The Stages of Endometriosis

 By Kyle J. Norton


During the last stage of the menstrual cycle, normally a layer of endometriosis lining on the inside of the uterus is expelled, known as menstruation blood, instead some of the endometriosis tissues grow somewhere in the body to cause endometriosis. Endometriosis also react to hormone signals of the monthly menstrual cycle, by building and breaking up tissues and eliminating them through menstrual period.
Endometriosis affects 
a) About 20% of reproductive age women with endometriosis present but without symptoms.
b) About 55% of women who have developed the new onset of severe menstrual cramps
c) About 25% of women with sub-fertility (less fertile than a normal couple), depending to the stages of endometriosis, according to the Clinical Center of Niš, the decreased fertilization rate in Stage I/II endometriosis might be a cause of subfertility in women, as a result of a hostile environment caused by the disease.
Since they grow in somewhere other than in the uterus, when they break there is no way for the period blood to exit causing blood attaching to the organs or lining of the abdomen resulting in scars or adheresion as well as weakening the normal function of organs.
Most of the time, the endometriosis tissues do not travel far. It is commonly found within the pelvic region, on the lining of peritoneum, in the ovaries, and on the surface of the uterus's outside wall, but they can be anywhere in the body such as well as fallopian tubes, the cervix, the vagina, and even the vulva.
Endometriosis can vary in appearance. It may be clear or white, reddish, brown or blue black, and cysts. They can be classified according to stage of severity(1):
a) Minimal stage:
Top surface, few in number. Commonly they are found in the inside wall of uterus, ligaments and ovary, causing a significant reduction in both progesterone and its ratio with 17 beta-oestradiol and luteal dysfunction and abnormal secretory patterns(3), in women with minimal stage endometriosis, of that may leads to unexplained causes of infertility(2). 


 b) Mild stage:
Deeper implants, greater numbers are presented. Commonly found in the same area as minimal stage, causing worsening of oocyte quality of women with mild stage of endometriosis of that may lead to infertility(4).

 c) Moderate stage:
Many implants, endometrial cysts present, affecting ovary function, causing scar tissues and adhesion is also present.
d) Severe stage:
Intensive peritoneal implants, large endometromas present and dense adhesion.
Each women experiences differently to endometriosis. Some women may have extensive endometrial tissues in their body but feel little or no pain at all, while other women may only be in the early stage of endometriosis but have excessive pain, according to the ¹I Katedra i Klinika Ginekologii Onkologicznej i Ginekologii Uniwersytetu Medycznego w Lublinie, in the advanced stage of endometriosis, Increased peritoneal fluid ox-LDL levels observed in women with advanced-stage endometriosis suggest the important role of oxidative stress in the pathogenesis of the disease(5). The University of California-San Francisco (UCSF),  suggested that genetic microRNA 21 (MIR21) and DICER1 transcripts may play important roles for microRNAs (miRNAs) in the pathogenesis of severe versus mild endometriosis, potentially through regulation of gene silencing and epigenetic mechanisms(6).


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References
(1) Stages of endometriosis: Does it affect in vitro fertilization outcome by Pop-Trajkovic S¹, Popović J², Antić V², Radović D², Stavanovic M², Vukomanović P².(PubMed)
(2) Mid to late luteal phase steroids in minimal stage endometriosis and unexplained infertility.

Barry-Kinsella C¹, Sharma SC, Cottell E, Harrison RF(PubMed)

(3) Cyclical gonadotrophin and progesterone secretion in women with minimal endometriosis by Williams CA, Oak MK, Elstein M.(PubMed)

(4) Follicular fluid from infertile women with mild endometriosis may compromise the meiotic spindles of bovine metaphase II oocytes by Da Broi MG¹, Malvezzi H, Paz CC, Ferriani RA, Navarro PA(PubMed)

(5) [Increased oxidized LDL cholesterol levels in peritoneal fluid of women with advanced-stage endometriosis] [Article in Polish] by Polak G¹, Mazurek D, Rogala E, Nowicka A, Derewianka-Polak M, Kotarski J(PubMed)

(6) Molecular evidence for differences in endometrium in severe versus mild endometriosis by Aghajanova L¹, Giudice LC(PubMed)