Introduction

Endometriosis is a chronic disease that affects girls and women of reproductive age. This disease causes the growth of tissue similar to the lining of the uterus to grow outside the uterus; this disease causes many symptoms, but the most common symptom is pelvic pain. In Painful Periods: Comprehending Endometriosis and Its Signs and Symptoms, we learned about endometriosis and its symptoms. Today we will take an in-depth look into the disease, specifically the stages of endometriosis. 

First, endometriosis can progress into different stages. Classified into one of four stages: I-minimal, II-mild, III-moderate, and IV-severe, depending on the location, extent, and depth of endometriosis implants; presence and severity of adhesions; and presence and size of ovarian endometriomas. 

Endometriomas are cystic lesions stemming from endometriosis commonly found in the ovaries. These lesions are referred to as chocolate cysts due to the thick dark brown appearance of the fluid contained within them. Found mainly in further stages of endometriosis. 

Stages of Endometriosis

Next, the stages of endometriosis are determined based on a point system. The most common method is a points rating and numerical scale system created by the American Society of Reproductive Medicine (ASRM), which determines disease stages by assigning points according to the characteristics of the disease. 

ASRM’s scale has four stages:

Stage I: Minimal disease (five points or less)

Stage II: Mild disease (six to 15 points)

Stages III and IV: Moderate to severe disease (16 points and higher). 

Additionally, this system was fundamentally developed as an indicator of endometriosis-associated infertility and, therefore, has no specific correlation with any symptoms- meaning that a woman in stage IV can be asymptomatic, while a stage 1 patient might be in debilitating pain.

Stage I Endometriosis

Stage I, or minimal endometriosis, is the first stage of the disease. In this stage, endometrial implants are few in number, small, and superficial. Implants are on organs or the tissue that lines the pelvis and abdominal cavity; scar tissue is not present or is minimal. Although endometrial lesions are minimum, individuals within this stage can have severe, debilitating pain. 

Stage II Endometriosis

Stage II, or mild disease, scores between 6 and 15 points. During this stage, implants are deeper than Stage I implants. There can be scar tissue at this stage but no signs of active inflammation. Like stage I, stage II patients can suffer from severe debilitating pain. 

Most women have minimal or mild endometriosis. 

Stage III Endometriosis

Stage III or moderate disease has between 16 and 40 points. At this stage, there are many deep endometrial implants and endometrial cysts in at least one of the ovaries. Also, at this stage, filmy adhesions may be present; these thin bands of scar tissue form in response to the body’s attempts to protect itself from the inflammation caused by endometriosis. 

Furthermore, it is at this stage that chocolate cysts are present. Endometriomas are the most common manifestation of endometriosis on the ovary. However, endometriomas can also be found throughout the abdomen, the bowel, in prior surgical incisions, and in rare cases, in distant locations of the body, such as the cerebellum. Approximately 17 to 44% of women diagnosed with endometriosis will experience an endometrium. 

Stage IV Endometriosis

Stage IV is the most severe stage of endometriosis, typically accruing over 40 points. During this stage, adhesions, scar tissue, and endometriomas are present. Likewise, with stage IV endometriosis, infertility is very likely. At stage four, finding treatment can be difficult. Even if a surgeon makes the diagnosis, they may not be familiar with or have experience using the surgical techniques for removing the lesions. Therefore, forcing patients to seek alternative treatment options to manage their symptoms. 

Last, please note that the stage of the disease does not necessarily reflect the level of pain or the presence of symptoms. Hence, the Endometriosis Foundation of America has proposed using more descriptive categories because every numbered stage has many variations and does not give any insight into the patient’s pain or where lesions can be localized.

Support Your Endometriosis

If you think you may have endometriosis, speak with a healthcare provider. If you or someone you know has information and is seeking a safe space to discuss your condition, please visit the Black Women Feel Pain Too Facebook support group.