Stages of Endometriosis

Doctors often grade endometriosis into four stages, from minimal to severe. The scheme most used is the revised American Society for Reproductive Medicine (rASRM) classification, and it is usually assigned at keyhole (laparoscopic) surgery.

The four stages

• Stage I (minimal). A few small, shallow patches.
• Stage II (mild). More patches, still mostly shallow.
• Stage III (moderate). Many deeper patches, often with ovarian cysts and some scar tissue (adhesions).
• Stage IV (severe). Widespread deep disease, large ovarian cysts and dense adhesions that can bind organs together.

The key thing to understand

The stage does not predict pain. A woman with stage I can have severe pain, and a woman with stage IV can have mild symptoms. Stage also does not reliably predict how hard it will be to conceive. So treatment is chosen by symptoms and goals, not by the stage alone.

How the disease behaves over time

• Endometriosis is usually long term and tends to fluctuate. It often improves with hormonal treatment and pregnancy, though not always.
• It generally settles after menopause, when oestrogen falls, unless hormone therapy is used.
• Without treatment it may progress in some women, and may stay the same or improve in others.

Newer approaches

Some centres use other systems, such as Enzian or the endometriosis fertility index, to describe deep disease and fertility outlook. Ask your doctor which is used for you.

A classical note. Ayurveda describes diseases moving through stages of dosha disturbance. This is a teaching framework. In practice, the stage given by a surgeon and your own symptoms guide care.

Focus on how you feel and what you want, and not only on the number.