Endometriosis is a diagnosis that gets bandied around the gynaecologist’s office when a patient presents with symptoms that could point toward either this condition or uterine fibroids. Being that March is Endometriosis Awareness Month1, this is the perfect month to set straight the differences (and similarities, why not?) between the two.
What’s the difference?
Fibroids2 can cause any combination of the following:
- Heavy menstrual bleeding
- Frequent urination and/or constipation due to larger fibroids growing into the area normally occupied by the bladder and/or digestive system
- Pain in the pelvic area and/or lower back. Pain can also occur during intercourse. Location of pain depends on both the size and location of the fibroid(s).
- Fertility difficulties
Endometriosis3 can cause very similar symptoms, including
- Pain in the lower pelvic area, including back pain, worsening during menstruation, as well as nausea, constipation and diarrhea at that time
- Pain that worsens during menstruation to the point of stopping usual activities, possibly increased while urinating or defecating. Also during menstruation, blood may appear in urine and stool.
- Pain during or after intercourse
- Fertility difficulties
Symptoms of endometriosis and fibroids often occur around the same time, when a woman enters her reproductive years. Late teens and twenties are the most common periods in which women begin experiencing symptoms of these conditions.
One study found that on average, women were diagnosed with endometriosis at age 31, whereas another study determined that women with UF received their diagnosis when they were older, at age 36.
As the two conditions are so similar, diagnosis must be done by a gynaecologist, who may use ultrasound, MRI or laparoscopy to understand what is truly going on inside. If the doctor chiefly suspects fibroids, an ultrasound will likely come first, whereby if suspicion points toward endometriosis, MRI will undoubtedly be the direction in which to turn.
Unique Challenges of Coexisting Endometriosis and Fibroids
Bad luck (and perhaps genetics) can have both conditions appearing in the same woman at the same time, though many women won’t even know it. One of these two conditions can go undiagnosed, as not all cases of either condition produce noticeable symptoms. Still, having continued symptoms after having been treated for a diagnosed condition is an unpleasant possibility.
It is for this reason that current recommendations include4 checking for both conditions at the same time and if no other treatment alternative succeeds, to visually look for one condition while surgically correcting the other. Prior to surgery, pain relievers and hormone pills5 will be tried as treatment, as they may make symptoms manageable enough to continue regular daily routines.
GnRH antagonists and agonists can be used to help reduce the size of fibroids, as well as relieve symptoms of endometriosis including heavy menstrual bleeding. These hormonal treatments reduce the amount of oestrogen in the body, helping balance the activity of the reproductive system and get symptoms under control.
Latest Research and Development
Research on comorbidity between uterine fibroids and endometriosis is still ongoing, and the likelihood of a woman having both conditions at once varies by geographical region. With some 10% of women globally thought to have endometriosis, and approximately 70% of women developing a fibroid at some point in their lifetime, it’s clear that there is a significant number of women who will have the conditions overlap.
According to a meta-analysis reviewing multiple studies of comorbidity, having endometriosis is correlated with a higher risk of developing a fibroid. However, the converse is not the case – women with fibroids do not have a higher likelihood of being diagnosed with endometriosis. is not a serious increase in the likelihood of endometriosis.
Support and Resources
Pain, bleeding and fertility issues are tough, but you don’t need to do this alone. We women lean on each other in good times and in bad, giving strength and understanding. Find your people, be it at an in-person, local community group, through online forums[6], or through recommendations from your doctor.
The Women Talking Fibroids Facebook group is a supportive, inclusive online community where you can receive support from real women who also have UF. Being a member of the group gives you access to critical information from expert doctors specializing in fibroids, as well as the knowledge that there is a community of women experiencing the same symptoms and challenges. Having others to lean on – for both medical expertise and a shoulder to cry on – is vital.
Beyond Awareness
So, you’re already one step ahead of the game by being aware. If you’re feeling pain, experiencing heavy bleeding or having trouble with fertility, get to a doctor for proper diagnosis. This is the first step toward pinpointing treatment and feeling better.
Since treatment for both fibroids and endometriosis isn’t immediate, it’s also important to gather your support circle. Crowdsourcing to find the best practitioners and advice, plus share the ups and downs along the journey is your golden resource.
- https://www.endometriosis-uk.org/endometriosis-action-month-2024#:~:text=March%20is%20Endometriosis%20Action%20Month
- https://talkingfibroids.com/symptoms/
- https://www.nhs.uk/conditions/endometriosis/
- Uimari O, Nazri H, Tapmeier T. Endometriosis and Uterine Fibroids (Leiomyomata): Comorbidity, Risks and Implications. Front Reprod Health. 2021 Oct 26;3:750018. doi: 10.3389/frph.2021.750018. PMID: 36304022; PMCID: PMC9580755.
- https://www.nhs.uk/conditions/endometriosis/treatment/
- https://endoubt.info/