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Written by Dr Serena Jones, GP
Dr Serena graduated from Manchester University in 2008 (MBChB).
She also holds the MRCGP, DRCOG and DFSRH.
Endometriosis is a common but often misunderstood gynaecological condition, affecting around 1 in 10 women of reproductive age in the UK. According to the NHS, it is one of the leading causes of chronic pelvic pain and can also contribute to fertility difficulties.
Although endometriosis is frequently discussed as a single condition, there are several different types of endometriosis, each with distinct characteristics. Understanding these types can help guide diagnosis, treatment, and referral decisions.
What is Endometriosis?
Endometriosis occurs when tissue similar to the lining of the womb (endometrium) grows outside the uterus. This tissue responds to hormonal changes during the menstrual cycle, leading to inflammation, irritation, and sometimes scar tissue (adhesions).
Common symptoms include:
- Severe period pain
- Chronic pelvic pain
- Pain during sex
- Painful bowel movements
- Fatigue
- Subfertility
Importantly, symptom severity does not always reflect how extensive the disease is.
The Main Types of Endometriosis
Superficial Peritoneal Endometriosis
This is the most common type. Endometrial-like tissue grows on the surface of pelvic organs or the lining of the pelvis (peritoneum). It may affect the ovaries, fallopian tubes, bladder, or outer surface of the uterus.
Although lesions are shallow, they can still cause significant pain, particularly during menstruation. Many patients report cyclical pelvic pain and bloating. This type may respond well to hormonal treatments that suppress ovulation.
Ovarian Endometriomas (“Chocolate Cysts”)
Endometriomas occur when endometriosis develops within the ovaries, forming cysts filled with thick, dark fluid. These are commonly known as “chocolate cysts”.
They can cause:
- Severe period pain
- Pelvic pressure
- Pain during intercourse
- Difficulty conceiving
Large or symptomatic cysts may require monitoring or surgical removal, particularly if fertility is a concern.
Deep Infiltrating Endometriosis (DIE)
DIE is defined as disease that penetrates more than 5mm beneath the surface of pelvic tissues. It can involve the bowel, bladder, uterosacral ligaments, or vaginal wall.
This type often causes more severe symptoms, including:
- Intense menstrual pain
- Pain during bowel movements
- Pain during sex
- Lower back pain
DIE is more likely to result in adhesions, where organs stick together. Management may require referral to specialist endometriosis centres for multidisciplinary care.
Other Rare Forms
In rare cases, endometriosis can be found outside the pelvis, such as in the lungs, diaphragm, or even the skin. Although uncommon, these forms can produce unique symptoms, including chest pain or skin lesions that coincide with menstrual cycles.
Why Does the Type Matter?
Identifying the type of endometriosis helps determine the most appropriate management plan. While superficial disease may respond to medication, deep infiltrating disease often requires specialist surgical expertise. Ovarian endometriomas may affect fertility planning and require tailored monitoring.
Early recognition, appropriate imaging, and timely referral are essential to improving outcomes.
When to seek Medical Advice:
Anyone experiencing severe period pain, pelvic pain that disrupts daily life, pain during sex, or fertility concerns should speak to their GP. Early assessment can lead to earlier intervention and improved quality of life.
Endometriosis is complex, but with the right support and individualised care, symptoms can be effectively managed.
Kinetik Wellbeing do a selection of women’s health products that can help with your pain, you can find them here.
