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What is the Enzian score for endometriosis?

Topic:Deep Disease
Affected areas:pelvicbowelbladder
An illustration of 3 silhouetted women each showing discomfort in areas of the pelvis.

The Enzian score is a detailed way clinicians describe where deep infiltrating endometriosis (DIE) is located and how extensive it is. Unlike simple “stage” systems, Enzian focuses on endometriosis that grows into deeper tissues and can involve structures like the uterosacral ligaments, rectovaginal area, bowel, bladder, and ureters—areas that often drive bowel, urinary, or deep pain symptoms.


In practical terms, an Enzian classification helps your surgical team communicate the anatomic pattern of disease and plan the right imaging, operative approach, and multidisciplinary support when organs may be involved. It’s also a reminder that symptom severity doesn’t always match what’s seen on exam or imaging—deep disease can be easy to miss without a targeted evaluation. If you’ve been told your findings are “mild” but your symptoms suggest deeper involvement, our team can help interpret prior reports and discuss what an Enzian-style mapping and excision-focused plan could look like.

Get clarity on your Enzian score

If your report mentions Enzian, we’ll explain what it means for deep infiltrating endometriosis and where disease may be affecting bowel, bladder, or ureters. Our specialists use this information to guide imaging, surgical planning, and the right multidisciplinary care.

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Dr. Steven Vasilev delivers best-in-class endometriosis guidance and a personalized treatment plan—built on evidence and your unique biology.


Led by Steven Vasilev, MD—an internationally recognized endometriosis specialist & MIGS surgeon—Lotus Endometriosis Institute is virtual-forward, with many patients traveling nationally for care. Clinical evaluation and surgical treatment are provided in California.

Santa Monica, CA

2121 Santa Monica Blvd, Santa Monica, CA 90404

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Arroyo Grande, CA

154 Traffic Way, Arroyo Grande, CA 93420