Ep47: The Limitations of the Endometriosis Staging System

Updated 2/2023. Many of us are familiar with the rASRM staging system, which classifies endometriosis into stage 1-4. In spite of its prevalent use, this staging system has many limitations – a major one being that it completely leaves out Extra Pelvic Endometriosis! We discuss some flaws of the rASRM, and chat about two other classification systems: the EFI, and the Enzian system.

**UPDATE November 2021: Since airing this episode, a new staging system was developed called the AAGL 2021 Endometriosis Classification, which was specifically designed to measure surgical complexity. Like the ASRM classification, the stage does not correlate to the patient’s pain, and the staging system doesn’t attempt to give fertility outcomes. However, there is hope that it will help in the future with surgical reimbursements and improve financial incentives to completely treat disease, especially in complex cases needing significant expert time and effort. The staging system is available as an downloadable app called AAGL Endo Classification. The surgeon can use it to go through the different areas of (abdominal) endo: peritoneal, left/right ovary, L/R fallopian tube, L/R uterer, bladder, cul-de-sac obliteration, vagina, retrocervical, rectovaginal septum, rectum/sigmoid colon, small bowel/cecum, appendix. After, they can download a PDF for you to see the locations/depth of your endo. 

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Video: The Stages of Endometriosis explained by Dr. Cook – Dr. Cook is an excision surgeon at Vital Health Endometriosis. You can also see the rASRM staging system here.

Extrapelvic Not Rare – a non-profit organization run by Wendy Bingham. Well-researched facts and informative videos on the body systems it affects and statistics.

Stages of Endometriosis – Article on endometriosis.net.

The rASRM score and the Enzian classification for endometriosis: their strengths and weaknesses. Dietmar Haas, Omar Shebl, Andreas Shamiyeh, Peter Oppelt. First published: 13 October 2012. https://doi.org/10.1111/aogs.12026.

How to improve the current ASRM classification of endometriosis? 

MR Imaging in Deep Pelvic Endometriosis: A Pictorial Essay – Antônio Coutinho, Jr, Leonardo Kayat Bittencourt , Cíntia E. Pires, Flávia Junqueira, Cláudio Márcio Amaral de Oliveira Lima, Elisa Coutinho, Marisa A. Domingues, Romeu C. Domingues, Edson Marchiori. Published Online:Mar 7 2011. https://doi.org/10.1148/rg.312105144