The classification of endometriosis: A comprehensive review

In: Modern Approaches to Endometriosis · 1991 · pp. 131–150 · doi:10.1007/978-94-011-3864-2_8 · W195820635
review OA: closed CC0 ⤵ 1 in-corpus citation
Full text JSON View on OpenAlex View at publisher
AI-generated summary by gemini-2.5-flash-lite+body, 2026-06-12

This review examines the historical evolution and critical assessment of endometriosis classification systems, contrasting descriptive, morphologic approaches with functional and clinical considerations.

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

AI-generated deep summary by claude@2026-06, 2026-06-07 · read from full text

This paper is a comprehensive review of how endometriosis has been classified over time, contrasting early descriptive, pathologist- and physiologist-driven schemes with modern diagnostic taxonomies based largely on morbid anatomy. Across the literature, it synthesizes major classification efforts and revisions and discusses how approaches have tried to link anatomic categories to clinical outcomes such as pain or infertility, while also considering methodological and conceptual limits of disease taxonomy that emphasizes form over function and observations over inferences. A key caveat explicitly implied in the framing is that reliance on morphologic categorization may not fully capture clinical behavior or patient-level illness experience, which affects how classification systems are interpreted. This paper is centrally about endometriosis — it reviews the historic evolution, critical evaluation, and status of classification systems for endometriosis.

Read from the paper's body, not the abstract. Not a substitute for reading the paper. No clinical advice. How this works

Full text 10,640 characters · extracted from oa-doi-fallback · 3 sections · click to expand

Abstract

Most early medical classifications were descriptive, frequently devised by pathologists and physiologists who were interested in the aetiology and pathophysiology of specific disorders. The impact on clinical medicine caused Feinstein1 to remark The organization of data and thought in modern clinical therapy is still based on a diagnostic classification of disease — the taxonomy of morbid anatomy — that was initiated almost 200 years ago. In preserving the diagnostic nomenclature of pathologic anatomy as the main contemporary system of identifying human ailments, clinicians perpetuate a mode of thinking that classifies morphologic form, but not clinical function; that classifies disease, but not people or illness; and that classifies clinical inferences, but not clinical observations. Preview Unable to display preview. Download preview PDF. Similar content being viewed by others

References

Feinstein, A.R. (1967). Clinical Judgment, pp. 72–73 (Huntington, NY: Robert E. Krieger) Sampson, J.A. (1921). Perforating hemorrhagic (chocolate) cysts of ovary. Arch. Surg., 3, 245–323 Sampson, J.A. (1922). The life history of ovarian hematomas (hemorrhagic cysts) of endometrial (muellerian) type. Am. J. Obstet. Gynecol., 4, 451–512 Wicks, M.J. and Larson, C.P. (1949). Histologic criteria for evaluating endometriosis. Northwest Med., 48, 611–613 Huffman, J.W. (1951). External endometriosis. Am. J. Obstet. Gynecol., 62, 1243–1252 Weitzman, G.A. and Buttram, V.C., Jr (1989). Classification of endometriosis. Obstet. Gynecol. Clin. North Am., 16, 64–77 Sturgis, S.H. and Call, B.J. (1954). Endometriosis peritonei—relationship of pain to function activity. Am. J. Obstet. Gynecol., 68, 1421–1431 Norwood, G.E. (1960). Sterility and fertility in women with pelvic endometriosis. Clin. Obstet. Gynecol., 3, 456–471 Riva, H.L., Kawasaki, D.M. and Messinger, A.J. (1962). Further experience with norethynodrel in treatment of endometriosis. Obstet. Gynecol., 19, 111–117 Beecham, C.T. (1966). Classification of endometriosis. Obstet. Gynecol., 28, 437 Ranney, B. (1971). Endometriosis. III. Complete operations. Am. J. Obstet. Gynecol., 109, 1137–1144 Candiani, G.C. (1986). The classification of endometriosis: historic evolution, critical review and present state of the art. Acta Eur. Fertil., 17, 85–91 Acosta, A.A., Buttram, V.C., Besch, P.K., Malinak, L.R., Franklin, R.R. and Vanderheyden, J.D. (1973). A proposed classification of endometriosis. Obstet. Gynecol., 42, 19–25 Mitchell, G.W. and Farber, M. (1974). Medical versus surgical management of endometriosis. In Reid, D.E. and Christian, C.D. (eds.) Controversy in Obstetrics and Gynecology, II, pp. 631–636. (Philadelphia: W.B. Saunders) Dmowski, W.P. and Cohen, M.R. (1975). Treatment of endometriosis with an antigonadotropin, Danazol. Obstet. Gynecol., 46, 147–154 Ingersoll, F.M. (1977). Selection of medical or surgical treatment of endometriosis. Clin. Obstet. Gynecol., 20, 849–864 Kistner, R.W., Siegler, A.M. and Behrman, S.J. (1977). Suggested classification for endometriosis: relationship to infertility. Fertil. Steril., 28, 1008–1010 Buttram, V.C. (1978). An expanded classification of endometriosis. Fertil. Steril., 30, 240–242 Buttram, V.C. (1979). Surgical treatment of endometriosis in the infertile female: a modified approach. Fertil. Steril., 32, 635–640 Cohen, M.R. (1979). Laparoscopy and the management of endometriosis. J. Reprod. Med., 23, 81–84 American Fertility Society (1979). Classification of endometriosis. Fertil. Steril., 32, 633–634 Hasson, H.M. (1981). Classification for endometriosis (Letter to the editor). Fertil. Steril., 35, 368–369 Rock, J.A., Guzick, D.S., Sengos, C., Schweditsch, M., Sapp, K.C. and Jones, H.W., Jr (1981). The conservative surgical treatment of endometriosis: evaluation of pregnancy success with respect to the extent of disease as categorized using contemporary classification systems. Fertil. Steril., 35, 131–137 Guzick, D.S., Bross, D.S. and Rock, J.A. (1982). Assessing the efficacy of the American Fertility Society’s classification of endometriosis: application of a dose-response methodology. Fertil. Steril., 38, 171–176 Brosens, I.A., Cornille, F., Koninckx, P. and Vasquez, G. (1985). Evolution of the revised American Fertility Society classification of endometriosis. Fertil. Steril., 44, 714–716 Buttram, V.C. (1985). Evolution of the revised American Fertility Society classification of endometriosis. Fertil. Steril., 43, 347–350 American Fertility Society (1985). Revised American Fertility Society classification of endometriosis: 1985. Fertil. Steril., 43, 351–352 Buttram, V.C. (1987). Classification of endometriosis. Contrib. Gynecol. Obstet., 16, 73–83 Beecham, C.T. (1949). Surgical treatment of endometriosis. Am. J. Obstet. Gynecol., 139, 971–972 Malinak, L.R. (1980). Infertility and endometriosis: operative technique, clinical staging, and prognosis. Clin. Obstet. Gynecol., 23, 925–936 Metzger, D.A., Olive, D.L., Stohs, G.F. and Franklin, R.R. (1986). Association of endometriosis and spontaneous abortion: effect of control group selection. Fertil. Steril., 45, 18–22 Williams, T.J. and Pratt, J.H. (1977). Endometriosis in 1,000 consecutive celiotomies: incidence and management. Am. J. Obstet. Gynecol., 129, 245–250 Jenkins, S., Olive, D.L. and Haney, A.F. (1986). Endometriosis: pathogenic implications of anatomic distribution. Obstet. Gynecol., 67, 335–338 Wheeler, J.M. and Malinak, L.R. (1985). Application of computerized pelvic mapping to the conservative surgical treatment of endometriosis: analysis of anatomic areas in relations to prognosis for postoperative pregnancy. Presented at the 41st Annual Meeting of The American Fertility Society, September 30, Chicago, Illinois Wheeler, J.M. and Malinak, L.R. (1987). Computer graphic pelvic mapping, second look laparoscopy, and the distinction of recurrent versus persistent endometriosis. Presented at the 43rd Annual Meeting of The American Fertility Society, September 28–30, Reno, Nevada Wheeler, J.M. and Malinak, L.R. (1987). When “bad” endometriosis is not “severe”: analysis of endometriosis of the bladder, ureter, cervix, vagina and vulva with implications current classification systems. Presented at the 43rd Annual Meeting of The American Fertility Society, September 28–30, Reno, Nevada Brosens, I., Vasquez, G. and Gordts, S. (1984). Scanning electron microscopy study of the pelvic peritoneum in unexplained infertility and endometriosis. Fertil. Steril., 41 (suppl.), S21 Vasquez, G., Cornillie, F. and Brosens, I. (1984). Peritoneal endometriosis: scanning electron microscopy and histology of minimal pelvic endometriotic lesions. Fertil. Steril., 42, 696–703 Murphy, A.A., Green, W.R., Bobbie, D., dela Cruz, Z.C. and Rock, J.A. (1986). Unsuspected endometriosis documented by scanning electron microscopy in visually normal peritoneum. Fertil. Steril., 46, 522–524 Jansen, R.P.S. and Russell, P. (1986). Nonpigmented endometriosis: clinical, laparoscopic, and pathologic definition. Am. J. Obstet. Gynecol., 155, 1154–1159 Dizerega, G.S., Barber, D.L. and Hodgen, G.D. (1980). Endometriosis: role of ovarian steroids in initiation, maintenance and suppression. Fertil. Steril., 33, 649–653 Muse, K. (1988). Clinical manifestations and classification of endometriosis. Clin. Obstet. Gynecol., 31, 813–822 Barbieri, R.L., Niloff, J.M., Bast, R.C., Jr., Schaetzl, E., Kistner, R.W. and Knapp, R.C. (1986). Elevated serum concentrations of CA-125 in patients with advanced endometriosis. Fertil. Steril., 45, 630–634 Badawy, S.Z.A., Cuenca, V., Marshall, L., Munchback, R., Rinas, A.C. and Coble, D.A. (1984). Cellular components in peritoneal fluid in infertile patients with and without endometriosis. Fertil. Steril., 42, 704–708 Vernon, M.W., Beard, J.S., Graves, K. and Wilson, E.A. (1986). Classification of endometriotic implants by morphologic appearance and capacity to synthesize prostaglandin F. Fertil. Steril., 46, 801–806 Syrop, C.H. and Halme, J. (1987). Peritoneal fluid environment and infertility. Fertil. Steril., 48, 1–9 Fakih, H., Baggett, B., Holtz, G., Tsang, K., Lee, J.C. and Williamson, H.O. (1987). Interleukin-1: a possible role in the infertility associated with endometriosis. Fertil. Steril., 47, 213–217 Verkauf, B.S. (1983). The incidence and outcome of single-factor, multifactorial, and unexplained infertility. Am. J. Obstet. Gynecol., 147, 175–181 Leridon, J. and Spira, A. (1984). Problems in measuring the effectiveness of infertility therapy. Fertil. Steril., 41, 580–586 Feinstein, A.R. (1964). Scientific methodology in clinical medicine. II. Classification of human disease by clinical behavior. Ann. Intern. Med., 61, 757–781 Cramer, D.W., Walker, A.M. and Schiff, I. (1979). Statistical methods in evaluating the outcome of infertility therapy. Fertil. Steril., 32, 80–86 Adamson, G.D., Drison, L. and Lamb, E.J. (1982). Endometriosis: studies of a method for the design of a surgical staging system. Fertil. Steril., 38, 659–666 Gonnella, J.S., Hornbrook, M.C. and Louis, D.Z. (1984). Staging of disease. J. Am. Med. Assoc., 251, 637–644 Olive, D.L. (1986). Analysis of clinical fertility trials: a methodologic review. Fertil. Steril., 45, 157–171 Guzick, D.S. and Rock, J.A. (1981). Estimation of a model of cumulative pregnancy following infertility therapy. Am. J. Obstet. Gynecol., 140, 573–578 Guzick, D.S., Bross, D.S. and Rock, J.A. (1982). A parametric method for comparing cumulative pregnancy curves following infertility therapy. Fertil. Steril., 37, 503–507 Olive, D.L. and Lee, K.L. (1986). Analysis of sequential treatment protocols for endometriosis-associated infertility. Fertil. Steril., 154, 613–619 Buttram, V.C., Reiter, R.C. and Ward, S. (1985). Treatment of endometriosis with danazol: report of a 6-year prospective study. Fertil. Steril., 43, 353–360 Editor information Editors and Affiliations Rights and permissions Copyright information © 1991 Springer Science+Business Media Dordrecht About this chapter Cite this chapter Groff, T.R. (1991). The classification of endometriosis: A comprehensive review. In: Thomas, E.J., Rock, J.A. (eds) Modern Approaches to Endometriosis. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-3864-2_8 Download citation DOI: https://doi.org/10.1007/978-94-011-3864-2_8 Publisher Name: Springer, Dordrecht Print ISBN: 978-94-010-5719-6 Online ISBN: 978-94-011-3864-2 eBook Packages: Springer Book Archive

Keywords

These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Text is read by the "Ask this paper" AI Q&A widget below. Extraction quality varies by source — PMC NXML preserves structure cleanly, OA-HTML may include some navigation residue, and OA-PDF can have broken hyphenation. The publisher copy (via DOI) is the canonical version.

My notes (saved in your browser only)

Ask this paper AI returns verbatim quotes from the full text · source: oa-doi-fallback

Answers must be backed by verbatim quotes from this paper's full text. Hallucinated quotes are dropped automatically; if no verbatim passage answers the question, we say so. How this works

Condition tags

endometriosis

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 (58)

Cited by (1)

Source provenance

openalex
last seen: 2026-06-10T17:14:06.276822+00:00
unpaywall
last seen: 2026-08-23T06:29:45.520198+00:00
License: CC0 · commercial use OK