Monday, 8 November 2010

Stages of endometriosis (revised AFS stages I-IV)

Revised American Fertility Society scores (0-5 = stage 1, 6-16 = stage 2, 16-40 = stage 4, >40 = stage 4) suggest a progression of "endometriosis" that coincides with symptoms and laparoscopic scores.  Neither is true.  In fact there looks like three forms of chronic pelvic pain - (1) CPP with no endometriosis (2) CPP with minor endometriosis (<15) (3) CPP with major endometriosis (>15) ......  and these are <!--more---> separate entities rather than a progression of the condition.

What is absolutely clear is that symptoms such as chronic pelvic pain, bear no relationship to the extent of the endometriosis found at laparoscopy.  For the most part this is predictable from a consideration of the aetiology.  Advanced nulliparous endometriosis associated with persistent physical straining during defaecation results from recurrent events and score heavily (particularly since fusion of the rectum to the vagina scores 20 points, stges 3/4).  Whereas significant injuries in childbirth are one-off injuries and the presence or absence of endometriosis may depend on choice of feeding; breastfeeding results in no endometriosis (yet plenty of pain, stage 0) though bottlefeeding results in early menstruation before the intrapartum injuries heal up (also plenty of pain, stage 1/2). 

Net result is that scores bear no relationship to symptoms, and, stages of endometriosis do not change significantly throughout the course of the condition. Surgical removal of endometriosis without dealing with underlying abnormal nerves, may not be entirely helpful.

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