Endometriosis Stages Explained

Highlights

Endometriosis stage can inform Western treatment options for this painful, chronic gynecological disease that affects at least 1 in 10 women of childbearing age.
In this disease, endometrial tissue grows in your pelvis and abdomen, mimicking the endometrium lining found in your uterus.
The tissue grows and breaks down during your menstrual cycles, creating inflammation, pain, and scar tissue.
Lesions, cysts, and adhesions occur in endometriosis, and their location and severity help determine endometriosis stages and types.
Complementary and alternative (CAM) therapies can help relieve your pain and the symptoms caused by all stages of endometriosis along with standard treatments.
Acupuncture, moxibustion, and Chinese herbal medicines can all help reduce the symptoms of even severe endometriosis.
Sound Cycle can help you find a CAM therapist near you.

Knowing your endometriosis stage is important to your doctor when deciding on treatment options. The severity of your symptoms is dependent on the stage and type of your endometriosis. Complementary and alternative medicine (CAM) therapies like acupuncture can help relieve the pain and symptoms of all endometriosis stages.

What is endometriosis?

Endometriosis is a painful gynecological condition where tissue similar to the endometrial tissue lining in your uterus grows around your reproductive organs, bowels, and into your abdominal cavity. Your normal monthly hormone changes affect the endometrial tissue, causing it to thicken and shed over time. This creates inflammation and pain in the location of the tissue.

Once the endometrial tissue breaks down, it has no way to leave your body and becomes trapped in your abdomen or pelvis, resulting in additional symptoms. The broken-down tissue causes irritation, scarring, and pelvic pain. It can also lead to cysts or adhesions and increases your risk of infertility.

It’s estimated that at least 11% of American women aged 15 to 44 have endometriosis, causing them chronic pelvic pain and more painful menstrual periods. It can also make it harder to get pregnant. Both the symptoms you experience and your treatment options depend upon your endometriosis stage and type.

Endometriosis stages

How is endometriosis staged?

The staging of endometriosis begins with diagnosis. Your doctor will probably begin with a pelvic exam to feel for cysts or lesions. In the early stages, there will probably be nothing to feel. Ultrasound is the next step, followed by MRI if your doctor feels it’s necessary.

The only way to get an accurate diagnosis of endometriosis, however, is with a laparoscopy, where your doctor will insert a thin scope through a tiny incision in your navel to visualize your pelvic cavity.

If they find any lesions, they will remove them at the same time. They will then send tissue samples to the lab, which will conclusively show whether you have endometriosis.

At that time, your endometriosis will be staged.

What are the stages of endometriosis?

The American Society of Reproductive Medicine (ASRM) classifies endometriosis into four stages based on a points system and the number and depth of the endometriotic lesions.

Classification of endometriosis takes only the severity of your lesions into account, not your pain or symptoms. You can have any level of pain or symptoms, no matter the stage of your disease.

The points system allows doctors to better determine your stage by numerically scaling your endometriosis. The four endometriosis stages range from the mildest cases in stage I to the most severe cases in stage IV.

Stage I

Endometrial lesions in this stage are minimal, with few superficial implants into your organs. You may have lesions surrounding your abdominal or pelvic tissue. Stage I classification is given to clients with minimal scar tissue and a numerical score of 1 through 5.

Stage II

If your disease scores between 6 and 15 points, you’ll be diagnosed with stage II endometriosis. This stage still represents mild disease levels but with increases in the number and depth of lesions over stage I. There is also more scar tissue at this stage.

Stage III

Clients with a moderate disease level of 16 to 40 points are diagnosed as stage III. You’ll have many implants and lesions with increased depth over the first two stages.

You may have small cysts on one or both of your ovaries, and you’ll have increased scar tissue. The thickening of your scar tissue can start to cause adhesions in your pelvis or abdomen.

Stage IV

This stage represents severe disease and is classified by points over 40. Endometriosis is the most widespread in stage IV, with many deep endometrial implants throughout your abdomen and pelvis. Larger cysts are present on at least one ovary, and there are thicker, more numerous adhesions.

Endometriosis doesn’t always progress from one stage to the next. The disease may worsen or improve over time or stay the same for decades. Doctors don’t know why some women with endometriosis have more severe stages of disease than others or why some cases of endometriosis worsen while others improve.

The types of endometriosis

Doctors also use the type of endometriosis you have to decide on treatment plans. The type of endometriosis is determined by where the lesions are located within your pelvis and abdomen.

Superficial peritoneal endometriosis

This is the least severe form of endometriosis. It affects the peritoneum, the membrane lining your pelvis and abdomen, and the organs within. Endometrial tissue attaches to your peritoneum in this type.

Ovarian endometriomas

Endometriomas are fluid-filled cysts that are dark in color, also called chocolate cysts. The size of chocolate cysts varies from small to large. Ovarian cysts are the most common, but cysts can occur anywhere in your pelvis or abdomen. The cysts can break and spread endometriosis within your body.

Deeply infiltrating endometriosis (DIE)

This more severe type of endometriosis occurs when your endometrial tissue infiltrates organs either in or outside of your pelvic region. This can include your ovaries, bladder, bowels, rectum, appendix, and diaphragm. In rare but severe cases of DIE, thick scar tissue and adhesions form around your pelvic organs, keeping them stuck in place. This is called a frozen pelvis.

Abdominal wall endometriosis

Endometrial tissue can also grow onto your abdominal wall. It’s common for the tissue to attach to incisions from surgeries, including C-sections.

Doctors determine your stage and type of endometriosis through ultrasounds and laparoscopic surgery. These minimally invasive procedures help your doctor identify the location and severity of your lesions.

How to treat endometriosis

Doctors base treatment of endometriosis on the stage and type a person has and whether they plan to become pregnant. Traditional treatments involve pain medications and hormone therapy, like birth control pills or the Mirena IU, or gonadotropin-releasing hormone (GnRH) agonists.

Sometimes surgery is used to treat endometriosis. Lesions and implants can be removed with a surgical procedure to reduce pain and other symptoms. Some doctors even recommend removing the uterus and ovaries in women who don’t wish to become pregnant.

As with all drugs, hormone therapy has side effects and may not work to relieve all your symptoms. Surgery offers more long-lasting relief, but the severe consequences are irreversible. Many people with endometriosis can get better symptom relief by adding one or more complementary and alternative therapies to their treatment plans.

The best CAM therapies for endometriosis

Complementary and alternative medicine (CAM) such as acupuncture, moxibustion, herbal medicines, and lifestyle changes can help ease your endometriosis symptoms.

Acupuncture for endometriosis

Acupuncture uses small needles to stimulate the tissues and nerves throughout your body. It helps increase blood flow and circulation, reducing inflammation and pain.

Research shows that people with endometriosis experience significant improvements in their symptoms when acupuncture is used alongside traditional treatments.

Moxibustion for endometriosis

Moxibustion treatment is another great CAM therapy for endometriosis. Moxibustion is proven to reduce chronic pelvic pain and painful periods. It can be used on its own or paired with acupuncture for better effectiveness.

Herbal remedies for endometriosis

You may also want to add herbal remedies like Xuefu Zhuyu decoction (XZD), an herbal blend from China. XZD has been used to treat endometriosis in China since 1983, and studies show it reduces the pain caused by endometriosis and may shrink endometriotic lesions.

Massage therapy for endometriosis

Massage therapy can also improve your endometriosis symptoms. Regular massage increases your blood and lymphatic circulation, helping to reduce levels of inflammation in your body. Massage therapy is shown to reduce the level of pain and muscle spasms people with endometriosis experience.

How Sound Cycle can help

The symptoms of endometriosis are chronic and impact your quality of life. Sound Cycle provides evidence-based information about complementary and alternative therapies that can help you manage your symptoms. To learn more, follow our blog.

To find a CAM therapist near you, visit our provider directory.

Endometriosis Stages Explained [+ Treatment Options]