Endometriosis and fibroids are often confused due to the similarity of symptoms. Endometriosis is when tissue similar to the endometrium (the inner lining of the uterus) grows outside the uterus.
Fibroids, also referred to as uterine fibroids, are noncancerous tumors that grow in or around the uterus. Known to stem from the muscle tissue of the uterus, fibroids can be as small as a pea or as a large as a melon and the severity of symptoms is often linked to the size of fibroids.
Both can cause pain, heavy menstrual bleeding, and infertility, but additional symptoms are also exclusive to each condition.
It is also possible to have both endometriosis and fibroids at the same time.
We’ll discusses the similarities and differences between endometriosis and fibroids, what causes each condition, and the treatment options available to relieve the symptoms of both.
Similarities Between Endometriosis and Fibroids
Although endometriosis and fibroids are different conditions, they do carry similarities and are often confused before a definitive diagnosis. It's also possible to have both conditions at the same time.
- Both conditions involve the uterus and the abnormal growth of tissue.
- Each condition can be asymptomatic, mild, or severe.
- Pelvic pain, lower back pain, infertility, and heavy menstrual bleeding are common to both endometriosis and fibroids.
- Hormone fluctuations directly impact both conditions
- Both conditions can cause pain during sex
What Causes Endometriosis amd Fibroids?
Medical researchers remain unclear about what causes endometriosis and fibroids. Several theories have been suggested, some disproven, while others lack evidence. The most accepted proposal within the medical community is that genetics play a part in both conditions.
This theory suggests the cells that eventually develop into endometriosis or fibroids are passed from one generation to another, and could already be present during fetal development.
Researchers also believe that hormone imbalances and/or the fluctuation of estrogen and progesterone are largely responsible for the severity and progression of both conditions.
Endometriosis vs Fibroids Symptoms
Endometriosis
Not all women with endometriosis experience chronic symptoms. For some women, endometriosis is asymptomatic (no symptoms) and for others symptoms are mild. Surgeons have also confirmed that women with several endometrial implants could experience mild symptoms, while women with few implants can suffer severe symptoms.
In other words, the severity of symptoms is not necessarily linked to the number, depth, or location of endometrial implants.
When symptoms do occur, they include the following:
- Chronic pelvic pain
- Severe menstrual cramping
- Heavy menstrual bleeding
- More painful periods than usual
- Stomach pain and bloating
- Intense lower back pain
- Painful bladder or bowel movements
- Pain during and after sex (dyspareunia)
- Spotting between periods
- Diarrhea, constipation, and nausea can occur during menstruation
Fibroids
There are three types of fibroids: subserosal, which grow on the outer wall of the uterus; intramural fibroids which grow within the muscular wall of the uterus, and submucosal fibroids which grow into the uterus.
Some women with fibroids experience no adverse symptoms, while others can suffer quite intensely. When symptoms do occur, they include the following:
- Pelvic pain
- Heavy menstrual bleeding or prolonged periods - often intense enough to cause anemia
- Lower abdomen swelling
- Lower back pain
- Feeling bloated or pressure in the pelvic area
- Pain during sex
- Frequent urge to urinate
- Constipation
- Difficulties getting pregnant
- Complications during natural childbirth
- Increased risk of C-section
At What Age Do Endometriosis and Fibroids Occur?
Endometriosis, according to statistics, occurs in at least 11% of women during their reproductive years. Although it is most commonly diagnosed in women aged 25-40, symptoms can occur with the first menstruation as early as age 14 or with gastrointestinal symptoms even earlier.
Due to the lowering of estrogen levels during perimenopause, symptoms typically subside for most women over 40, however, some are known to experience endometriosis symptoms after menopause.
That said, a large percentage of women don’t report their symptoms and many more wait years for a definitive diagnosis. For these reasons, it has been concluded that endometriosis could affect as many as 70% of women worldwide.
According to statistics, fibroids occur in over 70% of women aged between 30 and 50. Because estrogen levels begin to drop during perimenopause, it is rare that women in menopause suffer from fibroids.
Diagnosing Endometriosis vs Fibroids
How Endometriosis is Diagnosed
The only certain way to diagnose endometriosis is through a surgical procedure known as laparoscopy. Minimally invasive, surgeons make only a few small incisions in the abdomen to perform laparoscopic surgery. A tiny camera and surgical tools are inserted through the small incisions, abnormal tissue growths are removed and then tested in a lab. If the tissue proves to be endometrial-like tissue, endometriosis is diagnosed.
That being said, endometriosis can be treated without diagnosis via laparoscopic surgery. This would typically be based on a patient's symptoms, their family gynecological history, a pelvic exam, and an ultrasound showing the presence of abnormal tissue growth on pelvic organs.
Ultrasounds cannot determine if abnormal tissue growth is endometrial, but they can rule out fibroids and help healthcare practitioners progress with treatment options.
How Fibroids Are Diagnosed
Fibroids are often discovered by gynecologists during routine pelvic exams when they feel irregularities in the shape of the uterus. When patients approach their doctor with symptoms, however, certain tests are carried out to confirm the presence of fibroids.
These include an ultrasound to detect abnormal growths and blood tests to check for anemia or other bleeding disorders that would result in heavy menstrual bleeding. Magnetic resonance imaging (MRI) is also sometimes used to determine the exact size and location of fibroids before treatment begins.
If needed, a hysteroscopy can help to detect submucosal fibroids growing into the uterus, and a saline infusion sonogram can provide more information on the fallopian tubes, ovaries, and uterine lining.
Treating Endometriosis and Fibroids
Medical treatment for endometriosis and/or fibroids typically begins with over-the-counter pain medication and hormonal birth control to prevent both menstruation and the growth of endometrial tissue and/or fibroids. Progesterone-only therapy may be recommended for women who cannot take estrogen.
In cases of severe endometriosis and/or fibroids, Gonadotropin-releasing hormone (GnRH) is typically prescribed to alleviate symptoms by preventing the production of estrogen and ovulation. This type of hormone therapy can also instigate temporary menopause, and is not widely recommended for patients who are hoping to get pregnant.
For patients who feel little to no relief from hormone therapy and pain medication, surgery to remove endometrial implants, scar tissue, and/or fibroids would be the next step. Laparoscopic surgery is typically performed to confirm and remove endometrial-like tissue growing outside of the uterus. Fibroids are removed via one of several surgical procedures including endometrial ablation, fibroid embolization, myomectomy, myolysis, or hysterectomy.
Treating the Chronic Pain from Endometriosis & Fibroids
Pelvic physical therapy is highly recommended to relieve the chronic pelvic pain experienced with endometriosis and fibroids. In addition to alleviating pelvic pain and massaging painful scar tissue, physical therapy can also improve pelvic floor dysfunction, and reduce pain during sex.
With the guidance of a pelvic health physical therapist, women with endometriosis and fibroids can also benefit from at-home pelvic therapy by using pelvic wands and vaginal dilators in the comfort and privacy of their own home.
Designed to reduce muscle dysfunction and pain in the pelvic region, these medical tools are considered two of the best home remedies for endometriosis, fibroids, and many other pelvic conditions.
Self-care in the form of yoga, acupuncture, warm baths, and deep breathing practices can also help patients cope with the pain, stress, and anxiety often linked to endometriosis and fibroids.
Conclusion
Endometriosis and fibroids are both gynecological conditions that involve the uterus and can result in similar symptoms like pelvic pain, heavy menstrual bleeding, and infertility. Although often confused due to the similar side effects, some symptoms are unique to each condition. It is also possible to have both conditions at the same time.
If you suspect you have one or both conditions, schedule an appointment with your doctor for testing and possible treatment options. It’s also helpful to book a consultation with a pelvic physical therapist to learn how to relieve symptoms at home with the use of pelvic wands and vaginal dilators.
References
Endometriosis Foundation of America - Endometriosis: Defining It, Recognizing It, and Treating It - https://www.endofound.org/endometriosis
Office on Women’s Health – Fibroids - https://www.womenshealth.gov/a-z-topics/uterine-fibroids
National Institute of Health - How do healthcare providers diagnose endometriosis? - https://www.nichd.nih.gov/health/topics/endometri/conditioninfo/diagnose
University of California San Francisco – Diagnosing Fibroids - https://www.ucsfhealth.org/conditions/fibroids
Harvard Health - Treating the pain of endometriosis - https://www.health.harvard.edu/blog/treating-the-pain-of-endometriosis-2020112021458
National Library of Medicine - Uterine fibroids: Surgery - https://www.ncbi.nlm.nih.gov/books/NBK279531/