by Tamer Seckin, MD
Endometriosis Excision Surgeon & Founder of Seckin Endometriosis Center (SEC)

Endometriosis Stages

Our endometriosis specialists work with patients to understand symptoms, diagnosis, and treatment options for 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.

How are stages assigned?

The 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 endometriosis.

What is the problem with this method of classification?

The scoring and stage of the disease are not indicative of pain level. Instead, this system 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

What is the best way to obtain a thorough classification?

For an accurate diagnosis, it is necessary to conduct a direct visual inspection inside the pelvis and abdomen, as well as tissue biopsy of the implants. 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 the factors mentioned above, your normal one through four classification of endometriosis may be of less significance than our descriptive classifications. We define 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.

It is crucial to monitor and keep in mind the extent of your symptoms and the disease itself. Sometimes patients feel they need to mask their suffering, and it is incredibly disheartening and incorrect when their physician proceeds to tell them 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 having honest discussions about the extent of symptoms you may be experiencing.

References

• Stages: World Endometriosis Society consensus on the classification of endometriosis
• ASRM, Endometriosis