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The stages of endometriosis

We know what endometriosis is, and that it’s presentation can vary from person to person. The question is: how do doctors actually classify endometriosis and identify its severity?

Well, endometriosis is usually classified into one of four stages, based on the location, number, size and depth of the endometrial lesions.

How are the stages identified?

In order to identify the stage of the disease, a laparoscopy (a type of keyhole surgery) is typically performed, usually by a gynaecologist. The gynaecologist makes a small incision into the abdominal wall, and then inserts a thin camera into the pelvis to look for signs of endometriosis.

The gynaecologist will look for inflammation, endometriosis lesions, and pelvic adhesions. They may also look to see if any other organs are involved outside the pelvis. In some cases small tissue samples are removed for further testing in a lab. Based on what is seen in the pelvis and abdomen, the gynaecologist will stage the endometriosis out of 4.

So what are the 4 stages?

  • Stage 1 - Minimal: In this stage, there are small lesions, wounds or endometrial implants on the ovary. There may also be inflammation around the pelvic cavity.
  • Stage 2 - Mild: There are more lesions and implants compared to stage 1, mainly appearing on the ovary and pelvic lining. These may also sit deeper in the tissue and scar tissue may be present.
  • Stage 3 - Moderate: Those with moderate endometriosis will have deep implants on the ovary and pelvic lining, along with lighter lesions in some cases. There may be small cysts on one or both ovaries along with thick bands of scar tissue called adhesions.
  • Stage 4 - Severe: This stage is the most widespread; there are deeply infiltrating endometriosis implants, cysts on at least one ovary, and adhesions throughout the pelvic region

​Misconceptions about the stages

The stages of endometriosis stages do not correlate with the amount of pain experienced. Somebody with stage 1 endometriosis may experience more pain than someone with stage 4 endometriosis, for example. Similarly, somebody with stage 1 endometriosis may experience fertility problems whilst somebody with stage 4 does not.Treatment and surgery will therefore typically differ from person to person based on the symptoms they experience and the effects of those symptoms on their quality of life.A comparison between women with the condition is therefore hard to make.No matter which stage of endometriosis you have, it’s important to understand your own symptoms and to feel supported on your health journey. 

If you’re experiencing any unusual pelvic symptoms, try our Symptom Assessment Tool and join the Bloomful Pilot Consultation programme today to speak with our gynaecologists.

Author: Melissa Chan