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Balaji Horizon Women's Hospital

Endometriosis · Stages

Endometriosis Stages – What They Mean and Do Not Mean

Endometriosis is staged I-IV based on lesion size, location, and adhesions per the ASRM scoring system. Importantly, stage does not always correlate with symptom severity or pain.

ASRM staging

The classification system

Stage I (minimal): superficial implants, mild adhesions. Stage II (mild): more extensive superficial lesions. Stage III (moderate): deep implants, mild adhesions, ovarian involvement. Stage IV (severe): deep implants, dense adhesions, large endometriomas.

Limitations of staging

What ASRM does not capture

Pain severity does not correlate with stage – a woman with stage I disease can have severe pain. Bowel and bladder involvement are not well captured. Fertility impact varies independently of stage. Newer #Enzian system better captures deep disease.

Why staging still matters

Clinical use

Standardised communication between specialists. Surgical planning. Research and outcome comparison. Counselling about overall disease burden. Useful but not the only metric for treatment decisions.

Common questions
Endometriosis anatomy and rASRM staging illustration
rASRM staging is an anatomical score from surgery — it does not measure pain or predict fertility on its own.
Dr Priyadatt Patel, endometriosis and advanced laparoscopic surgeon, Ahmedabad

Dr Priyadatt Patel
Endometriosis & Advanced Laparoscopic Surgeon

Dr Patel maps and, where indicated, stages disease at surgery — but counsels on your symptoms, fertility and ovarian reserve, never on the stage number alone.

Standards & further reading. Aligned with ESHRE, ESGE and ISUOG guidance.

Explore related topics

Frequently asked

What stage am I?
Definitive staging requires laparoscopy. Imaging can suggest stage but cannot fully replace surgical assessment.
Is stage I endometriosis less serious?
Not necessarily. Stage I can cause significant pain and fertility impact. Severity is multifaceted.
Will my stage progress over time?
Endometriosis can progress, regress, or stay stable. Hormonal management reduces progression risk. Pregnancy temporarily suppresses disease.

Understand what your stage really means

A staging result is only useful alongside your symptoms, fertility goals and reserve. We put it in context.

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Dr. Priyadatt Patel

Senior Gynecologist · Advanced Laparoscopic Surgeon · IVF and Endometriosis Programme Lead

MS OBGyn · Pregnancy Care · Advanced Gynaecological Ultrasound · Fertility Preservation

ESHRE / ESGE / AAGL / ASRM guideline-aligned practice. 3D Karl Storz precision technique. Fertility-preservation-first philosophy. Evidence-based decisions, honest counselling, long-term outcomes orientation.

Endometriosis
Superficial to deep infiltrating, fertility-preserving excision
IVF & Fertility
Individualised protocols, ART Level 2 lab, transparent outcomes
Advanced Laparoscopy
3D Karl Storz precision, nerve-sparing technique
Pregnancy Care
Antenatal care, high-risk pregnancy, advanced ultrasound
Balaji Horizon Women Hospital
Science City Road, Ahmedabad 380060
Mon–Sat 11:00–20:00 · +91 97234 31544
Balaji Women Clinic (AEC)
Naranpura, Ahmedabad
Mon–Sat 08:30–10:30 · +91 70460 02566
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