Classification systems

Several systems have been devised to classify disease severity. The most widely used is one developed by the American Society for Reproductive Medicine (ASRM), in which points are allocated for endometriotic lesions, periovarian adhesions and pouch of Douglas obliteration (Fig. 44.1) [3]. The total score is then used to describe the disease as minimal (Stage 1), mild (Stage 2), moderate (Stage 3) or severe (Stage 4). This system was designed to assist in the prognosis and management of patients undergoing surgery for subfertility. Deeply infiltrating endometriosis (DIE), a major cause of pelvic pain and dys-pareunia, is typically assigned a low score (Stage 1 or 2) because only visible lesions contribute; this partly explains why there is little correlation between the total score and pain severity. Clearly, a better, more validated method to classify disease severity is needed, which can differentiate between typical lesions and DIE.

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