Endometriosis Classification, Staging and Reporting Systems: A Review on the Road to a Universally Accepted Endometriosis Classification

Nathalie Vermeulen, Maurício Simões Abrão, Mauricio S Abrao, Jon I Einarsson, Andrew W Horne, Neil Johnson, Neil P Johnson, Ted T M Lee, Stacey A. Missmer, Stacey Missmer, John Petrozza, John C. Petrozza, Carla Tomassetti, Krina T Zondervan, Grigoris Grimbizis, Rudy Leon De Wilde, International working group of AAGL, ESGE, ESHRE and WES
Journal of minimally invasive gynecology · 2021 · vol. 28(11) , pp. 1822–1848 · doi:10.1016/j.jmig.2021.07.023 · PMID:34690085 · W3208503352
review OA: hybrid CC0 ⤵ 29 in-corpus citations
🔓 Open OA copy View on OpenAlex View on PubMed View at publisher
⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This review identified 22 endometriosis classification systems, finding no international agreement and limited validation for correlating with patient outcomes, though ENZIAN and the endometriosis fertility index showed some utility.

One-sentence paraphrase of the abstract; not a substitute for reading it. No clinical advice. How this works

Abstract

OBJECTIVE: In the field of endometriosis, several classification, staging and reporting systems have been developed. Which endometriosis classification, staging and reporting systems have been published and validated for use in clinical practice? DATA SOURCES: A systematic PUBMED literature search was performed. Data were extracted and summarized. METHODS OF STUDY SELECTION: na TABULATION, INTEGRATION AND RESULTS: Twenty-two endometriosis classification, staging and reporting systems have been published between 1973 and 2021, each developed for specific, and different, purposes. There still is no international agreement on how to describe the disease. Studies evaluating the different systems are summarized showing a discrepancy between the intended and the evaluated purpose, and a general lack of validation data confirming a correlation with pain symptoms or quality of life for any of the current systems. A few studies confirm the value of the ENZIAN system for surgical description of deep endometriosis. With regards to infertility, the endometriosis fertility index has been confirmed valid for its intended purpose. CONCLUSION: Of the 22 endometriosis classification, staging and reporting systems identified in this historical overview, only a few have been evaluated for the purpose for which they were developed. The literature search was limited to PUBMED. Unpublished classification, staging or reporting systems, or those published in books were not considered. It can be concluded that there is no international agreement on how to describe endometriosis or how to classify it, and that most classification/staging systems show no or very little correlation with patient outcomes. This overview of existing systems is a first step in working towards a universally accepted endometriosis classification.

My notes (saved in your browser only)

Outcome instruments

Enzian

Condition tags

mesh:D004715endometriosisinfertility

MeSH descriptors

Endometriosis Endometriosis Infertility Female Humans Pain Quality of Life

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (89)

Cited by (29)

Source provenance

europepmc
last seen: 2026-06-04T01:30:01.192114+00:00
openalex
last seen: 2026-06-10T16:23:13.998983+00:00
pubmed
last seen: 2026-05-13T22:24:14.728497+00:00
License: CC0 · commercial use OK