolate cysts” appear. Endometriomas are filled with the red or brown blood that gives them their name, and can rupture, which can be very painful. As endometriomas grow, so do adhesions.
  • Stage 4: Severe. In this stage, large numbers of large cysts, and large numbers of adhesions are present. These may have spread from the outside of the uterus to the back wall of the uterus and the rectum, which may cause digestive symptoms. Infertility is also likely.

It’s important to note, though, that studies have found the amount of pain that endometriosis patients experience doesn’t correspond with the extent of the endometriosis, so it’s possible for women with stage 1 endometriosis to experience debilitating pain, and for women diagnosed with stage 4 endometriosis to only experience minimal symptoms.

It’s important to make sure you’re working with a healthcare provider who takes your symptoms seriously no matter what stage of endometriosis you’ve been diagnosed with. Pain that gets in the way of your day to day life should always be taken seriously.

Getting in the way of growth

Healthcare providers often recommend hormonal birth control and other hormonal medications as a way of controlling the growth of endometriosis. Dietary and lifestyle changes that aim to lower the level of estrogen in the body have the same goal.

Hormonal treatments can control endometriosis, but surgical treatments to remove growths can help remove some symptoms in certain cases. Multiple surgeries, however, can leave more scar tissue, which can lead to further growth.

The end of endometriosis?

Unfortunately, there isn’t a possibility of a true end of endometriosis until either menopause or a full hysterectomy, and there are some endometriosis patients who experience symptoms even after that. The women who experience symptoms after menopause or a hysterectomy are generally women who have unusually high estrogen levels in their bodies, including women taking hormonal medications that add estrogen to the body and women with a significant amount of excess body fat, which helps to produce estrogen.

  • G. Szendei, et al. “Is there any correlations between the stages of endometriosis and severity of chronic pelvic pain? Possibilities of treatment.” Gynecol Endincrinol. 21(2):93-100. Web. August 2005.
  • “Endometriosis.” HopkinsMedicine. Johns Hopkins Health System. Web.
  • Togas Tulandi. “The Association Between Infertility and Endometriosis and the Treatment.” obGyn. UBM Medica, June 30 2011. Web.
  • American Society for Reproductive Medicine. “Endometriosis, A Guide for Patients.” ASRM. American Society for Reproductive Medicine, 2012. Web.
  • “Control estrogen levels by lowering body fat?” BreastCancer., 2010. Web.
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