4 Endometriosis Stages: How They Are Determined and What Each One Means

Heavy periods with lots of cramps. Uncomfortable sex. Sharp, stabbing pains. Constant exhaustion.

Does any of this sound familiar to you? Then you may be one of the 190 million women worldwide suffering from endometriosis.

You may have heard that there are different stages of this disease, but you’re not sure which one you have or how that is determined.

We’ll explain what each endometriosis stage is and how they are determined, plus give you a run-down on how all stages of the condition can be treated — including some suggestions about ways you can help heal yourself naturally.

endometriosis stages

Table of Contents

How Are Endometriosis Stages Determined? 

The pain from endometriosis can bring you to your knees at times. Does that mean you have stage 3 or 4 of the condition?

Not necessarily.

The different stages of endometriosis aren’t determined by the amount of pain it causes you. Rather, when testing for endometriosis, doctors use a point system to classify it from stage 1 to stage 4.

Endometriosis stages are determined based on:

  • Where endometrial tissue grows in the body
  • How far it has spread; and
  • How much and what type of tissue is in each area

A more advanced stage of endometriosis doesn’t always mean you’ll have worse pain or more severe symptoms. Some women can have stage 4 endometriosis and not even feel it, while others may have stage 1 of the condition and experience severe pain.

My diagnosis of stage 4 endometriosis — which I can assure you came with a great deal of pain — is part of what inspired me to create Chiavaye. It was developed with women in mind and can be a great tool to relieve sensitive skin after a surgical procedure or a tough monthly cycle.

Let’s take a closer look at how the stages of endometriosis are classified.

what are the stages of endometriosis

Most Common Endometriosis Staging Method: ASRM’s Point System

Most doctors use the numerical scale system created by the American Society for Reproductive Medicine to evaluate the different stages of endometriosis. The stages range from 1 through 4 and are determined by assigning points based on the characteristics of the disease.

Other methods that may be used to determine endometriosis stages include:

  • ENZIAN classification system – This is used to supplement the ASRM system and uses MRI to grade the severity of invasiveness.
  • Endometriosis Fertility Index (EFI) – This scale was developed to predict the fertility rate of endometriosis patients.
  • Endometriosis Foundation of America descriptive categories – These classify the disease based on its anatomical location.

Key Endometriosis Terms To Understand Regarding ASRM Staging

When using the ASRM staging system, doctors may discuss endometriosis implants, endometrial adhesions, and ovarian endometriomas. Let’s explore what each term means so you’ll understand the context when you see them again.

Endometriosis Implants

Endometriosis typically begins with endometrial cells growing, or implanting, in other parts of the body besides the uterus where they are normally found. These implant lesions are usually small and flat. 

They can be found anywhere in the body but are most often on or near the ovaries, on the fallopian tubes, or behind the uterus.

Endometrial Adhesions

These clusters of fibrous bands are scar tissue that forms as part of an inflammatory process or in response to surgery used to diagnose and treat endometriosis. 

They can bind body parts (typically the abdominal and pelvic organs) together. 

Ovarian Endometriomas

These blood-filled cysts (also called chocolate cysts because they eventually turn brown) grow on the ovaries as endometrial cells spread there.

As endometrial tissue sheds during menstruation, it collects into the cyst along with old, thick blood, causing the cyst to grow larger and larger over time.

How Endometriosis Points Are Assigned 

Since endometriosis doesn’t usually show up on diagnostic imaging scans such as a CT or ultrasound, the only way for a doctor to officially confirm the diagnosis is to perform endometriosis surgery and look inside the abdomen and pelvis.

As the doctor examines the lesions, they’ll take note of things like appearance, depth, and color. Then they’ll assign points based on those characteristics to determine what stage of endometriosis the patient falls under.

endometriosis stages

What Are the Stages of Endometriosis? 

The stages of endometriosis range from 1 (minimal evidence of the disease) to 4 (severe evidence of the disease). Women at any stage of endometriosis may experience symptoms, which can include:

  • Infertility
  • Heavy or irregular periods
  • Painful menstrual cramps spreading into the lower back or abdomen
  • Pain during or after sexual intercourse
  • Diarrhea or constipation during your period
  • Pain while using the bathroom during your period
  • Blood in the stool or urine
  • Bleeding or spotting between periods
  • Low energy or fatigue

Let’s break down how points are assigned to determine the different stages of endometriosis.

Stage 1 Endometriosis: Minimal

Endometriosis that amasses from 1 to 5 points on the ASRM scale is classified as stage 1, or minimal.

Stage 1 is used to describe cases where:

  • Endometrial growths are few in number, small, and superficial
  • Growths appear on organs or tissue lining the abdominal cavity and pelvis
  • Scar tissue is nonexistent or minimal

As we said previously, stage 1 endometriosis does not mean that the patient won’t experience symptoms or that the disease won’t have a big impact on everyday life.

Stage 2 Endometriosis: Mild

Endometriosis that amasses from 6 to 15 points on the ASRM scale is classified as stage 2, or mild.

Stage 2 is used to describe cases where:

  • There are more endometriosis implants than in stage 1
  • Implants are deeper than in stage 1
  • Scar tissue may be present, but there are no signs of active inflammation

Stage 3 Endometriosis: Moderate 

Endometriosis that amasses from 16 to 40 points on the ASRM scale is classified as stage 3, or moderate.

Stage 3 is used to describe cases where:

  • Many deep endometrial implants are present
  • There are cysts (ovarian endometriomas) in or on at least one ovary
  • Filmy adhesions may be present

This is the first stage where adhesions are present. Adhesions often make organs stick together which can lead to sharp, stabbing pains. 

Adhesions can cause other problems as well. For instance, they can create GI issues like nausea when found on the bowels or they can make it harder to get pregnant when they appear on reproductive organs.

Stage 4 Endometriosis: Severe

Endometriosis that amasses more than 40 points on the ASRM scale is classified as stage 4, or severe.

Stage 4 is used to describe cases where:

  • The adhesions are extreme
  • There are many cysts

Some ovarian cysts go away on their own, but those that form because of endometriosis usually need surgical removal. These cysts have been known to grow as large as the size of a grapefruit.

There may also be small cysts on the back wall of the uterus and rectum in stage 4 endometriosis. This can lead to:

  • Abdominal pain
  • Nausea
  • Vomiting
  • Constipation; and
  • Painful bowel movements

If lesions, scar tissue, or cysts block one or both of the fallopian tubes, they may cause infertility. Despite stage 4 endometriosis being the most severe, some women have it and the only symptom they experience is trouble conceiving.

different stages of endometriosis

How To Treat All Endometriosis Stages 

The stage number of endometriosis doesn’t usually affect treatment type since most women seek medical help based on the symptoms of their condition. There is no cure for endometriosis, but it can be controlled with the following treatments.

Pain Medication

Your doctor may recommend over-the-counter NSAIDs such as ibuprofen and naproxen. If your pain is more severe and doesn’t respond to these, you may need prescription pain meds along with exploring other types of treatment. 

Hormone Therapy

Hormone therapy lowers the amount of estrogen present in your body. It can stop your period and also helps lesions bleed less. This helps prevent scarring, inflammation, and cyst formation.

Your doctor may prescribe:

  • Combination estrogen and progestin birth control pills, vaginal rings, or patches
  • Progestin-only birth control pills
  • Danazol, a hormone-decreasing oral medication used to treat pelvic pain and infertility caused by endometriosis
  • Gonadotropin-releasing hormone (GnRH) medications such as Lupron, Trelstar, and Eligard

These types of treatments come with risks, though. Oral contraceptives are known to cause an increased risk of breast cancer and cardiovascular issues. 

And GnRH medications mimic the effects of menopause, leading not only to side effects such as hot flashes and vaginal dryness but also to the risk of bone thinning.


If you’re experiencing infertility or a lot of pain, your doctor will perform surgery (usually laparoscopically) to remove as much of the affected tissue as possible. Endometrial tissue may continue to grow and cause pain even after surgery.

With severe endometriosis, a full or partial hysterectomy may be recommended.

Lifestyle Changes

Through my personal struggle with endometriosis — including multiple surgeries — and listening to other women I learned that holistic healing can take place through non-traditional medicine.

Did you know that what foods you eat can be a big factor in how your body responds to endometriosis? It’s true! Studies have shown that some foods actually cause inflammation for women with endo, so avoiding them can help with the symptoms.

Besides eating right, managing stress and exercising can also help diminish your endometriosis symptoms. And, of course, you should try your best to only use all-natural products such as Chiavaye in and on your body.

Chiavaye: An All-Natural Lube Created for Those Suffering With Endometriosis 

Endometriosis often leaves women with:

  • Intense pain
  • Excruciating periods
  • Skin irritation
  • Fluctuations in vaginal flora and dryness
  • Painful sex
  • Inflammation; and even
  • The inability to participate in everyday activities

Chiavaye was created as an all-natural lube and skincare product to help women combat these symptoms and feel like themselves again.

Chiavaye is vegan, hypoallergenic, and has only six natural ingredients. It is the perfect product for helping women suffering from endometriosis retain moisture and ease burning, discomfort, or pain during intercourse (or any other time you need a little extra help).

Visit our shop and see for yourself why so many endometriosis patients swear by Chiavaye.

endometriosis stages

The content in this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

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