Fibroids and endometriosis are conditions in the pelvis that require medical attention. However, many women don’t know the difference between the two. While they have similar symptoms, they each will require specific treatment paths.

What are they?

Uterine fibroids are almost always noncancerous fibrous growths of the uterus. Depending on the patient, some factors can vary such as the location, amount, and size of the growth. Uterine fibroids can form inside, outside, or within the muscle walls of the uterus. Some will form multiple tumors, and others can just be a singular growth. The growth can also range from the size of a seed to a grapefruit. According to Cleveland Clinic, around 40-80% of women have fibroids.

Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside of the uterus and attaches itself to other organs or the lining of the abdominal and pelvic cavity. The disease affects around one in 10 women during their reproductive years.

How are they caused?

While there’s no exact answer for what causes uterine fibroids or endometriosis, research has pointed to some factors that can impact your chances of developing either condition.

Factors that may increase the risk of uterine fibroids are:

  • obesity
  • hormonal imbalance: when estrogen levels are too high, it can lead to fibroid development and growth—fibroids have higher estrogen and progesterone receptors than the typical uterine muscle
  • genetics
  • other growth factors

As for endometriosis, factors include:

  • retrograde menstrual flow – this is when blood during a women’s period flows upwards into the fallopian tubes and into the pelvis, rather than out of the vagina
  • genetics
  • problems with immune system
  • hormonal imbalance – a higher level of estrogen can cause inflammation and pain

What are the symptoms?

Both uterine fibroids and endometriosis can cause symptoms of pain during your menstrual cycle or sexual intercourse, (in abdomen/lower back), reproductive issues, changes in menstrual cycle, fatigue, constipation, and more. While they both have similar symptoms, they can affect the body differently, so it’s important to get diagnosed right away and find the proper treatment.

How can I be diagnosed?

Schedule an annual exam with your gynecologist to make sure everything is healthy. Your doctor may be able to feel fibroids during a pelvic exam. Imaging, such as pelvic ultrasound, is typically ordered to assess for fibroids, including size and location. Endometriosis can only be diagnosed during a laparoscopy (a camera is inserted into the abdomen through a small incision); however, other evaluations, such as a pelvic exam or imaging tests, can help provide clues that endometriosis might be present.

What are treatment options?

Since uterine fibroids are typically non-cancerous and may not interfere with fertility, treatment may not be necessary if you are not experiencing symptoms. If the symptoms become more noticeable and persistent, your doctor can prescribe medication to control the symptoms or may recommend surgery to remove fibroids called a myomectomy. There are different types of myomectomies including hysteroscopic myomectomy, where fibroids are removed from inside the uterine cavity using surgical tools and a camera placed vaginally, or a laparoscopic or robotic myomectomy where fibroids are removed using a camera and surgical tools placed through a small incision on the abdomen. If future pregnancy is no longer a consideration, your doctor may recommend a hysterectomy, removal of the uterus, as definitive treatment as fibroids can no longer recur without uterine tissue present.

Endometriosis can also be managed and treated with medical or surgical options. Surgery includes removal of the visible implants and can often be performed using a minimally invasive approach such as laparoscopic or robotic surgery. Endometriosis is a chronic condition, so it is important that patients are counseled on the need for postoperative medication management after surgery to prevent the recurrence of endometriosis implants.

According to Dr. Melissa Nicosia, Director of Obstetrics and Gynecology at Mather Hospital, “There are many considerations we take into account when considering whether patients will benefit most from medication or surgery. This includes their symptoms, their desires for fertility, and a comprehensive exam and imaging evaluation. Many patients have been told that their symptoms are normal and part of being a woman and having a period, and that’s simply not true. Fibroids and endometriosis can severely affect our patients’ quality of life and we have a large array of treatment options to help.”