Revised American Society for Reproductive Medicine (rASRM) staging of endometriosis (I–IV) is based on surgical findings. However, this staging system has which well-recognised clinical limitation?

• A It poorly correlates with pain symptoms and fertility outcomes; Stage I–II can cause severe pain while Stage III–IV may be asymptomatic ✓
• B It does not categorise ovarian endometriomas or deeply infiltrating endometriosis
• C It is based on biochemical markers (CA-125) rather than anatomical involvement
• D It is applicable only to women over 30 years with infertility as the primary complaint

Explanation

The rASRM staging system scores peritoneal and ovarian implants, adhesions, and cul-de-sac obliteration to stage endometriosis I (minimal) through IV (severe). Its principal limitation is poor correlation with pain severity and fertility outcomes: patients with minimal (Stage I) disease may have debilitating dysmenorrhoea, while those with Stage IV extensive disease may have minimal pain. This occurs because pain correlates better with deep infiltrating endometriosis (especially bowel, bladder, uterosacral ligament involvement) than with the total anatomical score. Newer staging systems (ENZIAN, #ENDO) attempt to address this.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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