Stage 2 endometriosis: Effects on the body, fertility, and treatment

Doctors most often use the American Society for Reproductive Medicine (ASRM) staging system to classify endometriosis into four stages. The ASRM system categorizes endometriosis stages 1 (minimal), 2 (mild), 3 (moderate), and 4 (severe) based on the location, size, depth, and extent of tissue growths.

The stages indicate the severity of the condition, but not necessarily of the symptoms. Someone with mild, stage 2 endometriosis may experience severe pain or fertility difficulties. This means a person’s treatment may depend on their symptoms rather than the stage of their condition.

Endometriosis is a condition in which tissue similar to endometrium, the inner lining of the uterus, grows outside of the uterus.

This tissue usually exits the body during menstruation. However, in endometriosis, menstrual blood containing endometrial cells may flow backward through the fallopian tubes. These cells can form implants that attach to and grow outside of the uterus.

The receptors in endometrial cells respond to the hormones estrogen and progesterone. One function of these hormones is to thicken and grow the uterine lining. The cells continue this activity when they implant outside the uterus, which leads to growths, scarring, and inflammation.

The growths typically develop in areas of the pelvis, including the tissues outside of and supporting the uterus, the ovaries, and the fallopian tubes.

In stage 2 endometriosis, the implants are usually superficial, meaning they have not grown deeply into the tissues and organs in the pelvic area. At this stage, mild bands or clumps of scar tissue called adhesions may form.

In stage 1 endometriosis, the implants and adhesions are typically smaller and more superficial than in stage 2.

In stages 3 and 4, the implants may be larger and grow deeper into the tissues. In these stages, the adhesions also tend to be denser. This may result in complications, such as cutting off the blood supply or accumulating blood in organs or tissues in the pelvic area. Endometriomas, or chocolate cysts, may form, which are sacs filled with old blood.

Doctors use staging to determine the extent of the endometrial tissue growth in endometriosis, but staging does not necessarily describe the condition’s effect on fertility. Endometriosis may or may not cause fertility issues at any stage, and can affect natural and assisted conception.

Some research suggests that the chances of natural conception are between 2% and 4.5% per 30 days in people with mild endometriosis, compared to 15% to 20% in people without the condition. The chances of conception may be lower than 2% for people with moderate to severe endometriosis.

Around 30% of people with endometriosis experience infertility. This may occur if growths or scar tissue block the fallopian tubes. Inflammation may also damage the eggs or sperm, or prevent them from travelling through the uterus or fallopian tubes.

If a person has difficulty conceiving after one year, they may want to consider fertility treatments or consult a reproductive endocrinologist.

Treatments like artificial insemination and in vitro fertilization (IVF) can increase a person’s chances of becoming pregnant.

There are no specific diagnostic tests for endometriosis, and the symptoms overlap with those of many other conditions. This makes endometriosis difficult to identify, and a person usually only receives a diagnosis 4 to 11 years after their symptoms begin.

A laparoscopy can help doctors determine the size and extent of the endometrial growths. A doctor will diagnose stage 2 endometriosis if superficial implants and mild adhesions are present.

There is no cure for endometriosis, but treatment can help manage the symptoms and possible complications of the condition.

If a person is not trying to become pregnant, a doctor will typically prescribe hormonal birth control medication as the first line of treatment. This may include the oral contraceptive pill or shot, or an intrauterine device (IUD).

If a person is trying to conceive, a doctor may prescribe a gonadotropin-releasing hormone (GnRH) agonist, like Zoladex. This medication temporarily stops the menstrual cycle and helps reduce endometriosis growth. A person’s menstrual cycle returns once they stop taking it.

A doctor may also suggest over-the-counter (OTC) medications, such as ibuprofen (Advil and Motrin), to relieve pain and inflammation.

An individual may require surgery for stage 2 endometriosis if the condition does not respond to treatment with medication.

Surgical removal of endometriosis tissue may help relieve pain and improve fertility. It can also decrease inflammation in the pelvic area, which may increase a person’s chances of conception.

The most common endometriosis surgery is a laparoscopy to view and remove the endometrial tissue. A surgeon may remove the tissue through excision or ablation:

Reports of endometriosis recurrence rates vary. Different estimates indicate that the condition returns in between 6% to 67% of people after surgery.

According to the American College of Obstetricians and Gynecologists (ACOG), up to 80% of people have pain again within 2 years of endometriosis surgery.

Endometriosis is a chronic condition that requires long-term management.

After diagnosis, individuals with endometriosis may benefit from regular follow-up care and a comprehensive management strategy. This may include regular appointments with a doctor or a team of healthcare professionals.

Treatment, such as hormonal birth control medication, may help prevent recurrence. A healthcare professional can help a person develop strategies to manage long-term pain and offer mental health support.

The use of binary terms such as “male” and “female” or “men” and “women” in this article reflects the language of the sources we’ve used. Unless otherwise noted, it’s unclear whether the research we reference included participants with expansive gender identities.

Doctors may not immediately recognize endometriosis as the cause of a person’s symptoms, which can significantly delay diagnosis. This may be due to several factors, including similarities between symptoms of endometriosis and other conditions, and gender bias in healthcare.

Research suggests that doctors dismiss health concerns and delay diagnosing certain conditions more often in women.

Connecting with in-person or online support groups and patient advocacy groups, such as the Endometriosis Foundation of America, can provide access to valuable resources, like community and helpful information.

Additionally, mental health professionals or counsellors can help a person manage their mental well-being and find ways to cope with the emotional and psychological challenges of endometriosis.

A person may also want to speak with a healthcare professional for guidance on how to communicate with employers about accommodations for endometriosis at work.

If a person’s condition limits their ability to work, they may qualify for protection under the Americans with Disabilities Act (ADA). This mandates that employers provide reasonable accommodations, which may include:

There is no cure for endometriosis at any stage. However, hormonal birth control medication may help manage the symptoms.

There is no cure for endometriosis at any stage. However, hormonal birth control medication may help manage the symptoms.

Stage 2 endometriosis is a chronic condition. However, the condition is manageable with treatment, and many people are able to maintain a good quality of life.

The stage of endometriosis does not describe the severity of the symptoms. Treatment for stage 2 endometriosis can vary, depending on how severe a person’s pain and other symptoms are. A team of healthcare professionals can offer individualized healthcare plans and strategies for long-term management of the condition.

Endometriosis can affect various aspects of a person’s life and can impact their emotional, social, and psychological well-being. Resources like support groups, patient advocacy groups, and mental health professionals can provide further help and support.