What Causes Endometriosis? Current Theories & Evidence
Learn what causes endometriosis, how it grows, diagnosis options, current treatments, and holistic strategies to reduce symptoms and recurrence.
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Read moreStages & Progression
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Understand how endometriosis severity is staged and how it may change over time, with clear guidance on symptoms, fertility impact, monitoring, and evidence-based strategies to slow progression and tailor treatment.
Overview
Stages describe how widespread endometriosis is, not how much it hurts. The rASRM system labels stages I–IV based on implant number, size, and adhesions seen at surgery; it often underestimates deep lesions. For deep infiltrating disease, ENZIAN subtypes give a map of depth and organ involvement. Understanding stage helps anticipate surgical complexity and fertility impact, but it does not reliably predict pain severity or daily function. Imaging with targeted ultrasound or MRI can complement staging by showing where disease sits and how it may affect nearby organs.
Progression varies: some people remain stable for years, others develop adhesions, endometriomas, or deep disease. Factors like delayed diagnosis, ovarian cysts, and chronic inflammation may increase risk. Monitoring centers on symptom tracking, fertility goals, and focused reassessment with Ultrasound or MRI when decisions change. Strategies that may slow progression include continuous hormonal suppression, timely, expert Excision Surgery when indicated, and anti‑inflammatory lifestyle measures. Learn how stage informs treatment planning and fertility counseling, how progression is assessed over time, and which evidence‑based steps—from Medical Management to Anti-Inflammatory Diet and individualized planning within Fertility & Reproductive Health or Deep Infiltrating Endometriosis—can help protect quality of life and future goals.
What do stages I–IV actually measure?
Staging reflects the amount and location of disease and adhesions, mainly scored during laparoscopy. It does not capture nerve involvement, organ infiltration, or pain intensity, so a low stage can still cause severe symptoms. Deep disease is better characterized with ENZIAN and mapped by experienced MRI or Ultrasound teams.
Does endometriosis always get worse over time?
No. Many cases remain stable and some regress, especially with hormonal suppression; others progress, particularly with endometriomas or deep lesions. Regular follow‑up and timely adjustments in care help limit complications and preserve fertility.
Can medications stop progression or shrink lesions?
Hormonal therapies suppress ovulation and inflammation, often easing pain and sometimes reducing lesion activity or endometrioma size, but they do not eradicate disease and symptoms can return after stopping. They are useful to reduce new activity and recurrence risk as part of a tailored plan; see options in Medical Management.
When should imaging be repeated to monitor progression?
Routine scanning isn’t necessary if symptoms are stable. Repeat imaging is reasonable with new or worsening symptoms, fertility planning, or before surgery—Ultrasound for ovarian cysts and MRI for suspected deep disease—ideally with radiologists experienced in endometriosis.
How does stage affect fertility and treatment choices?
Higher stages (III–IV) with adhesions and endometriomas more often impair egg pickup and tubal function, but even early stages can affect fertility. Planning may include expert Excision Surgery to restore anatomy, expectant management, or assisted reproduction; explore pathways in Fertility & Reproductive Health and IVF & ART.