2 April 2024

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Here’s the four stages of endometriosis

Dr Ujvala Rao

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Dr Ujvala Rao

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Affecting 1 in 7 Australian women, and millions more worldwide, Endometriosis is an invisible yet chronic disease that brings with it several stages of progression.

Some women, such as Big Miracles' Ilina (who has severe endometriosis), liken the condition to having barbed wire dragged across their lower abdomen, with the pain impacting every aspect of their lives – this often prohibits ability to attend work, socialise and complete basic everyday tasks. Though achieving a diagnosis can offer relief and validation for the person, the definitive diagnosis usually requires a surgical procedure known as laparoscopy. At the time of undergoing this surgery, it is possible to assess the stage of endometriosis. Let's delve into the four stages of endometriosis, shedding light on what they mean for us, our symptoms, and our path to wellness. It is important to note that the severity of symptoms caused by endometriosis doesn’t always correlate with the stage of the disease - it is possible to have severe symptoms associated with the finding of minimal endometriosis on laparoscopy.

Stage I: Minimal Endometriosis

Stage I, also known as minimal endometriosis, is where our journey may begin. Here, we might encounter small patches of endometrial tissue scattered within our pelvic cavity. While symptoms may be subtle, we might experience mild pelvic discomfort or menstrual pain. Diagnosis often involves a laparoscopic approach, and treatment options abound, from pain management to gentle hormonal therapies, guiding us towards relief and empowerment. Symptoms of minimal endometriosis may be mild or absent altogether, making diagnosis challenging in some cases.

Common symptoms associated with Stage I endometriosis may include:

• Mild pelvic pain or discomfort, particularly during menstruation

• Dysmenorrhea (painful periods)

• Occasionally, pain during intercourse (dyspareunia)

• Infertility (in some cases)

Stage II: Mild Endometriosis

As we progress to Stage II, our journey gains momentum. Endometrial implants may become larger, affecting multiple pelvic organs such as the ovaries, fallopian tubes, and pelvic sidewalls. Pelvic structures may witness more significant involvement. With moderate pelvic pain as our companion, our toolkit expands to include a variety of strategies, from hormonal support to surgical interventions, paving the way for brighter days and improved fertility prospects.

Symptoms associated with Stage II endometriosis may include:

• Moderate pelvic pain, especially during menstruation and ovulation

• Increased frequency of dysmenorrhea and pelvic discomfort

• Intermittent pain during intercourse

• Heightened risk of infertility due to pelvic adhesions and distortion of anatomy

Stage III: Moderate Endometriosis

Stage III signals a deeper dive into our journey. Extensive involvement of pelvic structures may present formidable obstacles with formation of significant adhesions and scar tissue. Severe pelvic pain may test our resolve as the disease might begin to deeply infiltrate pelvic organs, leading to distortion of anatomy and increased severity of symptoms. Gastrointestinal symptoms may also join the fray. Laparoscopic exploration is indicated for this stage, leading to targeted interventions that restore hope and vitality.

Symptoms associated with moderate endometriosis may include:

• Severe pelvic pain, often debilitating in nature and impacting daily activities

• Chronic pelvic discomfort throughout the menstrual cycle

• Persistent dysmenorrhea and dyspareunia

• Increased prevalence of gastrointestinal symptoms such as bloating, constipation, or diarrhoea

• Elevated risk of infertility due to compromised ovarian function and tubal occlusion

Stage IV: Severe Endometriosis

In Stage IV, our journey reaches its zenith – but so does our strength. Extensive pelvic involvement may pose profound and debilitating challenges like extensive pelvic involvement, significant adhesions, and organ dysfunction. Excruciating pain is common with this stage of disease while endometrial implants may infiltrate vital structures such as the bladder, bowel, and ureters, leading to functional impairment. Surgical evaluation becomes our beacon of hope, guiding us towards tailored treatments that honour our journey and preserve our vitality.

Symptoms associated with severe endometriosis may include:

• Excruciating pelvic pain, often refractory to conventional treatments

• Chronic fatigue and malaise

• Bowel and bladder dysfunction, including urinary frequency, urgency, and bowel obstruction

• Severe dysmenorrhea and dyspareunia, significantly impacting quality of life

• High likelihood of infertility due to severe pelvic adhesions and compromised reproductive function

Endometriosis encompasses a spectrum of disease severity, ranging from minimal to severe, each with its unique clinical manifestations and implications for treatment and fertility. Endometriosis is more than a diagnosis; it's a journey of courage, resilience, and empowerment. Together, we navigate its twists and turns, supporting each other every step of the way. With unwavering support, advocacy, and understanding, we illuminate the path towards healing and empower future generations of endometriosis warriors.

If you have an endometriosis diagnosis (or suspect you may have it) and are having a hard time falling pregnant, please feel welcome to give us a call on 1800 041 839 to book a consult with a specialist.

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