Severe Endometriosis (Stage 4): What You Need to Know

UPDATED ON 24TH APR. 2025

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Endometriosis

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Overview

Endometriosis is a very common gynecological condition that can occur in any woman of childbearing age. Endometriosis means an overgrowth of tissue on the pelvis, uterus, and other reproductive organs. This can lead to various health problems, which sometimes can cause infertility too if not treated in time. 

Endometriosis has four stages, and every stage has its own different signs. Although the signs of the beginning stages are very faint and confusing. Stage four is also known as the last stage of endometriosis, and therefore, you need to have proper knowledge about it, which includes its signs, treatment, and other aspects.

How serious is stage 4 endometriosis?

Endometriosis has four stages, and the fourth or last stage of endometriosis is known as the severe stage of endometriosis. At this stage, several cysts along with tremendous adhesion are present in more than 40 accruing points. 

Although normal cysts go away with time, cysts developed due to endometriosis do not disappear and need to be removed with surgical operations. Hence, stage 4 endometriosis is the most severe stage; naturally, it is also the most serious stage of endometriosis. 

And people diagnosed with stage 4 endometriosis are most likely to face severe, painful menses, painful intercourse, and painful defecation. The majority of them also encounter chronic pelvic pain due to the severity of the disease. 

Stage 4 endometriosis can cause severe pain in the abdomen, pelvic pain, and infertility. But one must not panic if diagnosed with stage 4 endometriosis; instead, keep calm and contact a specialist for timely treatment.

What signs are stage 4 Endometriosis?

Endometriosis has four different states, and the division of its stages is made depending upon the number of acquired points, place of occurrence, size, and depth of it. Stage 4 endometriosis is a severe stage of endometriosis where it has specific signs that help the doctors to identify it with diagnosis.

Also, everyone needs to be fully aware of the stage 4 endometriosis signs so that they can reach out to the doctors immediately. Therefore, we will share the basic signs of stage 4 endometriosis below:

• Heavy and abnormal menstruation
• Painful urination during periods (monthly cycle)
• Pain felt during intercourse
• Painful bowel movements, especially during periods.
• Infertility
• Digestive issues
• Vomiting
• Nausea
• Diarrhoea
• Constipation, etc.

One must note that the severity of endometriosis does not reflect the amount of pain a woman faces due to endometriosis. Because many women do not feel any pain with severe endometriosis, on the other hand, some women can also experience abominable pain with milder endometriosis.

If you’re experiencing signs of stage 4 endometriosis, don’t wait—reach out to Shree IVF Clinic today to book your appointment at 099209 14115 to set up an appointment with one of India’s best endometriosis surgeons, Dr. Jay Mehta! .

Is stage 4 Endometriosis curable?

Another important aspect most people worry about is the curability of any disease,, and there is no exception in endometriosis. As stage 4 endometriosis is the severe stage of endometriosis, many people fear whether it is even a curable medical condition or not. 

But one must not worry unnecessarily because nowadays, with all the medical advancements and developments, even the most severe cases of endometriosis are possible to cure.

Currently, various gynecology hospitals and private clinics are working across India that offer several treatments to cure the disease. Therefore, there is nothing to worry about in stage 4 endometriosis because if you visit the specialist in time and receive the proper treatment, you will recover completely.

Stage 4 Endometriosis Treatment

There are several types of treatment available for stage 4 endometriosis that doctors determine to prescribe to the patient, depending on some crucial factors. The factors are

• Recent symptoms of the patient
• Medical background of the patient
• Affected area
• Patient’s tolerance for any medication, therapies and procedures
• The course of the medical condition (expected)
• Patient’s pregnancy desire, etc. 

Here’s a quick overview of the main treatment options available for people dealing with endometriosis.

• Medication for Pain—In this treatment, patients are prescribed nonsteroidal anti-inflammatory drugs to prevent the pain caused by endometriosis.

• Hormone therapy—Hormone therapy is another option to treat endometriosis. This treatment includes various ways, such as oral contraceptives, single progestins like Dinogest, and oral GnRH antagonists like Elagolix. 

However, we must understand that any form of medical management is predominantly only for the temporary separation of the pain that is associated with endometriosis. Unfortunately, in a country like India, this is a promise that has been given to a patient that when you take medical management to be cured of endometriosis, this virtually puts an end to the warranty and indicates surgical management for many women. 

The obvious necessary surgical management is a severe spread of the disease, which occurs in the pelvis, resulting in permanent fertility damage as well as extensive surgeries, giving rise to a high morbidity 

Surgical Management of Grade 4 Endometriosis? 

As we speak, as of 2025, surgical management with an expert is the treatment of choice for endometriosis. Surgery is typically characterized by a minimally invasive surgery, which is performed either with the help of advanced laparoscopic instruments or in the form of robotic assistance.

However, for a patient, it is important to note and understand that it is the man who is performing the surgery, which is much more important than the type of minimally invasive surgical approach that has been chosen for the patient. One thing is absolutely clear: open surgery, or laparotomy, is no longer the treatment of choice for the management of surgical endometriosis. 

When you are a patient with endometriosis and opt for surgical management, you should keep in mind that the confidence and expertise of the surgical team are extremely important because a dedicated approach to surgery requires a lot. Many years of expertise are needed to give the patient a radical clearance of the disease. 

Radical clearance of the disease is extremely important in order to make sure that the patient has an extremely limited rate of recurrence following the surgery, and the patient can exploit the maximum post-surgical fertility benefit. 

Since we are referring units for endometriotic processes across India, we have had the experience of operating geometry offices at multiple locations across the country, and we predominantly operate on patients who have multi-compartment endometriosis. These are long surgeries with a difficult surgical recovery and are expensive surgeries, and as a result of this, we always propagate the fact that the first surgery for endometriosis should always be done by a super specialist because it should be your best surgery. 

Unfortunately, in a country like India, many women are subjected to endometriosis surgery. not done by experts, and as a result, the majority of these women experience a recurrence of the disease within the first year of the surgery. 

In fact, as a rational unit for endometriosis, it predominantly operates on patients who have been operated on at least once or twice before by experts who run advertisements across social media platforms. 

Dr. Jay Mehta and his team have performed more than 600 live surgeries for endometriosis on Facebook to give surgical training informally to gynecological colleagues across the world, where more than a hundred countries have participated.

Conclusion

Stage 4 endometriosis is the most serious stage of endometriosis, and women who do not experience much pain as a symptom can also develop serious endometriosis. But you must not panic if you feel something is wrong. Though stage 4 endometriosis is the final stage of endometriosis, it is still curable with medical treatments and surgeries. 

FAQ’S

What happens if you do not treat stage 4 endometriosis?

An uncured stage 4 endometriosis can trouble you in the long run. Untreated stage 4 endometriosis can cause infertility in women and even increases the chance of cancer with the development of cysts on different parts of reproductive organs.

Can you get pregnant with stage 4 endometriosis?

Though doing surgery is definitely the treatment of choice in order to exploit the best fertility potential for this disease, it is common to find every year approximately 5 to 7% of the women who are in the fertility or the reproductive age group who end up conceiving naturally, despite having grade 4 endometriosis

This is predominantly because, despite having an advanced stage of disease, the fallopian tubes and the architecture of the tubes have remained intact, and this allows for spontaneous ovulation as well as spontaneous conception to occur. 

However, one has to keep in mind that just because you’ve become pregnant, it does not indicate that you have been cured of endometriosis. Women, after their pregnancy is finished and breastfeeding is finished, which is typically one year after childbirth, usually report back with similar symptoms or even more aggressive symptoms of endometriosis than what they had before the pregnancy.

As a result of this, maintaining a strong follow-up with your endometriosis super specialist plays a key role in making sure that you have a long-term and healthy outcome of this disease after you’ve had an operation. 

As a referral unit for endometriosis for people whom we operate on across India, we usually try to maintain a once-a-year follow-up for the next eight years. This is predominantly done by us through telemedicine for people who are in different cities.

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