Endometriosis: Progression and Treatment

Let’s continue our look at endometriosis, a complicated disease that is not always fully understood but which can have a serious impact on your ability to conceive. How is the disease categorized? How does it affect fertility? And what are some possible treatment options?

Stages of Endometriosis

Endometriosis progresses through four stages, differentiated by the amount and location of endometrial tissue outside the uterus. Three particular kinds of tissue are used to diagnose the current stage of the disease:


  • Endometrial implants are the basic sign of the disease, endometrial tissue growing throughout the pelvic area.
  • Endometrioma is a cyst caused when endometrial tissue grows on the ovaries.
  • Adhesions are scar tissue that forms due to inflammation, which can be caused by endometriosis as well as arising as a complication of surgery.


The stages are tracked by the presence and amount of each of these types of tissue:


  • Stage I, or minimal, features a few endometrial implants and minimal adhesions.
  • Stage II, or mild, sees more implants forming deeper throughout the pelvis but still has minimal adhesions.
  • Stage III, or moderate, features many deep implants, some endometriomas on the ovaries, and more noticeable adhesions.
  • Stage IV, or severe, is defined by many endometrial implants, large cysts on the ovaries, and dense adhesions.


While a patient’s stage of endometriosis is defined by these tissues, their symptoms are not necessarily tied to the stage. Pain, heavy bleeding, fertility problems, and the various other symptoms of endometriosis can vary greatly from one patient to another, even for those in the same stage.

Effects of Endometriosis on Fertility

When looking at infertility as a symptom of endometriosis, no direct scientific link has been made between the minimal and mild stages and a decreased fertility rate. While 30-40% of infertile women have endometriosis, most women with the disease are not also infertile.

The connection is stronger with moderate and severe endometriosis, as the presence of more and deeper tissue — and especially endometriomas on the ovaries — can lead to structural issues that impair ovulation and conception. While some studies show that treatment of severe endometriosis has a greater chance of improving fertility than simply doing nothing, the fertility rate for these patients remains as low as 1-2 per month.

Treatment Options

The main treatments include medications and surgery. Since the primary treatable symptom is the pain, many doctors will begin by prescribing over-the-counter pain relievers. Typically, these will be non-steroidal anti-inflammatory drugs like ibuprofen and naproxen.

Hormone treatments can slow or stop the growth of endometrial tissue outside of the uterus. The simplest of these are hormonal contraceptives like the birth control pill, which can help control pain, especially during menstruation. Other hormone treatments can slow the growth of endometrial tissue. But all hormone therapies will disrupt a woman’s menstrual cycle and definitely impair fertility.

To preserve your fertility options, you may need surgery to remove endometrial implants and other tissue. Such procedures may be performed laparoscopically or with more traditional abdominal incisions. Surgery is often necessary if the pain from endometriosis is too severe for painkillers alone.

You should consult with your doctor to determine what treatment options are right for you. If you are trying to get pregnant, understand that surgery may be recommended, and it may be followed by a course of hormone therapy for several months.

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