Uterine fibroids and endometriosis are two common reproductive health issues that can affect anyone with a uterus. Symptoms of uterine fibroids are often similar to those of endometriosis, and because of this, endometriosis is sometimes mistaken for uterine fibroids. Studies suggest a link between the two conditions, as they can occur together, and both can impact fertility.
The exact causes of uterine fibroids and endometriosis are unknown. However, genetics are believed to contribute to their development. Hormonal changes, particularly shifts in estrogen and progesterone levels, may also influence the severity of symptoms and the progression of the diseases.
What are the features of uterine fibroids?
There are four different kinds of fibroids.
- Intramural fibroids develop inside the muscle wall of the uterus.
- Submucosal fibroids, which extend into the uterus cavity.
- Subserosal fibroids form on the outer surface of the uterus.
- Pedunculated fibroids are connected to the uterus by a thin stem or stalk.Â
Diagnosis and treatment of fibroids
Doctors usually diagnose fibroids using a pelvic exam, ultrasound, or MRI. Treating fibroids depends on how severe the symptoms are and the size and location of the fibroids.
Medications
Excess estrogen can contribute to the development of fibroid tumors, while low progesterone levels prevent the body from controlling this growth. Progesterone can help counteract estrogen’s impact on fibroids and, in some cases, can slow their growth or even reduce their size.
Medication options include drugs like Gonadotropin-Releasing Hormone (GnRH) agonists such as Lucrin and Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) such as Nurofen. These can help manage symptoms but won’t get rid of the fibroids completely. Gn-RH agonists help treat fibroids by stopping the body from producing estrogen and progesterone. Progestin-releasing IUDs such as Kyleena, often used for birth control, can reduce heavy bleeding caused by fibroids.
Non-invasive options
Various treatments are available to address uterine fibroids, apart from pharmaceutical and surgical approaches. One is MRI-guided focused ultrasound, which targets and destroys small fibroid tissue areas. Techniques are also available to eliminate fibroids without the need for surgery, such as Uterine Fibroid Embolization (UFE). This is a technique that cuts off the blood supply to fibroids, making them shrink over time. In more severe cases, however, surgical removal may be necessary.
Surgical options
If fibroids are large or symptoms are severe, surgery may be required. A myomectomy removes the fibroids but leaves the uterus in place, making it a good option for women who still want to have children. In more serious cases, doctors might recommend a hysterectomy, which involves complete removal of the uterus.
What are the features of endometriosis? 
Endometriosis occurs when tissue similar to the uterine lining grows outside of it, often on organs in the pelvic area. Like the uterine lining, this tissue builds up and breaks down each month, but since it can’t leave the body, it gets trapped. This can lead to pain, swelling, and scar tissue forming over time.
Causes of endometriosis
The exact cause of this condition isn’t fully understood. One idea is that menstrual blood flows backward into the pelvic area instead of out of the body, a process called retrograde menstruation. Other possible causes include genetics, problems with the immune system, and hormonal imbalances.
Diagnosis and treatment of endometriosis
There are various methods for diagnosing endometriosis. Doctors might perform a pelvic exam and use imaging techniques such as ultrasound or a laparoscopy. A small camera is inserted into the abdomen during a laparoscopy to look at the reproductive organs.
The goal of endometriosis treatment is to ease pain and control symptoms to provide the patient with an improved quality of life. There is currently no cure for the condition.
Women with endometriosis often have elevated estrogen levels, which can impact endometrial tissue outside the uterus, causing inflammation and discomfort. Estradiol, a form of estrogen, plays a key role in controlling the growth of uterine tissue. It has been linked to the formation and worsening of endometriosis-related adhesions in the abdominal area. To alleviate pain and other symptoms, women with endometriosis are often given treatments aimed at lowering estrogen levels.
Medication
Hormonal treatments like birth control pills (Nexplanon, Mirena, and Kyleena), GnRH agonists such as Zoladex, and Lupron, and, and synthetic steroid hormones (progestins) like Depo-Povera can manage pain by adjusting hormone levels that lead to the growth of endometrial tissue.
Surgical treatments
In severe cases, doctors might recommend surgery to remove endometrial tissue. The most common type is laparoscopic surgery, where small cuts are made, and special tools are used to remove or destroy the tissue.
What are the common symptoms of uterine fibroids and endometriosis?
Fibroids and endometriosis have several similar symptoms. For example, both can lead to severe pelvic pain and may impact a woman’s ability to have children. While neither condition can be fully cured, treatments are available to help manage the symptoms. Common symptoms of both fibroids and endometriosis are
- Menstrual pain
- Discomfort during penetrative sex
- Lower back pain
- Infertility (more frequently associated with endometriosis than fibroids)
What are the differences between uterine fibroids and endometriosis
Let’s take a look at some of the main differences between the two conditions.
Location
Fibroids are benign growths that form in the uterine wall. Endometriosis occurs when tissue, such as the lining of the uterus, grows outside the uterus, often affecting the ovaries, fallopian tubes, or other organs in the pelvis.
Growth Behavior
Fibroids are solid, clearly shaped growths that can be small or large enough to change the shape of the uterus. Endometriosis occurs when tissue similar to the uterine lining grows outside of it, leading to swelling and scar tissue.
Symptoms
The symptoms of these two conditions can differ from person to person, making a medical diagnosis necessary to determine which condition you have, even if you experience symptoms clearly associated with one or the other.
Impact on fertility
Both uterine fibroids and endometriosis can impact fertility, but they do so in different ways. Fibroids grow and can block the fallopian tubes or change the shape of the uterus, making it harder for an embryo to attach. Endometriosis can lead to inflammation and scar tissue, which may harm egg health and disrupt how the fallopian tubes work.
While uterine fibroids and endometriosis share some overlapping symptoms, such as pelvic pain and potential fertility challenges, they differ significantly in their causes, growth patterns, and how they affect the body. Both conditions require a medical diagnosis to determine the best course of treatment.
FAQs
What is an endo belly?
Endo belly refers to extreme abdominal bloating that many individuals with endometriosis experience. For some, the swelling can become so severe that they appear pregnant.
Which condition causes more pain, uterine fibroids or endometriosis?
Both conditions can cause discomfort, but endometriosis usually leads to more long-term and intense pain, particularly during periods or during sexual activity. Fibroid pain, on the other hand, depends more on the size and location of the growth(s).
Can you have both fibroids and endometriosis at the same time?
It is possible to have both conditions at the same time, even though they are separate diseases that impact the uterus and pelvic area in different ways.
Which condition is more likely to cause infertility?
While both conditions can cause infertility, it is more likely with endometriosis. Endometriosis is more likely to cause infertility due to scarring and blockages in the reproductive organs.