Endometriosis: What are the Types and Stages?

With one in ten women experiencing endometriosis during the ages 16-49, it’s important that you are aware of the signs, symptoms and potential issues that can arise with this condition. Many women may not recognise that abnormal periods, menstrual cramps and pelvic pain can be signs of endometriosis and can often go untreated.

What is endometriosis?

Endometriosis occurs when the cells that are found in the uterine lining (endometrium) are found outside of the uterus on other tissues and organs, such as the ovaries, bladder and bowel. Because the cells can not shed and leave the body the same way the endometrium can, they can result in scarring and cysts that can be both painful and harmful to women.

The most common signs of endometriosis are:

  • Abnormal periods, including heavy bleeding, strong cramps before and during your period and spotting
  • Pain during intercourse and pain defecating
  • Pain and fullness in the lower abdomen
  • Pain in the pelvis, rectum or vagina

If you experience these symptoms, we advise you speak to your GP to check for the possibility of endometriosis.

What are the types and stages?

There are two commonly used categorisations of endometriosis, with the ARSM stages using a points system to determine the stage and the Endofound Endometriosis Classification that has more descriptive categories to help understand the severity.

There are four types of endometriosis, determined in stages of severity, number of lesions and depth of infiltration. Note that the stage does not dictate the amount of pain that the patient experiences.

ARSM stages

Stage I (minimal) will have a few superficial implants and minimal manifestation.

Stage II (mild) has more implants that are deeper than stage I.

Stage III (moderate) will have a number of deep implants, presence of filmy adhesions and will have small cysts on either one or both of the ovaries.

Stage IV (severe) is the most severe form with many deep implants, dense adhesions and large cysts on one or both of the ovaries.

Endofound Endometriosis Classification

Category I (peritoneal)

Minimal form of endometriosis where the membrane that lines the abdomen is infiltrated with endometriosis tissue.

Category II (ovarian)

Endometriosis is already established in the ovaries. Ovary cysts are at risk of breaking and spreading the tissue within the pelvic cavity.

Category III (Deep Infiltrating Endometriosis I)

The first form of endometriosis where various organs within the pelvic cavity are infiltrated. This includes the ovaries, rectum and uterus, and can severely impact the anatomy of pelvic organs.

Category IV (Deep Infiltrating Endometriosis II)

The most severe form of endometriosis involves organs both within the pelvic cavity and outside it, including the ovaries, uterus, rectum, diaphragm, appendix, heart and lungs.

Using tests, a doctor or specialist can determine the stage of endometriosis and propose appropriate surgery or treatment.

Speak to your doctor for more information

If you have any questions or concerns about pelvic pain or the possibility of endometriosis book an appointment with your GP. New can existing patients can contact Omni Gynaecare on 1300 851 968.

OMNI Ultrasound & Gynaecological Care

Condous performs Advanced Endosurgery procedures for women needing intervention for pelvic masses, adnexal pathology, severe endometriosis or hysterectomy. He also runs ‘Hands on’ Live Sheep Laparoscopic Workshops for gynaecologists at Camden Veterinarian School.
Having completed an undergraduate degree with the University of Adelaide, he left Australia in 1993 and moved to London where he completed his training in Obstetrics and Gynaecology. From 2001 to 2003 Condous worked as a Senior Research Fellow at St George’s Hospital, London. At St George’s he set up the Acute Gynaecology Unit, the first in the United Kingdom. It was also during this time that he developed an interest in Early Pregnancy and especially the management of pregnancies of unknown location (PULs). Condous has developed many mathematical models for the prediction of outcome of PULs which have been featured in numerous peer review journals. In 2005, he returned to Australia where he completed his Laparoscopic Fellowship at the Centre for Advanced Reproductive Endosurgery, Royal North Shore, Sydney.

Condous was appointed as a Consultant Gynaecologist and Senior Lecturer at Nepean Hospital in 2006 and soon was made Associate Professor. In 2010, he was made Departmental Head of Obstetrics and Gynaecology at Nepean Hospital. He obtained the MRCOG in 1999 and was made FRANZCOG in 2005. In 2009, he was awarded his Doctorate in Medicine (MD), University of London, for his thesis entitled: “The management of pregnancies of unknown location and the development of new mathematical models to predict outcome”.

Condous has edited three books including the “Handbook of Early Pregnancy Care”, published over 100 papers in international journals and is internationally renowned for his work in Early Pregnancy. He is the Associate Editor for Gynaecologic Obstetric Investigation, which is a European based journal, as well as the Australasian Journal of Ultrasound in Medicine (AJUM). He is on the organising committee and is an invited speaker at the International Society of Ultrasound in Obstetrics and Gynaecology (ISUOG) Scientific meeting in Sydney 2013. His current research interests relate to the management of ectopic pregnancy, 1st trimester growth, PULs and miscarriage and the use of transvaginal ultrasound (in particular sonovaginography, to predict posterior compartment deep infiltrating rectovaginal endometriosis).Condous is also actively involved with post-graduate education including the annual running of the Early Pregnancy and Gynaecological Ultrasound Interactive Courses for Sonologists, Radiologists, Sonographers and Gynaecologists in Australia.