The revised ASRM (American Society for Reproductive Medicine) classification of endometriosis assigns points based on location, size, and adhesions. In which stage would a patient with bilateral ovarian endometriomas (3 cm each), obliterated cul-de-sac, and dense bowel adhesions be classified?

• A Stage I (minimal, 1–5 points)
• B Stage II (mild, 6–15 points)
• C Stage III (moderate, 16–40 points)
• D Stage IV (severe, >40 points) ✓

Explanation

The revised ASRM scoring system assigns points for peritoneal implants (size, superficial vs deep), ovarian endometriomas (unilateral vs bilateral, size ≤3 vs >3 cm), and adhesions (filmy vs dense, extent). Bilateral ovarian endometriomas alone score heavily (4 points each for size ≤3 cm or 16 each for >3 cm), an obliterated cul-de-sac adds 40 points automatically (irrespective of other findings), and dense bowel adhesions further add >15 points. Obliterated cul-de-sac alone classifies Stage IV. This patient easily exceeds 40 points, placing her in Stage IV (severe).

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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Written and medically reviewed by the StethoPrep medical team.