Endometriosis classification systems: an international survey to map current knowledge and uptake

K T Zondervan, Krina T. Zondervan, S Missmer, MS Abrao, Missmer S, Abrao MS, J I Einarsson, M S Abrao, A W Horne, Einarsson JI, N P Johnson, Horne AW, T T M Lee, Johnson Np, Lee TTM, J Petrozza, Petrozza J, C Tomassetti, Carla Tomassetti, N Vermeulen, Vermeulen N, G Grimbizis, R L De Wilde, Grimbizis G, International Working Group of AAGL, ESGE, ESHRE and WES, De Wilde RL
Facts, views & vision in ObGyn · 2022 · vol. 14(1) , pp. 5–15 · doi:10.52054/fvvo.14.1.001 · PMID:35226445 · PMC9612861 · W4214619892
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⚙ AI-generated summary by claude@2026-06, 2026-06-10 ⓘ

This survey of 1178 clinicians found that while most use an endometriosis classification system, they desire a new, simple, clinically relevant surgical descriptive system.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 · read from full text ⓘ

This international cross-sectional survey studied clinician uptake and motivations for using existing endometriosis classification and reporting systems, focusing on rASRM, EFI, and ENZIAN. Data from 1178 clinicians (surgeons, gynecologists, reproductive endocrinologists, fertility specialists, and sonographers) were collected via an online SurveyMonkey questionnaire and analyzed with SPSS. The study found that 75.5% reported using some endometriosis classification system, with rASRM best known and used, while EFI and ENZIAN were known by many but used by only a minority, and lack of clinical relevance was the most commonly reported problem. The paper explicitly limits inference about clinical accuracy or patient outcomes because it assesses self-reported use and feedback rather than objective performance. This paper is centrally about endometriosis—an international survey mapping current uptake of classification systems and identifying clinician expectations for a new simple surgical descriptive system.

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Abstract

Background: In the field of endometriosis, several classification, staging and reporting systems have been developed and published, but there are no data on the uptake of these systems in clinical practice. Objectives: The objective of the current study was to examine whether clinicians routinely use the existing endometriosis classification systems, which system do they use and what are the clinicians’ motivations? Materials and Methods: A cross-sectional study was performed to gather data on the current use of endometriosis classification systems, problems encountered and interest in a new simple surgical descriptive system for endometriosis. Of particular focus were three systems most commonly used: the Revised American Society for Reproductive Medicine (rASRM) classification, the Endometriosis Fertility Index (EFI), and the ENZIAN classification. Data were analysed by SPSS. A survey was designed using the online SurveyMonkey tool consisting of 11 questions concerning three domains— participants’ background, existing classification systems and intentions with regards to a new classification system for endometriosis. Replies were collected between 15 May and 1 July 2020. Main outcome measures: Uptake, feedback and future intentions. Results: The final dataset included the replies of 1178 clinicians, including surgeons, gynaecologists, reproductive endocrinologists, fertility specialists and sonographers, all managing women with endometriosis in their clinical practice. Overall, 75.5% of the professionals indicate that they currently use a classification system for endometriosis. The rASRM classification system was the best known and used system, the EFI system and ENZIAN system were known by a majority of the professionals but used by only a minority. The lack of clinical relevance was most often selected as a problem with using any system. The findings of the survey suggest that clinicians worldwide are open to using a new classification system for endometriosis that can achieve standardised reporting, and is clinically relevant and simple. Conclusions: Even with a high uptake of the existing endometriosis classification systems (rASRM, ENZIAN and EFI), most clinicians managing endometriosis would like a new simple surgical descriptive system for endometriosis. What is new? The findings therefore support future initiatives for the development of a new descriptive system for endometriosis and provide information on user expectations and conditions for universal uptake of such a system.
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Abstract

Background In the field of endometriosis, several classification, staging and reporting systems have been developed and published, but there are no data on the uptake of these systems in clinical practice.

Objectives

The objective of the current study was to examine whether clinicians routinely use the existing endometriosis classification systems, which system do they use and what are the clinicians’ motivations?

Materials and methods

A cross-sectional study was performed to gather data on the current use of endometriosis classification systems, problems encountered and interest in a new simple surgical descriptive system for endometriosis. Of particular focus were three systems most commonly used: the Revised American Society for Reproductive Medicine (rASRM) classification, the Endometriosis Fertility Index (EFI), and the ENZIAN classification. Data were analysed by SPSS. A survey was designed using the online SurveyMonkey tool consisting of 11 questions concerning three domains—participants’ background, existing classification systems and intentions with regards to a new classification system for endometriosis. Replies were collected between 15 May and 1 July 2020. Main outcome measures Uptake, feedback and future intentions.

Results

The final dataset included the replies of 1178 clinicians, including surgeons, gynaecologists, reproductive endocrinologists, fertility specialists and sonographers, all managing women with endometriosis in their clinical practice. Overall, 75.5% of the professionals indicate that they currently use a classification system for endometriosis. The rASRM classification system was the best known and used system, the EFI system and ENZIAN system were known by a majority of the professionals but used by only a minority. The lack of clinical relevance was most often selected as a problem with using any system. The findings of the survey suggest that clinicians worldwide are open to using a new classification system for endometriosis that can achieve standardised reporting, and is clinically relevant and simple.

Conclusions

Even with a high uptake of the existing endometriosis classification systems (rASRM, ENZIAN and EFI), most clinicians managing endometriosis would like a new simple surgical descriptive system for endometriosis. What is new? The findings therefore support future initiatives for the development of a new descriptive system for endometriosis and provide information on user expectations and conditions for universal uptake of such a system.

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Outcome instruments

rASRM Enzian

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 (12)

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