Stages of Endometriosis


What are the stages of endometriosis?

Endometriosis is classified into four stages; I-minimal, II-mild, III-moderate, and IV-severe. Staging has been defined by the American Society for Reproductive Medicine (ASRM), with criteria based on the location of the disease, extent, depth of endometriosis implants, presence and size of ovarian endometriomas, and the presence and severity of adhesions.

StageAmerican Society of Reproductive Medicine Severity Classifications
Stage I Mild
Stage II Minimal
Stage III Moderate
Stage IV Severe

How are these stages of endometriosis assigned?

These criteria that make up the stages of endometriosis are graded on a point system to determine classification. First developed in 1973, the classification scheme has been revised and refined three times for a more precise method of documentation. A score of 1-15 indicates minimal or mild endometriosis, while a score of 16 or higher indicates moderate to severe.

What is the problem with this method of classification?

The scoring and stage of the disease are not indicative of the pain level. Staging was fundamentally developed as an indicator of endometriosis-associated infertility, and, therefore, has no specific correlation to any symptoms. This means that a woman in stage IV can be asymptomatic, while a stage 1 patient might be in debilitating pain.

Our Approach to Classifying Endometriosis

What is the best way to obtain a thorough classification of endometriosis?

For an accurate diagnosis, a direct visual inspection inside of the pelvis and abdomen, as well as tissue biopsy of the implants are necessary. A pathologist will observe the obtained biopsy sample under a microscope in order to view any inflammatory changes or signs of cancer, which they will then report back to the surgeon. This ultimately allows your surgeon to gain a better understanding of the extent of your disease and thus provide a more descriptive classification of your particular case of endometriosis.

What are our “Descriptive Classifications of Endometriosis?”

Due to all the factors mentioned above, your normal one through four classification of endometriosis may be of less significance than our “Descriptive Classifications.” This represents four different forms of the disease that must be considered: peritoneal disease, ovarian endometrioma, deep infiltrating endometriosis (DIE) and Frozen Pelvis. Though different, they are not altogether clinically distinct, and the pathophysiological mechanisms involved in all four remain poorly understood.

Dr. Seckin’s Prefered ClassificationDescription
Early peritoneal endometriosis
  • Infiltration to the lining of the abdomen (peritoneum)
Ovarian endometriomas
  • Large, "chocolate" fluid-filled cysts that form on, and even encapsulate, the ovaries
Cul-de-sac obliteration
  • Infiltration of the tissue lining the back wall of the uterus and rectum (cul-de-sac), an extension of the peritoneum
Deep infiltrating endometriosis (DIE)
  • Invasive endometriosis that penetrates to the bladder and bowel wall
Frozen pelvis
  • Rare condition, in which there are deep infiltrative attachments to pelvic ligaments, nerves and muscle tissue that partially or totally cements pelvic organs

For patients suffering from endometriosis, it is crucial to monitor and keep in my mind the extent of your symptoms and the disease itself. It is disheartening to hear when patients feel they need to mask their suffering and are told by their physician that their pain is simply “emotional stress.” We believe that you deserve the care and attention that a complicated disease such as endometriosis deserves. This includes opening up a personal, private discussion to the descriptive classification and extent to which you may be suffering from endometriosis.

Our office is located on 5th Ave and 68th NY, NY.
You may call us at 212-988-1444 or have your case reviewed by clicking here.

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