Stages of Endometriosis

Key Takeaways

• Endometriosis is a condition that occurs when tissue similar to your uterine lining grows outside the uterus, where it normally belongs. This can cause pain, irregular periods, and even affect fertility.
• While there's no cure for endometriosis, there are treatment options to manage symptoms and improve your chances of pregnancy.
• Fertility Associates of Memphis offers comprehensive care for women with endometriosis, including diagnosis, treatment, and support.

Understanding Endometriosis

Endometriosis affects almost 200 million women worldwide according to the World Health Organization, making it a relatively common condition.

Think of endometriosis as an unwelcome guest. It's tissue that belongs in your uterus, but it's decided to set up shop elsewhere in your body. Imagine tiny patches of that tissue growing on your ovaries, fallopian tubes, even your bladder or bowels. This misplaced tissue acts just like the tissue in your uterus, responding to your monthly hormones.  

The problem is, these cells outside the uterus don't have a way to escape like your normal menstrual flow does. Instead, they can cause inflammation, scarring, and even painful adhesions, all of which can disrupt your reproductive system and cause a lot of discomfort. And furthermore, endometriosis severity doesn’t always match symptoms. Some women with mild cases may still have pain or difficulty getting pregnant, while those with severe cases might not.

Types of Endometriosis: Understanding the Variations

Doctors use various terms to describe the location and severity of endometriosis, including:

• Superficial Ovarian and Peritoneal Growth: This type of endometriosis is the most common, accounting for about 80% of cases. These lesions appear on the surfaces of organs like the bladder, intestines, reproductive organs, and even the peritoneum (the lining of the abdominal cavity). 

• Deep Infiltrating Endometriosis (DIE): DIE is a more advanced form of superficial endometriosis. Here, the lesions invade deeper into the tissue, causing more severe scarring and potentially damaging nerves, leading to difficult-to-manage pain. This affects about 1% of women of childbearing age.
• Endometriomas: Often called "chocolate cysts," endometriomas occur when endometrial cells invade INSIDE the ovary. They form cysts lined with tissue that resembles the uterus's lining. During menstruation, these cells grow and bleed, resulting in blood buildup within the ovary. This old blood turns dark brown, giving the cysts their name. Endometriomas can cause inflammation and compromise ovarian function.
• Adenomyosis: This occurs when endometrial cells invade the muscular wall of the uterus itself.  Scarring from the inflammatory response can significantly disrupt blood flow during pregnancy, making surgical correction difficult due to unclear margins and compromised blood supply. Fortunately, new IVF protocols provide a means to reduce the effects of adenomyosis for women aiming to conceive.

Doctors also use different systems to classify endometriosis. The most common one ranks it from 1 to 4. Others describe it based on the location and depth of the lesions, or simply as mild, moderate, or severe. Typically, if organs are involved, it’s classified as severe.

However, the severity of endometriosis doesn’t always match the symptoms. As mentioned previously, some with mild endometriosis may have severe symptoms, while others with severe cases might have few symptoms. Understanding how symptoms affect a patient’s comfort is crucial for personalized treatment.

Endometriosis and Fertility

Getting pregnant can be more difficult for those with endometriosis, particularly when symptoms are severe. While not everyone will experience fertility issues, it's a relatively common complication. Studies suggest that 30%-50% of women with endometriosis may face difficulty conceiving.

Endometriosis can affect fertility in various ways, including:  

• Pelvic anatomy changes: The growth of endometrial tissue can alter the structure of the reproductive organs.
• Adhesions:  These sticky bands can form between organs, disrupting normal function.
• Fallopian tube scarring:  Scarring can block the tubes, preventing the egg from traveling to the uterus.
• Pelvic inflammation: Inflammation can create an environment that is hostile to pregnancy. 
• Immune system changes: Endometriosis can alter the immune system's response, making it harder for a fertilized egg to implant.  
• Hormonal environment shifts:  The disease can affect hormonal balance, making it difficult to maintain a healthy pregnancy. 
• Pregnancy implantation challenges:  The abnormal tissue can interfere with the implantation of a fertilized egg in the uterus.
• Changes in egg quality:  Endometriosis can impact the quality of eggs, making it harder to conceive. 

Endometriosis and Treatment

Endometriosis occurs when the body fails to eliminate endometrial cells outside the uterus. And just like autoimmune diseases such as rheumatoid arthritis, there’s no cure for endometriosis. So what’s the best path for treatment?

Our own Dr. Paul Brezina frequently describes endometrial cells like a lawn. You can mow it to reduce its size, but it will grow back. Similarly, surgery can reduce endometriosis but not eliminate it. 

Cutting off the lawn’s water supply makes the grass brown and stops its growth. This is how most medical treatments for endometriosis work—they limit exposure to estrogen. Treatments include birth control pills, progesterone-releasing IUDs, and medications like Orilessa and Lupron. However, stopping these treatments allows the endometriosis to return, and they often prevent pregnancy by stopping ovulation.

Letting the grass grow normally with water is like having natural cycles while trying to conceive. Each month, endometrial cells grow and bleed, causing inflammation and damage.

Removing the sod entirely is like a hysterectomy, which removes the problem but isn’t an option for women wanting to maintain fertility.

In Vitro Fertilization (IVF)

In Vitro Fertilization (IVF) is a top treatment for severe endometriosis cases. By extracting eggs directly from the ovaries, IVF minimizes the impact of the inflammatory environment. Embryos are grown in a lab, away from inflammation, and medical suppression creates optimal conditions for implantation. While IVF doesn’t cure endometriosis, it’s the best option for achieving pregnancy.

Consult our Fertility Care Experts

At Fertility Associates of Memphis, we're dedicated to providing compassionate care for women with endometriosis. We know the journey can be challenging, and we're here to support you every step of the way. If you’ve been trying to conceive for a year without success, it’s time to see a fertility specialist. For women ages 35 to 39, seek help after six months. Women aged 40 and older should get help immediately. Early intervention is key, as fertility declines with age.

If you have irregular periods, pelvic pain, or suspect endometriosis, consult a specialist sooner. These issues can affect fertility and need expert evaluation. Our board-certified doctors specialize in endometriosis and fertility treatments. They will assess your situation, offer personalized advice, and create a tailored treatment plan. Contact us to schedule your appointment.

This information is for educational purposes only and not medical advice. Please consult a fertility expert for personalized recommendations.