Endometriosis Classification

Several classification schemes to assist in describing the anatomic location and severity of endometriosis at operation have been created. Although none is entirely satisfactory, the scoring systems are useful for reporting operative findings and for comparing the results of various treatment protocols. The revised American Fertility Society classification is given in Table 40-1 and

Fig 40-3.


Figure 40-3. Staging of endometriosis. Determination of the stage or degree of endometrial involvement is based on a weighted point system (

see Table 40-1 for point values). Distribution of points has been arbitrarily determined and may require further revision or refinement as knowledge of the disease increases. To ensure complete evaluation, inspection of the pelvis in a clockwise or counterclockwise fashion is encouraged. Number, size, and location of endometrial implants, plaques, endometriomas, and/or adhesions are noted. For example, 5 separate 0.5-cm superficial implants on the peritoneum (2.5 cm total) would be assigned 2 points. (The surface of the uterus should be considered peritoneum.) The severity of the endometriosis or adhesions should be assigned the highest score only for peritoneum, ovary, tube, or cul-de-sac. For example, a 4-cm superficial and a 2-cm deep implant of the peritoneum should be given a score of 6 (not 8). A 4-cm deep endometrioma of the ovary associated with more than 3 cm of superficial disease should be scored 20 (not 24). In patients with only one set of adnexa, points applied to disease of the remaining tube and ovary should be multiplied by two. Points assigned may be circled and totaled. Aggregation of points indicates stage of disease (minimal, mild, moderate, or severe). The presence of endometriosis of the bowel, urinary tract, fallopian tube, vagina, cervix, skin, etc, should be documented under “additional endometriosis.” Other pathology such as tubal occlusion, leiomyomata, uterine anomaly, etc, should be documented under “additional pathology.” All pathology should be depicted as specifically as possible on the sketch of pelvic organs, and means of observation (laparoscopy or laparotomy) should be noted. (Copyright 1996, American Society for Reproductive Medicine. From: Revised ASRM classification for endometriosis: 1996. Fertil Steril 1997;67:820.)

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Revision date: June 11, 2011
Last revised: by David A. Scott, M.D.