Stage 4 endometriosis is the final and most severe stage of this chronic condition. In stage 4, uterine tissue grows in many places throughout the body. Extensive adhesions are present, where scar tissue fuses organs together, such as the uterus and rectum or the ovaries and fallopian tubes.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ca812458-bb71-4e04-aeaf-76b30f1b1267e60dc2a1-f33c-4a05-9b50-8e3e8e59762968593b44-a8a4-4f9a-b41c-7f58de25433a Endometriosis isn’t life threatening, but it can cause serious complications. Although endometriosis has no cure, treatments can slow the spread and help people manage pain.
Signs and Symptoms of Stage 4 Endometriosis Symptoms Pain and infertility are the most common symptoms of all endometriosis stages , but additional symptoms can vary.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a5a8095b-f6da-4438-85f4-95385b84378d Your endometriosis stage doesn’t always correlate with your symptoms. Some people with stage 4 may have no symptoms, while others in stage 1 may report many.e60dc2a1-f33c-4a05-9b50-8e3e8e59762959cbf77c-b3b9-4926-b7fb-bc9c0ef791ef Other symptoms of stage 4 endometriosis include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629ea2acd8e-f22b-4ee0-bb91-2b50b9cb1cc9e60dc2a1-f33c-4a05-9b50-8e3e8e597629bd7dbe55-dee1-4c39-9e2b-fe4836e2ef4fe60dc2a1-f33c-4a05-9b50-8e3e8e5976291dbef497-891c-4972-9e12-7d3fbf56a61e Extremely painful period cramps Worsening menstrual pain over time Painful sex ( dyspareunia ) Lower abdominal pain Pain with urination and bowel movements during a period Very heavy periods Spotting or bleeding between periods Chronic pelvis or lower back pain Fatigue Diarrhea , constipation , bloating , or nausea Blood in stool or urine
Causes and Risk Factors of Stage 4 Endometriosis Causes Experts don’t know for sure what causes endometriosis at any stage. But the causes and risk factors may center on genetic, biological, and environmental elements. Experts think that the same triggers of early endometriosis may also lead to its progression to stage 4. These causes include:e60dc2a1-f33c-4a05-9b50-8e3e8e5976290b74b485-c02a-47ba-ab31-3855f6733acbe60dc2a1-f33c-4a05-9b50-8e3e8e597629169e3509-6d53-4f03-9784-e5ce3f5158c0 Retrograde menstruation: This is when menstrual blood, including endometrial tissue, flows backward into the fallopian tubes instead of out of the body. More exposure to estrogen : This may be from early menstruation or short periods. Immune system dysfunction: The immune system might fail to prompt the body to remove endometrial tissue that is growing outside the uterus. An overactive inflammatory response: This happens when the immune system reacts to endometrial implants outside the uterus. Direct transplantation: This is when endometrial cells attach to other areas of the body after a surgery, such as a C-section. Risk factors for stage 4 endometriosis include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629c1d5fefd-9c55-4a38-be79-ca9e0d2cfac8e60dc2a1-f33c-4a05-9b50-8e3e8e597629169e3509-6d53-4f03-9784-e5ce3f5158c0 Age (25 to 50) Genetics or a family history of endometriosis Not having had children A diet high in red meat and trans fats Menstruation issues, such as short cycles, heavier flows, or longer periods Getting your first period before age 11
How Is Stage 4 Endometriosis Diagnosed? Diagnosis To diagnose stage 4 endometriosis, your provider must evaluate your symptoms and perform tests. Endometriosis is staged based on factors like:e60dc2a1-f33c-4a05-9b50-8e3e8e59762971cf7b14-7a10-4ac2-afe7-aaf048508c78e60dc2a1-f33c-4a05-9b50-8e3e8e5976298a417d58-0744-4519-bbab-89b129f66fd9 Amount of deep and superficial implants Number and severity of adhesions Presence of chocolate cysts in the ovaries (growths filled with old blood) Your provider will use one or more of the following to diagnose stage 4 endometriosis:e60dc2a1-f33c-4a05-9b50-8e3e8e597629bd91f736-3632-4c21-b060-5333d458cb91e60dc2a1-f33c-4a05-9b50-8e3e8e597629f5507c51-c650-4f04-a011-105c0f6da7d2 Pelvic exam: Your provider feels for large growths or scars behind your uterus. Ultrasound: This imaging test , done with a vaginal wand or device placed on your stomach, uses sound waves to create a picture of your organs. MRI: Magnetic resonance imaging, or MRI , takes a more detailed picture of your body’s insides. Laparoscopy: To perform a laparoscopy , a surgeon makes two or three small incisions in your abdomen and inserts a camera to look for lesions and implants. During surgery, they may take small samples of suspicious tissue to check in the lab. If your provider doesn’t find evidence of endometriosis using these exams and tests, they may prescribe hormonal birth control and medication that blocks the menstrual cycle and lowers estrogen. If your pain improves on this medicine, it suggests that you have endometriosis.e60dc2a1-f33c-4a05-9b50-8e3e8e597629186f7f05-52af-4f25-a100-8b050a8ff7c1 Endometriosis Staging With endometriosis, areas of uterine tissue (endometrial) growth, called “lesions,” “implants,” or “nodules,” are typically found near the uterus.e60dc2a1-f33c-4a05-9b50-8e3e8e597629bd91f736-3632-4c21-b060-5333d458cb91 The American Society for Reproductive Medicine (ASRM) divides endometriosis into four stages, with stage 1 being mild and stage 4 being severe. The ASRM bases staging results on the location and size of implants and lesions, along with damage to nearby organs.e60dc2a1-f33c-4a05-9b50-8e3e8e5976297c527728-bbe4-4277-8eb3-a8acd7a88b70 Since people don’t always experience symptoms that match up with their stage, some experts believe that other staging methods may better direct treatment.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296d954e1f-d3b3-44bc-af1b-f031ea8775bde60dc2a1-f33c-4a05-9b50-8e3e8e5976297c527728-bbe4-4277-8eb3-a8acd7a88b70
Treatment and Medication Options for Stage 4 Endometriosis Treatment Treatment for endometriosis looks similar across all stages, except that stage 4 endometriosis may require surgery for symptom control.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295dddf7b6-8100-4028-9474-6fb4b3afd62b Medication Options Medication for stage 4 endometriosis focuses on relieving pain and managing hormone levels. Hormone therapies can slow endometrial tissue growth and prevent new implants. Hormonal medications come in pills, shots, and nasal sprays, including:e60dc2a1-f33c-4a05-9b50-8e3e8e5976295dddf7b6-8100-4028-9474-6fb4b3afd62be60dc2a1-f33c-4a05-9b50-8e3e8e5976293505ece1-074f-444c-b553-3e59fd89b2ca Birth control pills: These control estrogen and progesterone levels and can be right for those who are not trying to get pregnant. Levonorgestrel-releasing intrauterine devices: These may help with pelvic pain. ( Mirena is an example of one.) Progestins: These stop menstrual periods and the growth of endometrial tissue. Gonadotropin-releasing hormone (GnRH) antagonists: These limit ovarian hormone production. GnRH agonists: These stop ovarian hormones. Aromatase inhibitors: These lower estrogen levels.e60dc2a1-f33c-4a05-9b50-8e3e8e597629fd9389b3-76e8-4a2c-95a7-b2141b3db492 Your provider may also recommend pain relievers for symptom management.e60dc2a1-f33c-4a05-9b50-8e3e8e5976293505ece1-074f-444c-b553-3e59fd89b2cae60dc2a1-f33c-4a05-9b50-8e3e8e597629e30cc875-dc19-4b8c-becd-20d056b81c43e60dc2a1-f33c-4a05-9b50-8e3e8e597629daaf901d-5eb5-4896-bc6e-43bae364cf96 Nonsteroidal anti-inflammatory drugs : These include ibuprofen (Advil), and naproxen (Aleve). Opioids: In rare cases, morphine or other opioids may be prescribed for severe pain. Surgery For severe stage 4 endometriosis, your provider may recommend surgery to remove endometrial tissue and scar tissue.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e30cc875-dc19-4b8c-becd-20d056b81c43 Surgical options include:e60dc2a1-f33c-4a05-9b50-8e3e8e5976295dddf7b6-8100-4028-9474-6fb4b3afd62be60dc2a1-f33c-4a05-9b50-8e3e8e597629e43a4bc5-dcce-466f-8144-5d12100c94aa Laparoscopy: In this minimally invasive procedure, endometrial tissue and scar tissue are removed via small incisions. Laparotomy: This requires a larger incision to remove tissue and is used less often. Hysterectomy: In this procedure, the uterus is removed to stop endometrial tissue growth. Oophorectomy: Here the ovaries are removed to stop hormone production. Complementary and Integrative Therapies Some people with stage 4 endometriosis report symptom relief from complementary therapies, such as:e60dc2a1-f33c-4a05-9b50-8e3e8e597629fd9389b3-76e8-4a2c-95a7-b2141b3db492e60dc2a1-f33c-4a05-9b50-8e3e8e597629e9c013f0-036d-4367-8577-31fbc6eb4906 Acupuncture Pelvic floor physical therapye60dc2a1-f33c-4a05-9b50-8e3e8e597629329fe7e5-ed0f-4022-9b23-1a7ebdc2490c Chiropractic care Exercise e60dc2a1-f33c-4a05-9b50-8e3e8e597629ed522010-4212-487b-a1bd-29fc5f751056 Anti-inflammatory dietse60dc2a1-f33c-4a05-9b50-8e3e8e597629c566e86b-75f0-460c-9ee8-06438d3f5453 Yoga Relaxation techniques Omega-3 fatty acids Curcumin N-acetyl cysteine Vitamin C Epigallocatechin gallate Cinnamon twig Licorice root Magnesium Anticonvulsant medications, such as gabapentine60dc2a1-f33c-4a05-9b50-8e3e8e597629f28ff97a-b2b0-4271-b917-7e11b8514b82 Marijuanae60dc2a1-f33c-4a05-9b50-8e3e8e597629b07a105d-e054-44d8-b57e-3cf227db4baf Always check with your healthcare provider before taking any new herbs or supplements.
Prevention of Stage 4 Endometriosis Prevention Although endometriosis itself can’t be prevented, you can slow its progression to stage 4 by following your treatment plan.e60dc2a1-f33c-4a05-9b50-8e3e8e597629190842eb-aeb9-4694-8115-d5a02eb4880e Medications that treat endometriosis can slow tissue growth and prevent new implants. If you experience any symptoms of endometriosis, let your provider know.
Stage 4 Endometriosis Prognosis Prognosis and Outlook No cure exists for stage 4 endometriosis, but the condition isn’t life-threatening, and you can treat the symptoms and slow its progression.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296544ccbb-8641-416b-9205-ba152fed4f28 Some people may experience relief over time, as endometriosis pain can improve after menopause. Others may have continual pain that affects their daily life.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e6c4078c-1fdf-4c70-abdd-7977f7764336
Complications of Stage 4 Endometriosis Complications The most common complication of stage 4 endometriosis is infertility. People with endometriosis may experience higher rates of miscarriage and ectopic pregnancy .e60dc2a1-f33c-4a05-9b50-8e3e8e5976298c805730-2b63-4adf-b94e-c291333c25a4 If you’re concerned about your fertility , you can ask your provider about the many treatments to improve fertility in stage 4 endometriosis.e60dc2a1-f33c-4a05-9b50-8e3e8e5976293e34bac1-ff68-407b-8b73-dd996d90dd08 Other complications of stage 4 endometriosis may include:e60dc2a1-f33c-4a05-9b50-8e3e8e5976297c304677-9d67-495b-81e6-590bd1bba596e60dc2a1-f33c-4a05-9b50-8e3e8e5976298c805730-2b63-4adf-b94e-c291333c25a4 Ovarian cancer e60dc2a1-f33c-4a05-9b50-8e3e8e597629af51ec7c-3238-45b6-913f-2595e84233a1 Depression and anxiety e60dc2a1-f33c-4a05-9b50-8e3e8e5976292d74098d-8c22-4cb9-b7a9-43e0052fc9c0 Sexual function issuese60dc2a1-f33c-4a05-9b50-8e3e8e5976292d74098d-8c22-4cb9-b7a9-43e0052fc9c0 Lower quality of life Pain recurrence after surgery Bowel and bladder problems Shortness of breath Chest pain If you experience any of these symptoms, notify your healthcare provider. For shortness of breath and chest pain, go to a nearby emergency room or call 911.
Research and Statistics: Who Has Stage 4 Endometriosis? Research and Statistics Around the world, endometriosis affects about 190 million women and girls of reproductive age (10 percent).e60dc2a1-f33c-4a05-9b50-8e3e8e59762964a8a282-d466-4bb1-ac53-18a5f415d218 In a study review of about 127,000 women with endometriosis in the United States, only 2 percent had stage 4, compared with 20 percent with stage 1.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f331bb83-b992-4d4d-b941-88111d546073 Disparities may exist in data involving endometriosis of any stage, since few studies have explored how symptoms vary across different races and ethnicities. These inequities often come from selection bias — choosing mostly people of white racial origin for studies. So, experts may not identify stage 4 endometriosis in women of color as easily.e60dc2a1-f33c-4a05-9b50-8e3e8e5976298a0bf3d5-2b90-4b14-b29e-fae1f6b42f66 Some studies indicate that endometriosis diagnoses are more common in Asian women and less common in Black women , compared with white women.e60dc2a1-f33c-4a05-9b50-8e3e8e597629df98525c-8f90-4ddd-8c71-3caed816d479 But other research finds no difference in endometriosis between racial groups. Endometriosis is one of the most common reasons for Black women in the United States to have gynecologic surgery.e60dc2a1-f33c-4a05-9b50-8e3e8e5976298a0bf3d5-2b90-4b14-b29e-fae1f6b42f66
Related Conditions Related Conditions Endometriosis is a disease of the uterus, involving the overgrowth of uterine endometrial tissue outside of that organ. The pain and other symptoms associated with this disease can also point to other related conditions, including:e60dc2a1-f33c-4a05-9b50-8e3e8e5976293f14995e-4491-4102-955f-c4739d783e82e60dc2a1-f33c-4a05-9b50-8e3e8e5976298f5a5f8f-55d8-46c6-843e-c053ccaf284a Uterine fibroids (fibrous growths in the uterus) Gynecologic cancer (cervical, ovarian, uterine, vaginal, vulvar) HIV (human immunodeficiency virus) Interstitial cystitis (chronic bladder condition) Polycystic ovary syndrome (multiple ovarian cysts) Sexually transmitted infections (chlamydia, syphilis, herpes) Pelvic inflammatory disease (reproductive organ infection) Bowel diseases ( irritable bowel syndrome , constipation, inflammatory bowel disease)
Support for People With Stage 4 Endometriosis Support The Endometriosis Association This organization offers support for anyone with endometriosis. They offer an advocacy program, a correspondence support network, an online community , and a crisis hotline. Endometriosis Foundation of America (EndoFound) This organization provides support through patient resources, conferences, and community outreach programs. They also support research, boost public awareness, and provide education on endometriosis to communities and healthcare providers. MyEndometriosisTeam This organization offers emotional support and practical advice through discussion forums, resource sharing, and peer support. They provide a safe space for people to connect and exchange treatment insights with other people going through similar symptoms.
The Takeaway Stage 4 endometriosis is the most severe stage of this chronic disease, with symptoms including increased pain, implants outside the pelvis, and extensive scar tissue. Experts don’t know what causes endometriosis at any stage, but risk factors include age, family history, not having had children, diet, and getting your first period before age 11. Treatments for stage 4 endometriosis may include hormone medications, pain relief, and surgery. Although stage 4 endometriosis has no cure, treatments can help you manage symptoms and live a long, full life.
Resources We Trust Mayo Clinic: Endometriosis: Diagnosis and TreatmentEndometriosis Foundation: Endometriosis Stages: Understanding the Different Stages of EndometriosisMyEndometriosisTeam: The 4 Stages of Endometriosis: Understanding the ProgressionCleveland Clinic: Can Endometriosis Affect Fertility?Harvard Health Publishing: Treating the Pain of Endometriosis
Read the full article here
Leave a comment
