Klassifikation der Endometriose

Jutta Engel, E. Berkes, Hans‐Rudolf Tinneberg
In: Der Gynäkologe · 2015 · vol. 48(3) , pp. 200–208 · doi:10.1007/s00129-014-3423-z · W78081670
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⚙ AI-generated summary by claude@2026-06+body, 2026-06-13 ⓘ

The rASRM classification stages endometriosis severity, the EFI incorporates fertility prognosis, and the ENZIAN classification addresses deep infiltrating endometriosis, yet no system fully captures all multidimensional aspects, including pain.

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This review paper discusses the need for an accepted, easy-to-use endometriosis classification to support research and treatment algorithm development, noting that endometriosis affects about 10% of women of reproductive age and is characterized by recurrent lower abdominal pain and reduced fertility. It summarizes major existing scoring systems: the rASRM (revised American Society of Reproductive Medicine) classification based on laparoscopic staging (I–IV), and the endometriosis fertility index (EFI), which builds on rASRM while adding anatomical and medical history parameters, alongside the ENZIAN classification for deep infiltrating endometriosis that uses a TNM-like approach across three abdominal compartments with severity grades. A key limitation stated is that both rASRM/EFI and ENZIAN omit the clinically relevant pain dimension, which the authors say must be separately captured using a visual analog scale (VAS), and they conclude no system yet multidimensionally reflects all aspects of endometriosis. This paper is centrally about endometriosis — it reviews and compares existing endometriosis classification systems (rASRM, EFI, and ENZIAN) and highlights what they do and do not capture, including deep infiltrating disease and pain.

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Abstract

Background Endometriosis is a chronic disease, which affects approximately 10 % of women of reproductive age and due to recurrent lower abdominal pain and impairment of fertility has a negative impact on the work force and the quality of life. A generally accepted and easy to apply classification of endometriosis would be helpful in the research of various aspects of the disease and in formulating a treatment algorithm.

Results

and discussion The most commonly available classification was established by the American Fertility Society and is now known in a revised form as the American Society of Reproductive Medicine (rASRM) classification. It is based on a scoring system after laparoscopic evaluation and stages from I–IV can be applied which reflect the severity of disease. As this rASRM classification does not clearly reflect a prognosis for infertility patients, the endometriosis fertility index (EFI) was developed which is based on the rASRM classification but in addition includes anatomical and medical history parameters for each patient. However, neither of these two scoring algorithms considers the clinically relevant deep infiltrating endometriosis. For this reason the ENZIAN classification was developed, which includes a classification of infiltrating endometriosis and is based on the TNM classification for tumors. The ENZIAN classification describes manifestations of endometriosis in three different anatomical compartments of the abdomen and assigns each to a degree of severity.Although this classification represents a significant improvement, up to now no classification exists which reflects all aspects of endometriosis multidimensionally. For example, the dimension “pain” is not present in any of the classification systems and must be additionally documented using a visual analog scale (VAS). Similar content being viewed by others Literatur American Fertility Society (1979) Classification of endometriosis. Fertil Steril 32:631–634 American Fertility Society (1985) Revised American Fertility Society classification: 1985. Fertil Steril 43:351–352 American Society of Reproductive Medicine (1997) Revised American Society of Reproductive Medicine classification of endometriosis. Fertil Steril 67:817–821 Mettler L, Schollmeyer T, Lehmann-Willenbrock E et al (2003) Accuracy of laparoscopic diagnosis of endometriosis. JSLS 7:15–18 Vercellini P, Fedele l, Aimi G et al (2006) Reproductive performance, pain recurrence and disease relapse after conservative surgical treatment for endometriosis: the predicitive value of the current classification system. Hum Reprod 21:2679–2685 Adamson GD, Pasta DJ (2010) Endometriosis fertility index: the new, validated endometriosis staging system. Fertil Steril 94:1609–1615 Wei DM, Yu Q, Sun AJ et al (2011) Relationship between endometriosis fertility index and pregnancies after laparoscopic surgery in endometriosis-associated infertility. Zhonghua Fu Chan Ke Za Zhi 46:806–808 Thomasetti C, Geysenbergh B, Meuleman C et al (2013) External validation of the endometriosis fertility index (EFI) staging system for predicting non-ART pregnancy after endometriosis surgery. Hum Reprod 28:1280–1288 Tuttlies F, Keckstein J, Ulrich U et al (2005) ENZIAN-Score, a classification of deep infiltrating endometriosis. Zentralbl Gynakol 127:275–281 Hackethal A, Luck C, Konrad L et al (2012) Deep infiltrating endometriosis is frequent in all stages of endometriosis and the depth of infiltration influences surgical parameters proportionally. J Endometriosis 2:205–2012 Tuttlies F, Keckstein J, Ulrich U et al (2008) ENZIAN-Klassifikation zur Diskussion gestellt: Eine neue differenzierte Klassifikation der tief infiltrierenden Endometriose. J Gynakol Endokrinol 18:7–13 Tinneberg HR, Tuttlies F, Berkes E et al (2014) Classification of Endometriosis endometriosis − pathogenesis and treatment. In: Harada T (ed) Springer, Berlin Heidelberg New York Tokyo Haas D, Chvatal R, Habelsberger A (2011) Comparison of revised American Fertility Society and ENZIAN staging: a critical evaluation of classifications of endometriosis on the basis of our patient population. Fertil Steril 95(5):1574-1578 Einhaltung ethischer Richtlinien Interessenkonflikt. H.R. Tinneberg, J. Engel und E. Berkes geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren. Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Engel, J., Berkes, E. & Tinneberg, H. Klassifikation der Endometriose. Gynäkologe 48, 200–208 (2015). https://doi.org/10.1007/s00129-014-3423-z Published: Issue date: DOI: https://doi.org/10.1007/s00129-014-3423-z

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