Stages of the Disease

Your surgeon can determine the extent and severity of your disease once surgical diagnosis is made through both sight of the lesions and biopsy results. Staging has been defined by the American Society for Reproductive Medicine  (formerly the American Fertility Society), with criteria based on the location of the disease, amount, depth and size. These factors are graded on a point system and classification is determined. The first classification scheme was developed in 1973, but since then it has been revised and refined three times for a more precise method of documentation. Currently, stages are 1 though 4: minimal, mild, moderate and severe.

The stage of disease is not indicative of pain level. Staging was fundamentally developed as an indicator of Endometriosis-associated infertility, and has no specific correlation to any symptoms. A woman in Stage 4 can be asymptomatic, while a Stage 1 patient might be in debilitating pain. As such, staging criteria may be of less significance than Dr. Seckin’s “Triad of Endometriosis.”

The Triad of Endometriosis

The “Triad” represents the three different forms of the disease that must be considered: peritoneal disease, deeply infiltrating rectovaginal Endometriosis and ovarian endometriomas. Though different, they are not altogether clinically distinct, and the pathophysiological mechanisms involved in all remain poorly understood.

Peritoneal Disease

Early peritoneal disease may be asymptomatic or silently progressive. Early Endometriosis typically occurs on the lining of the organs in the pelvic and intra-abdominal areas (peritoneum). Even this early-onset disease is associated with increased immune system activity, and the lesions are very hormonally active. These particular implants cause chronic recurrent bleeding and inflammation, which can ultimately lead to fibrosis (thickening and scarring of the areas affected). This early yet active form of disease is commonly found in younger patients, and can explain why the disease may be viewed as so aggressive in teens and adolescents.

Deep Infiltrating Endometriosis

Another form, Deep Infiltrating Endometriosis (often called “DIE”), is a highly invasive form often characterized by rectovaginal (the space between the vagina and rectum) nodules and disease of the uterosacral ligaments, rectum, rectovaginal septum, vagina and bladder. This significant and severe form of Endometriosis is strongly associated with high levels of pelvic pain, anatomic distortion, infertility, dysuria, dysmenorrhea, dyspareunia, and gastrointestinal distress, which may include “irritable bowel” type symptoms.

Ovarian Endometriomas

The last form is Ovarian Endometriomas. These are highly common and may present in up to 30-40% of women with the disease. Endometriomas are large, fluid-filled cysts that form on and may even encapsulate the ovaries. These sizable cystic masses are comprised of menstrual debris, including fragments of endometrial tissue, thickened blood and inflammatory enzymes. These so-called "chocolate cysts", aptly named for the appearance of the "old" blood they contain, may acutely rupture, causing spillage and adherence of their contents to the walls and nearby organs within the abdominal cavity. They can cause excruciating abdominopelvic pain.

All forms of Endometriosis can be associated with significant pain, infertility and interruption of a woman or girl’s ability to go about her normal routine. Early intervention is the key to effectively resolving this disease.