What Are The Stages Of Endometriosis?

pictures of different stages
How Is Endometriosis Staged?

Although doctors use a number of different classification systems to stage endometriosis, typically it is staged in four phases: minimum, mild, moderate and severe. The stage of disease does not necessarily indicate a severity of endometriosis symptoms, although it can be useful in predicating the chance of infertility in women. In order for a stage to be diagnosed, a laparoscopy (a procedure which allows surgeons to look directly inside the body) must be performed. Your doctor may initially use an ultrasound scan to rule out other causes, but only an exploratory laparoscopy (endometriosis diagnosis) can determine if endometrial growths are present and how widespread they are.

Stages Of Endometriosis

Stage 1: Minimum
Minimal endometriosis means that there are isolated implants found outside of the uterus (womb) but no significantly big adhesions. Your doctor may give you a score between 1 and 5 - this is a scoring system devised by the American Society for Reproductive Medicine (ASRM). The figure is determined by the size and depth of the endometrial implants, if they are present on the ovaries and peritoneum (tissue lining the abdominal wall), the amount of scar tissue around the ovaries and fallopian tubes and if an area of the pelvis called the cul-de-sac (where the cervix and top of vaginal meet) is blocked with scar tissue.

Stage 2: Mild
There are several small endometrial implants, less than 5cm in size present. There are also a few small areas of scar tissue (adhesions), which can affect fertility. Your doctor may give you a score between 6 and 15.

Stage 3: Moderate
There is obvious area of scar tissue and implants are widespread and deep. There may also be scaring around the fallopian tubes and ovaries. Typically patients who experience pain or other symptoms of endometriosis have stage 3 of the disease. However it is still possible to have stage 3 without symptoms, and for women with stage 1 of the disease to suffer severe pelvic pain. To a certain extent it depends where the implants are located. Sometimes scarring can cause the pelvic organs to stick together, so that normal pelvic functions become painful or impaired. Your doctor may give you a score of between 16 and 40.


picture of endometrial implants severe stage
Severe stage: note scar tissue has glued organs together and implants are widespread and large.
See our diagrams on the female body for a complete picture of the organs of the body.


Stage 4: Severe
Women with severe endometriosis have widespread implants which are thick and deep. There are also large ovarian endometriomas (particular type of cyst which grows on the ovaries, see ovarian cysts). Pelvic pain and infertility is very common in women with stage 4. Your doctor will give you a score of over 40.

If you suspect that you may be suffering from endometriosis it is important to consult your doctor. If it is untreated there is a risk that your autoimmune system will become depleted and unable to defend itself (increasing your risk of infections). This is one of the reasons (along with pain, heavy periods and infertility) why endometriosis treatment is so important. Research indicates a depleted immune system could make you more susceptible to other conditions like fibromyalgia, chronic fatigue syndrome (100 times more common in women with endometriosis) and rheumatoid arthritis. Your doctor will be able to recommend a suitable therapy, including alternative treatments for endometriosis.

Video Taping Your Exploratory Laparoscopy Procedure

Some clinics are now offering patients the chance to have their laparoscopic evaluation (or treatment) videotaped for their medical records. This is because the classification and staging system for endometriosis is constantly being refined and updated, and having a videotape of your procedure will allow doctors to 're-stage' your condition should the current classification system be changed.

Related Questions
• Prognosis and risks: Can endometriosis lead to cancer?
• Menstrual issues and irregular periods: Can endometriosis cause missed periods?
• Pregnancy complications and recurrent miscarriage: Can endometriosis cause miscarriages?
• Diagnostic Procedures: Can endometriosis be seen on ultrasound?

• Need more information? See: Guide to Endometriosis
• Got another question? See: Womens Health Questions

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