What are the stages of endometriosis?

From the Guidelines

The staging of endometriosis should be done using a combination of the r-ASRM system and, where appropriate, the Enzian and EFI staging systems, as recommended by the World Endometriosis Society consensus 1. This approach is based on the latest consensus guidelines, which aim to improve the quality of life for women with endometriosis. The r-ASRM system is a widely used classification system that categorizes the disease into different stages based on the location, extent, and depth of endometriotic implants, as well as the presence of adhesions and ovarian endometriomas.

• Key points to consider when staging endometriosis include:
  • The location and extent of endometriotic implants
  • The presence and severity of adhesions and ovarian endometriomas
  • The use of additional staging systems, such as the Enzian and EFI systems, to provide more comprehensive information
• It is essential to note that the stage of endometriosis does not necessarily correlate with symptom severity or fertility outcomes, and accurate staging requires surgical visualization, typically through laparoscopy 1.
• The use of a combination of staging systems, as recommended by the World Endometriosis Society consensus, can help guide treatment decisions and provide a standardized way to document disease progression, ultimately improving the quality of life for women with endometriosis.

From the Research

Staging of Endometriosis

• The staging of endometriosis is a complex process, with various classification, staging, and reporting systems having been developed over the years 2.
• Despite the existence of these systems, there is currently no international agreement on how to describe or classify endometriosis, and most systems show little correlation with patient outcomes 2.
• The ENZIAN system has been confirmed to be valuable for surgical description of deep endometriosis, while the endometriosis fertility index has been validated for its intended purpose in relation to infertility 2.
• The lack of a universally accepted classification system for endometriosis highlights the need for further research and development in this area 2.

Classification Systems

• A total of 22 endometriosis classification, staging, and reporting systems have been published between 1973 and 2021, each with its own specific purpose 2.
• These systems have been evaluated in 46 studies, but there is a discrepancy between the intended and evaluated purposes, and a general lack of validation data 2.
• The development of a universally accepted endometriosis classification system is essential for improving patient outcomes and facilitating more effective treatment strategies 2.

Treatment Implications

• The staging and classification of endometriosis can have significant implications for treatment, with different systems potentially leading to different treatment approaches 3, 4, 5, 6.
• Medical therapy is often the first line of management for women with endometriosis, with treatment options including non-steroidal anti-inflammatory drugs, combined oral contraceptives, progestins, and gonadotropin-releasing hormone agonists/antagonists 3, 4, 5, 6.
• The choice of treatment is based on several factors, including age, patient preference, reproductive plans, intensity of pain, severity of disease, and incidence of adverse effects 6.