What Is Stage 4 Endometriosis?

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.

• 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

• 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.

• 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

• Amount of deep and superficial implants
• Number and severity of adhesions
• Presence of chocolate cysts in the ovaries (growths filled with old blood)

• 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.

Endometriosis Staging

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.

• 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.

  [10]

• 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

• 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

• Acupuncture
• Pelvic floor physical therapy

  [14]

• Chiropractic care
• Exercise

  [15]

• Anti-inflammatory diets

  [16]

• Yoga
• Relaxation techniques
• Omega-3 fatty acids
• Curcumin
• N-acetyl cysteine
• Vitamin C
• Epigallocatechin gallate
• Cinnamon twig
• Licorice root
• Magnesium
• Anticonvulsant medications, such as gabapentin

  [17]

• Marijuana

  [18]

Always check with your healthcare provider before taking any new herbs or supplements.

• Ovarian cancer

  [21]

• Depression and anxiety

  [22]

• Sexual function issues

  [22]

• 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.

• 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)

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.

• 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.