4 stages of endometriosis and why it could take 10 years to be diagnosed

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For many women, the journey to a proper endometriosis diagnosis is long and frustrating, often taking 7 to 10 years from the onset of symptoms.

Endometriosis is a chronic condition where tissue similar to the lining inside the uterus, known as the endometrium, grows outside the uterus.

Approximately 10% of women of reproductive age, which translates to around 176 million women worldwide, are estimated to have endometriosis.

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Despite its prevalence, it remains one of the most misdiagnosed and misunderstood medical conditions.

For many women, the journey to a proper diagnosis is long and frustrating, often taking seven to 10 years from the onset of symptoms to an accurate identification of the disease.

This delay is not just a matter of inconvenience; it significantly impacts the quality of life, leading to chronic pain, infertility, and psychological distress.


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Endometriosis is categorised into four stages, based on the extent, depth, and location of the endometrial implants, as well as the presence and severity of adhesions and ovarian endometriomas (cysts).

Imagine just a few tiny spots or implants of endometrial tissue, almost like little freckles scattered here and there in your pelvic area, on the pelvic organs or peritoneum.

Endometriosis illustration(HealthDirect)

The spots are mainly on the surface and haven’t really dug in deep. At this stage, you might not even notice any symptoms, or if you do, they might be very mild and easy to brush off as normal period pain.

There may be minimal or no scar tissue (adhesions).

Now, picture those tiny spots growing a bit more numerous and slightly deeper. It’s like adding a few more freckles and some of them are starting to darken.

The implants are still mostly on the surface, but there are more of them, and you might start to feel more noticeable discomfort or pain during your periods. There might be some mild scar tissue (adhesions), but it’s not causing major problems yet.

This is where things start getting a bit more serious. The implants are not just on the surface anymore; they’re starting to grow deeper into the tissues.

Think of it as freckles turning into small patches that go below the surface. There might be small cysts forming on one or both ovaries, which can add to the pain.

Scar tissue or adhesions are starting to form, which can cause organs to stick together, making everything feel a lot more uncomfortable.

In this stage, the endometrial tissue is quite extensive. Picture those freckles turning into large, deep patches and even forming big cysts on your ovaries, known as endometriomas.

The adhesions are pretty serious now, making organs stick together tightly, which can cause significant pain and other symptoms.

At this stage, the pain is often quite severe and can affect your daily life, not just during your period but all month long.

A diagram showing how endometriosis occurs in female reproductive organs

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Generally, endometriosis is a long-term condition that can persist for many years. It can start as early as the onset of menstruation, typically between ages 12-15. However, it is often diagnosed later, with an average delay of 7-10 years from the first symptoms.

In some cases, endometriosis symptoms may reduce after menopause due to decreased estrogen levels, though symptoms can persist in some individuals, particularly if hormone replacement therapy is used.

Endometriosis is often misdiagnosed due to a variety of factors, as highlighted by several research studies. Here are some key reasons supported by research:

  1. Symptom overlap with other conditions: Research shows that the symptoms of endometriosis often overlap with those of other conditions like irritable bowel syndrome (IBS), pelvic inflammatory disease (PID), and ovarian cysts.
  2. Normalisation of menstrual pain: Many women and healthcare providers consider severe menstrual pain to be a normal part of menstruation. Societal attitudes towards menstrual pain can also lead to delays in seeking medical help and receiving an accurate diagnosis.
  3. Invasive diagnostic procedures: The definitive diagnosis of endometriosis often requires laparoscopic surgery, an invasive procedure. Many women may go undiagnosed because less invasive diagnostic methods are inconclusive.
  4. Variable symptom presentation: Endometriosis can present with a wide range of symptoms, which can vary significantly from one individual to another. Some women may have severe disease with minimal symptoms, while others may have severe symptoms with minimal disease.
  5. Bias and gender disparities in healthcare: Gender biases in healthcare can lead to women’s pain being taken less seriously. Women often have their pain and symptoms dismissed or underestimated by healthcare providers.
  6. Slow diagnostic pathway: The British Journal of General Practice found that many women with endometriosis see multiple healthcare providers over several years before receiving a diagnosis.

These statistics highlight the widespread nature of endometriosis and the importance of increased awareness, timely diagnosis, and effective management to improve the quality of life for those affected.

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