At Maiden Lane Medical in Manhattan, NY, our expert team specializes in diagnosing and treating all forms of endometriosis. Whether you are experiencing mild symptoms or struggling with severe pain, our specialists provide compassionate, effective care. If you suspect you may have endometriosis, contact us today to schedule a consultation.
What Are the Different Endometriosis Stages?
The American Society of Reproductive Medicine (ASRM) developed a classification system to describe the four stages of endometriosis. These stages are based on the location, depth, number, and size of endometrial implants, adhesions, and ovarian cysts (also known as chocolate cysts or ovarian endometriomas).
Stage 1
Minimal with few superficial growths
Stage 2
Mild with slightly deeper growths and filmy adhesions
Stage 3
Moderate with many deep growths, some small ovarian cysts, and dense adhesions
Stage 4
Severe with many deep infiltrating growths, large ovarian cysts, very dense adhesions, and multiple organs glued to each other
- Stage I – Minimal Disease
Involves a few small superficial implants on the peritoneal tissue without significant scar tissue. Symptoms may be mild, but endometriosis pain can still be present. - Stage II – Mild Disease
Patients may have more implants that are deeper than in stage I. These may be found in the fallopian tubes, the ovaries, behind the uterus, or in the tissue lining the pelvis. - Stage III – Moderate Disease
Women with moderate endometriosis often have many growths, small cysts on one or both ovaries, and dense adhesions that affect the fallopian tubes or reproductive organs. Fertility problems are common. - Stage IV – Severe Disease
The most advanced stage includes many deep implants, large cysts on one or both ovaries, multiple adhesions, or a frozen pelvis where the reproductive organs are bound together by thick adhesions. This is often referred to as severe endometriosis and typically causes severe pain and fertility issues.
It’s important to note that the stages of endometriosis don’t always reflect the intensity of a patient’s endometriosis symptoms. Some women with minimal disease may experience debilitating pain, while others with advanced disease may have only mild symptoms.
What Are the Categories of Endometriosis?
Beyond stages, doctors also classify types of endometriosis based on how and where the disease develops:
- Superficial Peritoneal Endometriosis: The most common form, where endometrial implants grow on the surface of the pelvic cavity.
- Ovarian Endometriomas (Chocolate Cysts): Cysts filled with old blood that develop on one or both ovaries. These can cause severe pain and fertility issues.
- Deep Infiltrating Endometriosis (DIE): This involves deep endometrial implants that penetrate organs such as the bowel, bladder, or deeper layers of the pelvic wall. Patients with deeply infiltrating endometriosis often have severe pain, especially during bowel movements or their menstrual cycle.
- Abdominal Wall Endometriosis: Rarely, endometrial tissue implants into scars from surgeries like C-sections. This form may cause abdominal pain around the scar.
Each type can exist in different stages of endometriosis, making diagnosis and treatment highly individualized.
How Do I Know What Stage or Type of Endometriosis I Have?
Diagnosing endometriosis begins with a thorough evaluation. At Maiden Lane Medical, we use a combination of tools, including:
- Medical history and symptom review: Symptoms such as pelvic pain, abdominal pain, painful menstrual periods, or discomfort during bowel movements may suggest symptomatic endometriosis.
- Pelvic exam: While not always conclusive, this can detect larger cysts or thick adhesions.
- Imaging tests: Ultrasound and MRI can reveal ovarian cysts and deep infiltrating endometriosis.
- Laparoscopy: The gold standard for endometriosis diagnosis, allowing direct visualization and biopsy of endometriosis tissue.
Only laparoscopy can definitively stage endometriosis according to the revised American Fertility Society system, which remains the clinical standard.
What Happens if Endometriosis is Left Untreated?
Untreated endometriosis can worsen over time, leading to:
- Progression from minimal or mild disease to moderate or severe disease
- Development of ovarian cysts, chocolate cysts, or frozen pelvis
- Increased risk of infertility due to damage to the fallopian tubes or reproductive organs
- Persistent endometriosis pain that impacts quality of life
- Adhesions bind organs together, making endometriosis surgery more complex
For some women, untreated disease may lead to worsening abdominal pain, heavy bleeding, and disruption of normal menstrual cycles.
Are the Treatments Different for Each Stage or Type of Endometriosis?
Yes. Endometriosis treatment often depends on whether a patient has minimal or mild disease versus moderate or severe disease and what type of endometriosis is present.
Medical Treatments
Medical treatments may include the following:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain
- Hormonal therapy (such as birth control pills, hormonal IUDs, or injections) to suppress menstrual cycles and manage symptoms
- Medical therapy with stronger hormone regulators for more severe disease
Surgical Treatments
Surgical treatments may include the following:
- Endometriosis surgery may involve removing endometrial implants, ovarian endometriomas, or dense adhesions.
- In severe cases, surgery can restore fertility by clearing the fallopian tubes or preserving reproductive organs.
Fertility Options
For women with infertility related to endometriosis, in vitro fertilization (IVF) may be recommended, especially in cases of severe stage disease or when medical treatments fail.
Each treatment plan is personalized. At Maiden Lane Medical, our specialists work closely with patients to manage symptoms, preserve fertility, and improve quality of life.
Managing Endometriosis for Long-Term Relief
Whether you’re dealing with superficial peritoneal endometriosis, deep infiltrating endometriosis, or advanced stage IV disease, it’s important to remember that effective treatment is available. A combination of hormonal therapy, medical treatments, and sometimes surgery can help manage symptoms and preserve reproductive health.
Take Control of Your Endometriosis Today
Living with endometriosis can be overwhelming, but you don’t have to face it alone. At Maiden Lane Medical, our experienced team is here to help you navigate your options, whether that means medical therapy, hormone therapy, or advanced endometriosis surgery.
If you’re struggling with pelvic pain, severe menstrual cycles, or infertility, schedule a consultation today in NYC. The first step toward relief and long-term health is understanding your diagnosis and getting the right care. Contact us to begin your journey toward pain relief and improved well-being.