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How is endometriosis diagnosed: determining the severity of endometriosis HOW IS ENDOMETRIOSIS DIAGNOSED: DETERMINING THE SEVERITY OF ENDOMETRIOSIS
Once a diagnosis has been made the gynaecologist should mark the size and location of all your implants, cysts, endometriomas and adhesions on a drawing or prepared chart of the reproductive organs. If you have any endometrial implants or cysts located outside the pelvic cavity such as on the bowel or cervix, the gynaecologist will make a note of the location of those implants and cysts somewhere on the chart. Similarly, if any other conditions, such as pelvic inflammatory disease, are found these will also be noted.
Because of the progressive and recurrent nature of endometriosis it is important that an accurate chart of your endometriosis be made at the time of your diagnostic laparoscopy. The chart will provide a record of the initial extent of your endometriosis that can be compared at a later date with the charts made during any subsequent laparoscopics so that an accurate assessment can be made of the progress of your condition.
The information gained from the laparoscopy and the chart is then used to rate the extent and severity of your condition. There are several formal classification systems which have been developed, the most widely known being a system developed by the American Fertility Society. These classification systems generally allocate a certain number of points to each implant or cyst depending on its nature, size and location and the total number of points is then used to classify the severity of the condition.
For example, according to the American Fertility Society's classification scheme, a woman with a four centimetre endometrioma on one ovary, some adhesions on both ovaries and implants in the Pouch of Douglas would score a total of 30 points (20 + 2 + 2 + 6) which would be defined as moderate endometriosis (16-40 points).
However it appears that few gynaecologists in Australia use any of the formal classification systems. Their classification of the disease is usually based on their visual impression gained from the laparoscopy.
The four categories most commonly used to classify endometriosis are minimal, mild, moderate and severe. The terms stage I, stage II, stage III and stage IV are also used occasionally. A brief description and diagram of a typical example of each category is shown in Fig.9 on p.56.
It is important to remember that the classification system only rates the extent and severity of your endometriosis and your classification does not necessarily bear any relationship to the severity of your symptoms. Minimal or mild endometriosis can cause severe symptoms while severe endometriosis can sometimes cause no symptoms.
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