Understanding the Different Types of Endometriosis Lesions

In "Understanding the Different Types of Endometriosis Lesions," our experts turn to the primary goals of treatment and the disease's four distinct subtypes.

The panel opens Section 2 on optimizing medical management by first breaking down the different subtypes of endometriosis, which may be distinct diseases or may simply coexist within the same patient. Superficial, or peritoneal, endometriosis describes lesions sitting above the peritoneal layer without infiltrating below it. Deep endometriosis is subperitoneal disease that can range from half a millimeter to three or four centimeters and can invade the muscularis of adjacent organs like the bowel or bladder. Ovarian endometriosis, commonly called a chocolate cyst, involves endometrium-like tissue inside the ovary itself, and the panel stresses that 85% of the time it comes with associated deep disease elsewhere, even though it is easily picked up on a basic ultrasound. That combination can catch surgeons off guard when they are called into another surgeon's operating room expecting an isolated cyst and instead find extensive disease throughout the pelvis. A fourth category, extra-pelvic endometriosis, describes endometrium-like tissue found entirely outside the pelvis. The panel then turns to when medical treatment is indicated, explaining that a patient history revealing dysmenorrhea, non-menstrual pain, and dyspareunia correlates highly with an endometriosis diagnosis, alongside dyschezia, dysuria, and infertility. For patients not immediately seeking pregnancy, ovarian suppression through hormonal management becomes the primary medical treatment path. The discussion also revisits a familiar clinical puzzle: pain severity does not reliably correlate with disease extent, so a patient with only superficial disease can have overwhelming pain. Dr. Davitt agrees, adding that treatment goals should always come from the patient, whether that means symptom relief or optimizing fertility, and that age, reproductive goals, and symptom severity together determine the treatment path a clinician recommends alongside a thorough history and physical exam.

The next episode in this series, "Weighing Surgical Versus Medical Management in Endometriosis," turns to Dr. Davitt's approach to surgery and its real-world costs.