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I've (had)endo, as is typical, unknowingly for years till diagnosed, and would gladly share all I have learned from the research I've done & the treatment experience I've had. There's so much press & education out there about breast cancer & other conditions yet more women go undiagnosed or undertreated with endo than almost all other diseases. It can be painful & disabling, yet many in the medical profession are quite ignorant about it. Much more organization & education is needed to improve care for women with endometriosis. Just to take one aspect of endo, not even the most serious but certainly very common - The millions, billions even of menstual cramps women endure could be drastically reduced if there was more attention & concern given to this disease. When I was finally treated properly by a true endo specialist, I stopped that cycle of pain & haven't had a menstrual cramp since!

I've been diagnosed with stage four endometriosis. Can you explain the different stages and different treatments for each stage?
Thank you!

Hi, Angelica. What a pain! Literally!

I dealt with endometriosis for the better part of a decade or so, I'd say. I'm glad you're seeing a doctor for it. Have you already had any procedures or treatment? Or are you at the very beginning? And might I ask how old you are, and if fertility is an issue for you? Are you having a lot of cyclical pain?

The stages in endometriosis are based on how many places you have the tissue growing, and how much is there, and where it is. Here's how the Merck Manual defines each stage:

Stage I -- Minimal
A few superficial implants

Stage II -- Mild
More and slightly deeper implants

Stage III -- Moderate
Many deep implants, small endometriomas on one or both ovaries, and some filmy adhesions

Stage IV -- Severe
Many deep implants, large endometriomas on one or both ovaries, and many dense adhesions, sometimes with the rectum adhering to the back of the uterus

Treatment depends partially on whether your goal is simply relief from pain and other symptoms, or whether you're trying to get pregnant. Non-steroidal anti-inflammatory medicine can be given to control the cramps and related pain. If getting pregnant is not an issue, drugs can be given to suppress the ovarian function -- birth control pills are one example -- but of course if pregnancy is a goal, that's not a good option. Your doctor can do microscopic or laparoscopic surgery to go in and remove the endometriosis; this provides a lot of symptomatic relief and gives you a better fertility window, but endometriosis often grows back. After a surgical procedure to remove all the lesions, fertility rates usually are between 40% to 70% depending on how severe it was.

Let me make sure you've seen our Empowher page on endometriosis:

http://www.empowher.com/media/reference/endometriosis

Here's the Merck page on endometriosis:

http://www.merck.com/mmpe/sec18/ch247/ch247a.html

And this page goes into a little more detail about each of the medicines and/or hormonal options that are available:

http://www.womenshealthcaretopics.com/living_with_endometriosis.htm

Usually, especially if a woman wants to become pregnancy, she and her doctor will use a combination of treatments -- medicine, surgery and possibly fertility treatments once the endometriosis has been surgically removed and before it grows back. Pregnancy actually sends the endometriosis into retreat, as does menopause later in life.

What is your doctor recommending as a course of treatment?