Endometriosis Stages: How Severe Is Your Condition?

Endometriosis occurs when endometrium, similar to the tissue that lines the uterus, grows outside the uterus. This can result in the formation of scar tissue, adhesions, and many accompanying symptoms. If you’ve been diagnosed with endometriosis, you’ll likely want to know more about its stages and how severe your condition is. This knowledge will empower you to gain control over your body and pursue suitable treatment options.

The Endometriosis Classification System

A classification system for endometriosis has been developed to standardise communication between scientists and healthcare professionals. This system helps them describe the disease and strengthen research efforts to develop treatments and diagnostic methods. The most widely used classification system was created by the American Society for Reproductive Medicine, also known as ASRM.

Endometriosis is a complex condition; it presents in various forms and symptoms. Each woman’s experience and treatment will differ based on the number of endometrial lesions, depth, location, size, severity, and whether ovarian endometriomas are present. Points are assigned to each diagnostic category – the higher the points, the more severe the form and structure of the endometriosis. It’s important to note that the severity of the condition may not directly correlate to the symptoms and pain women endure.

The Stages of Endometriosis

The ASRM endometriosis classification system assigns points based on various aspects of the endometrial tissue. For example, superficial endometriosis smaller than 1cm in size may only be given 1 point, while deep ovarian endometriosis larger than 3cm may be given 20 points.

Endometriosis Stage Presentation
Stage 1: 1 – 5 points
  • Minimal
  • Few superficial implants, wounds, or lesions
  • Implants may be found on organs or tissue lining the pelvis or abdomen
  • Little to no scar tissue
Stage 2: 6 – 15 points
  • Mild
  • More implants
  • Implants are deeper
  • Scar tissue may be present
Stage 3: 16 – 40 points
  • Moderate
  • Many deep implants
  • Small cysts on one or both ovaries
  • Bands of scar tissue known as adhesions
Stage 4: over 40 points
  • Severe
  • Widespread with many deep implants
  • Large cysts on one or both ovaries
  • Many thick adhesions

What Are the Limitations of the ASRM Endometriosis Classification System?

While the system developed by the American Society for Reproductive Medicine is widely adopted, it has some limitations. As mentioned above, this system doesn’t necessarily correlate with the pain or the prospect of conception. A woman with minimal to mild endometriosis can experience different pain levels and fertility challenges compared to someone with severe endometriosis. The ASRM classification system helps guide the treatment, but other factors still need to be considered when creating a treatment plan.

In light of this, other classification systems have been developed. The ENZIAN system, however complex, has not been widely accepted. This system does, however, help doctors classify deep, infiltrating endometriosis. The Endometriosis Fertility Index is used to predict the effects of endometrial surgery on fertility. The American Association of Gynecologic Laparoscopists (AAGL) classification system was developed to account for pain and fertility. Retrospective studies have shown that the AAGL system doesn’t perform as well as the ASRM system. 

The Ultrasound based Endometriosis staging system (UBESS) is utilized to predict the level of complexity of laparoscopic surgery for endometriosis. It has the potential to facilitate the triage of women with suspected endometriosis to the most appropriate surgical expertise required for laparoscopic endometriosis surgery.

Knowing the stage of your endometriosis may not directly correlate with your pain and fertility levels, despite knowing its severity. However, it can be empowering to learn more about the depth and extent of the condition, and whether endometrial cysts are present in your ovaries. Ultimately, your healthcare professional will use diagnostic tools such as ultrasound to provide you with more information about your endometriosis, helping to formulate an effective treatment plan.

OMNI Ultrasound & Gynaecological Care

Condous performs Advanced Endosurgery procedures for women needing intervention for pelvic masses, adnexal pathology, severe endometriosis or hysterectomy. He also runs ‘Hands on’ Live Sheep Laparoscopic Workshops for gynaecologists at Camden Veterinarian School.
Having completed an undergraduate degree with the University of Adelaide, he left Australia in 1993 and moved to London where he completed his training in Obstetrics and Gynaecology. From 2001 to 2003 Condous worked as a Senior Research Fellow at St George’s Hospital, London. At St George’s he set up the Acute Gynaecology Unit, the first in the United Kingdom. It was also during this time that he developed an interest in Early Pregnancy and especially the management of pregnancies of unknown location (PULs). Condous has developed many mathematical models for the prediction of outcome of PULs which have been featured in numerous peer review journals. In 2005, he returned to Australia where he completed his Laparoscopic Fellowship at the Centre for Advanced Reproductive Endosurgery, Royal North Shore, Sydney.

Condous was appointed as a Consultant Gynaecologist and Senior Lecturer at Nepean Hospital in 2006 and soon was made Associate Professor. In 2010, he was made Departmental Head of Obstetrics and Gynaecology at Nepean Hospital. He obtained the MRCOG in 1999 and was made FRANZCOG in 2005. In 2009, he was awarded his Doctorate in Medicine (MD), University of London, for his thesis entitled: “The management of pregnancies of unknown location and the development of new mathematical models to predict outcome”.

Condous has edited three books including the “Handbook of Early Pregnancy Care”, published over 100 papers in international journals and is internationally renowned for his work in Early Pregnancy. He is the Associate Editor for Gynaecologic Obstetric Investigation, which is a European based journal, as well as the Australasian Journal of Ultrasound in Medicine (AJUM). He is on the organising committee and is an invited speaker at the International Society of Ultrasound in Obstetrics and Gynaecology (ISUOG) Scientific meeting in Sydney 2013. His current research interests relate to the management of ectopic pregnancy, 1st trimester growth, PULs and miscarriage and the use of transvaginal ultrasound (in particular sonovaginography, to predict posterior compartment deep infiltrating rectovaginal endometriosis).Condous is also actively involved with post-graduate education including the annual running of the Early Pregnancy and Gynaecological Ultrasound Interactive Courses for Sonologists, Radiologists, Sonographers and Gynaecologists in Australia.