The American Society for Reproductive Medicine (ASRM) revised classification of endometriosis scores lesions based on size, depth of invasion, and location. A woman with bilateral ovarian endometriomas (combined score 16), no adnexal adhesions, and mild cul-de-sac obliteration would be assigned which stage?

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

Explanation

The ASRM revised classification (rASRM 1996) assigns numerical scores based on peritoneal and ovarian endometriosis lesion size/depth, cul-de-sac involvement, and adhesions. Scores are: Stage I minimal (1–5), Stage II mild (6–15), Stage III moderate (16–40), Stage IV severe (>40). Bilateral ovarian endometriomas of significant size score heavily; a combined lesion score of 16 places the patient in Stage III (moderate) assuming cul-de-sac partial obliteration and bilateral endometriomas. Stage IV requires >40 points, typically seen with complete cul-de-sac obliteration and dense adhesions.

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

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