The different types of endometriosis

If endometriosis, this endometrial disease which affects 10% of women in France, is starting to be discussed more and more, it is less known that it is divided into three different types depending on where the pathological development occurs. of the endometrium creates adhesions in the bodies of affected people. Superficial, ovarian or deep endometriosis : what are the differences between these three forms of endometriosis , can they be combined and how to treat them? In today's article, we take the time to focus on the three types of endometriosis that exist and can affect you. 

First of all, what is endometriosis?

Before introducing you to the three forms of endometriosis, let's start at the beginning: what is endometriosis?

What is endometriosis?

Endometriosis is a disease of the endometrium . The endometrium is the lining of the uterine wall which develops during the luteal phase of the menstrual cycle to accommodate the potential embryo and which is expelled during menstruation. However, in the case of endometriosis, the endometrium spreads beyond the uterus, into the fallopian tubes, outside the uterus, to the small intestine or even, in the deepest cases and serious, in the brain. The endometrium cannot then be expelled and creates adhesions which cause all sorts of inconveniences including severe pain, particularly during menstrual cycles .

What causes endometriosis?

The causes of endometriosis are still unknown. For a long time, endometriosis has been associated with multifactorial causes, notably genetic, but this approach has been called into question since 2023 and discoveries which would tend to associate endometriosis with a bacterial infection. Here is a summary of the considered causes of endometriosis according to the current state of knowledge:

• Retrograde menstruation theory: This theory envisages that fragments of endometrial tissue break away from the uterus during menstruation and travel through the fallopian tubes to other parts of the pelvic cavity (tubes, ovaries, bladder, rectum ), where they implant and develop, causing endometriosis;
• Genetic factors: Women who have women with endometriosis in their immediate family (sister, mother, grandmother) have a greater risk of contracting the disease. This would suggest that there is a genetic component in the development of endometriosis.
• Hormonal factors: Hormones, especially estrogen, play an important role in the growth and development of endometriosis. This is why researchers believe that hormonal imbalances or increased sensitivity to hormones may contribute to the development of the disease.
• Immune system dysfunction: It has been suggested that abnormalities in the immune system may allow endometrial cells to spread and implant in other parts of the pelvic cavity, instead of being eliminated normally by the system. immune.
• Environmental factors: Certain environmental factors, such as exposure to toxic chemicals and endocrine disruptors, may also play a role in the development of endometriosis, although research on this is still limited.
• Bacterial infection: In 2023, researchers from the Japanese University of Nagoya demonstrated that an infection caused by a bacteria of the Fusobacterium genus is involved in this hormone-dependent disease whose causes are genetic and environmental. A hypothesis never considered to date.

💡 While hormonal variations linked to pregnancy can have an impact on endometriosis, no research has yet demonstrated that pregnancy and endometriosis could be linked.

Common symptoms of endometriosis

Endometriosis affects approximately 1 in 10 women, but these figures remain unclear because the diagnosis can be long and complicated. This, on the one hand because the disease remains little studied, on the other hand because it is still common to consider it normal to have pain during your period and finally because the symptoms are very diverse and not specific to endometriosis :

• Chronic lower abdomen pain: This is one of the most common symptoms. The pain can be very severe and increase sharply during menstruation;
• Pain during sex: Some women experience pain during or after sex. This can be explained by adhesions generated by poorly expelled remains of the endometrium;
• Heavy or irregular menstrual bleeding: Menstrual bleeding that is heavier and/or more prolonged than average (usually between 2 and 5 days) can be a symptom of endometriosis;
• Intestinal or urinary pain during menstruation: Abdominal pain, digestive problems or pain when urinating can be signs of endometriosis during menstruation;
• Chronic fatigue: Fatigue can be a symptom associated with endometriosis, likely due to pain and sleep disturbances.

Can we cure endometriosis?

As of this writing, there is no cure for endometriosis. However, it is interesting to note that it diminishes significantly at menopause, when estrogen levels drop sharply in the body and cease to vary.

Current treatments consist of:

1. Slow down the occurrence of menstrual cycles, in particular by giving the pill continuously, so as to slow the progression of the disease ;
2. Perform surgery to remove sites of endometriosis in the most serious cases.

There are, however, reasons to be optimistic: since the spread of the word about this disease around ten years ago, research (and discoveries) on endometriosis have intensified. Even though just a few years ago, the disease was not considered – even by gynecologists who went so far as to deny its existence – it is now better known. Recent advances are moving towards better management of the disease.

The three types of endometriosis

There are three types of endometriosis which are distinguished from each other depending on the organs affected by the development and clumping of the endometrium.

Superficial endometriosis

Superficial endometriosis is the most common form of endometriosis – approximately 70% of endometriosis cases. In this form, lesions develop on the peritoneum, the membrane that lines the abdominal cavity and covers the abdominal organs. This form of endometriosis is particularly difficult to spot on imaging (ultrasound and MRI) and may require laparoscopy, a medical examination which consists of surgically removing a small piece of the wall of the uterus to observe it.

⚠️ Superficial endometriosis is called “superficial” in opposition to “deep” (another form of endometriosis) and not in relation to the pain it causes: superficial endometriosis can be particularly painful, just as painful in particular than deep endometriosis.

Ovarian endometriosis

In the case of ovarian endometriosis , endometriotic clumps are found on the ovaries, forming cysts called endometriomas or endometriotic ovarian cyst. They can settle on one or two ovaries.

Ovarian endometriosis is very often associated with the third form of endometriosis: deep endometriosis (60 to 70% of women with ovarian endometriosis also have deep endometriosis).

Deep endometriosis

The third form of endometriosis is called deep pelvic endometriosis, or subperitoneal endometriosis or deep infiltrating endometriosis. It is characterized by lesions located more than 5 mm from the surface of the peritoneum . The organs affected can be: the ovaries, the vagina, the uterosacral ligaments (50% of cases), the intestine (20 to 25% of cases), the rectum, the colon, the bladder (10% of cases) and the ureters (3% of cases).

Other organs, even more distant, can be affected by the disease. We then speak rather of extra-pelvic damage. Lesions in the brain were even found in one patient!

Superficial, ovarian or deep endometriosis: which is more serious?

For a time, we spoke of “stages of endometriosis” according to the organs affected by the disease (there were four stages). This term has passed and we now prefer to speak of forms or types of endometriosis. This, in particular, for one reason: these forms do not designate levels of pain or severity but rather different forms of the disease. So, deep endometriosis is not more serious or more painful than superficial endometriosis.

The type of endometriosis is above all useful for diagnosing your disease and managing it. This is all the more the case when it comes to surgery, to remove endometrial agglomerates (even if this affects a minority of women: the lesions must be perfectly localized.

How do I know if I have endometriosis?

Despite its still low recognition, endometriosis is a common disease which affects 10% of women. However, it suffers from a significant delay/absence of diagnosis: it is estimated that on average it takes seven years to be diagnosed with endometriosis after the first symptoms appear.

Know how to recognize symptoms and warning signs

Endometriosis can appear as early as puberty, at the onset of the first period, or later. It is associated with the fertile period of menstruating people: it most often resolves at menopause.

The three main symptoms that should alert you are:

1. Pelvic pain: permanent lower abdominal pain which intensifies around the time of ovulation and menstruation is the most common symptom of endometriosis (and in particular superficial endometriosis);
2. Heavy or irregular menstrual bleeding: heavy and/or long-lasting menstrual bleeding (more than 5 days) is also a symptom of endometriosis;
3. Pain and difficulties linked to transit and urination: disturbed intestinal transit and pain associated with urination, particularly during periods, can be associated with endometriosis (and in particular deep endometriosis).

All of these signs may appear “normal” to you and you might be reluctant to go for a consultation for “so little”. After all, periods are painful for many of us, right?

The warning signs that should lead you to consult are:

• New pain during your period: If you experience much more pain than usual during your period, it may mean that there is a problem. This is especially true if several consecutive cycles become more painful;
• Pain that prevents you from living: have you always had pain during your period but now it prevents you from living normally? It is not normal ;
• Difficulty getting pregnant: In some cases, endometriosis can lead to infertility. If you are unable to get pregnant naturally, it is normal to be concerned.

Consult a healthcare professional

To get diagnosed–or at least to understand and treat the pain you are experiencing–the first step in your medical journey is to talk to a healthcare professional.

The general practitioner and the gynecologist are the two professionals who can answer your questions regarding your pain and endometriosis. They will listen to you and depending on your symptoms, they will carry out a clinical examination and prescribe specific tests.

Please note that there are also gynecologists specialized in the diagnosis and treatment of endometriosis. It might be interesting to consult them but their jobs are often very busy and places are expensive!

Pass clinical exams

There are several clinical tests that can help diagnose endometriosis. However, these do not always prove effective and it is often necessary to multiply them before finding the causes of your pain.

• History and physical exam: Your doctor will often begin by discussing your medical history and symptoms. He will perform a physical examination and may in particular perform a pelvic exam, looking for any abnormalities, such as painful nodules that may indicate the presence of endometriosis.
• Pelvic ultrasound: Pelvic ultrasound is often the first test ordered to see endometriosis. It can help distinguish abnormalities that may affect the uterus and ovaries, including ovarian cysts.
• Pelvic MRI: Pelvic MRI is often used to detect and evaluate endometriosis, especially in cases where ultrasound or other imaging methods do not provide sufficient information.
• Pelvic scanner: Less used than ultrasound and MRI, this examination may be prescribed to obtain information different from the latter in the event of suspicion of endometriosis.
• Laparoscopy: If medical imaging exams do not provide enough information (this is often the case in superficial endometriosis), laparoscopy can be considered. This examination is surgical: it involves incising and removing a very small part of the wall of the organs suspected of being affected for observation. It is the examination which currently allows the most precise diagnosis of endometriosis.
• Colonoscopy: This last examination can be considered in the case of suspected deep endometriosis. This involves visualizing, using a small camera, the interior of the colon and intestine, during general anesthesia.

🖐️ To be continued! Very recently, a saliva test capable of detecting endometriosis was developed by the company Ziwig. The High Health Authority is currently carrying out tests to evaluate its effectiveness , which could lead to its reimbursement by social security and mutual insurance companies.

What treatments?

Currently, there is no treatment to cure endometriosis, whatever its form. However, there are three solutions to limit the impact and symptoms of the disease: treatment of the symptoms of the disease, slowing down the disease via hormonal treatments and surgery to reduce cysts and adhesions.

Treatments to alleviate symptoms

The first solutions that exist to treat endometriosis are solutions aimed at treating the different symptoms of endometriosis:

• Painkiller treatments to limit pelvic and abdominal pain linked to the progression of the disease and attacks linked to menstruation;
• Treatments to regulate intestinal transit and facilitate the periods surrounding menstruation;
• Treatment to facilitate urination when the bladder or ureters are affected by deep endometriosis.

Treatments to slow down the disease

At the same time, doctors most often try to slow the progression of the disease to prevent it from hitting you too hard or getting worse (developing more spots of endometriosis). For this, the solution is often hormonal treatment: it involves taking the pill continuously or a hormonal IUD. These help limit hormonal variations in your body and thus limit crises.

Surgery to treat cysts and adhesions

Finally, in a very small minority, a treatment for endometriosis can be surgery. This involves removing the sites of endometriosis which create pain or prevent ovulation (in particular ovarian cysts in the case of ovarian endometriosis).

What natural solutions can relieve pain?

If you have endometriosis, you may be bothered by the idea of ​​taking daily hormones and regular pain medications to curb the symptoms of endometriosis. We completely understand that you may be looking for alternative and more natural solutions: below you will find natural ways to relieve your pain .

Disclaimer: Consult a doctor before stopping treatment

Whatever your reasons, do not decide to stop medical treatment (hormonal, painkillers) without first talking to a healthcare professional. You remain in control of your treatment and your choices but these must be informed: before making any decision, talk to the professional(s) who follow you and do not hesitate to take several notice.

This is also the case if you want to adopt another type of treatment to limit your pain (CBD, herbal medicine): ask a doctor what he thinks and if these solutions do not conflict with the medications you are taking. . It is indeed possible that there are interactions!

Natural solutions that exist to relieve you

• Adoption of a healthy lifestyle: A varied diet, regular hydration, good sleep and limiting abuse (alcohol, tobacco or even caffeine) can reduce the pain linked to endometriosis.
• Application of heat: Heat is a muscle relaxant. It can alleviate the contractions of the uterus which partly cause menstrual pain. Taking a hot bath and using a hot water bottle are two interesting solutions!
• Practicing physical activity: Exercising when your period pain is severe is not easy, but if you can do it, the endorphins released by the body can help relieve your pain.
• Stomach massage: Massaging your stomach can help soothe your pain. Indeed, this action produces heat and invites you to concentrate on your sensations and to breathe.

• Relaxation practices: Yoga, meditation and even sophrology are practices that help reduce period pain. Test the practices that suit you and reduce your pain.
• Electrostimulation: Electrostimulation involves running tiny electrical currents through your body. This stops the pain message sent from our nerves to your brain.

• Masturbation / Sexual relations / Orgasm: Masturbating during your period has the effect of relieving pain. This is also the case with sexual practice: making love releases hormones which help to reduce pain. If penetration isn't an option for you, clitoral stimulation can also work. And if you're not planning to have sex, don't force yourself! It's just one solution among others. ;)
• Cannabidiol (known as CBD) is a molecule derived from hemp and in particular hemp flowers. Its effects on menstrual pain are currently being studied and seem interesting. You can consume it in the form of oil for an immediate effect or in the form of a cure, in oil or herbal tea, to supplement your body in the long term. Consult a doctor before combining it with other medications if you are under treatment.

• Finally, several plants, consumed as herbal teas or as food supplements, can support your body to limit menstrual pain and the disorders caused by endometriosis. Be careful though: herbal treatment is not trivial. Consult a doctor before using it, especially if you are already under treatment.