The rASRM (revised American Society for Reproductive Medicine) classification of endometriosis scores peritoneal implants, ovarian endometrioma, and adhesions. A patient with bilateral ovarian endometriomas (3 cm each), dense cul-de-sac obliteration, and bilateral adnexal adhesions would be classified as:
- A Stage III (moderate) — total score 16-40
- B Stage II (mild) — bilateral cysts place her in stage II by definition
- C Stage IV (severe) — total score ≥40 ✓
- D Classification cannot be determined without laparoscopic staging
Explanation
rASRM staging: Stage I (1-5), Stage II (6-15), Stage III (16-40), Stage IV (>40). Dense cul-de-sac obliteration scores 40 points alone (partial = 4, complete = 40 points). Bilateral endometriomas 3 cm each contribute significantly (each scores: right ovary >3 cm = 16 points in partial or complete). Thus bilateral endometriomas with complete cul-de-sac obliteration and bilateral adhesions easily exceeds total score of 40, placing her in Stage IV. However, rASRM stage does not correlate well with pain severity or fertility outcomes — ENZIAN score is more comprehensive for deep infiltrating endometriosis (DIE).
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.