Fibroids vs. Endometriosis

Navigating the differences between uterine fibroids and endometriosis is essential for maintaining your health and quality of life. Both uterine fibroids and endometriosis are common female reproductive conditions that lead to significant challenges, impacting millions of women worldwide. Although similar in many ways, it’s important to understand their distinct causes, symptoms, and treatment options to effectively communicate with your healthcare provider to find the most suitable option for your symptoms and needs.

Uterine Fibroids

Uterine fibroids are non-cancerous growths that develop within the muscular wall of the uterus. They vary in size, ranging from small nodules that are barely noticeable to large masses that can distort the shape of the uterus. Fibroids are quite common, affecting up to 70-80% of women by the age of 50.

Types of Fibroids

Women can have multiple fibroids that vary in location in the uterus and range in size over time from a pea to a grapefruit. There are four different types of fibroids, including: 

• Intramural Fibroids: These grow within the muscular wall of the uterus and are the most common type of fibroid.
• Subserosal Fibroids: These extend beyond the outer wall of the uterus and can grow large enough to make the uterus appear bigger on one side.
• Submucosal Fibroids: These protrude into the uterine cavity and are the least common type but often cause the most severe symptoms.
• Pedunculated Fibroids: These are attached to the uterine wall by a stalk-like growth, which can sometimes cause twisting, leading to pain.

Uterine Fibroid Causes 

The exact cause of uterine fibroids is unknown but there are common risk factors that may play a role in their development, such as hormonal imbalances, high estrogen levels, and race. African American women are three times more likely to have fibroids than any other race of women. Other common risk factors related to uterine fibroids include:

• Early onset of menstruation
• Family history of fibroids
• High blood pressure
• Vitamin D deficiency
• Obesity 
• Women between the ages of 30 and 54

Uterine Fibroid Symptoms

While most uterine fibroids are asymptomatic, some women may experience uncomfortable and painful symptoms. The severity of symptoms depends on the location, size, and number of fibroids in the uterus. Some common symptoms may include:

• Heavy menstrual bleeding that can cause anemia
• Prolonged menstrual bleeding 
• Irregular menstrual bleeding
• Spotting or bleeding between periods
• Severe menstrual cramps
• Chronic pelvic pain
• Fullness or pressure in the lower abdomen and pelvis
• Pain during sexual intercourse
• Frequent urination
• Enlarged or swollen abdomen 

Fibroids Diagnosis

Diagnosing uterine fibroids typically involves a physical examination, pelvic exam, and image testing such as an ultrasound or MRI. These tests help fibroid specialists visualize the fibroids and determine their size, number, and location. In more complex cases, specialists may use additional imaging tests like a hysteroscopy to examine the uterus and internal structures in more detail. If imaging tests don’t provide doctors with enough definitive information, blood tests may also be used to check for any hormonal imbalances related to fibroid growth. 

Uterine Fibroid Treatments

There are multiple treatment options to consider when dealing with symptoms of uterine fibroids. The type of treatment depends on the number and size of your fibroids and if you want to get pregnant in the future. It’s important to discuss all your options with your doctor and choose which one works best for you. 

• Medications: Anti-hormonal agents, like gonadotropin-releasing hormone (GnRH) agonists, can shrink fibroids but are usually temporary solutions due to side effects.
• Hysterectomy: A highly invasive surgical procedure that involves removing the uterus, eliminating fibroid symptoms completely but removes the chance of pregnancy in the future,  increases the risk of early menopause, and requires a long recovery period. 
• Myomectomy: A minimally invasive procedure that removes fibroids and keeps the uterus intact but only removes specific types of fibroids and has a higher risk of fibroid regrowth.
• Ablation: A minimally invasive procedure that involves destroying the uterine lining to reduce fibroid symptoms effectively, but may lead to high-risk pregnancies or miscarriages. 
• Uterine Fibroid Embolization (UFE): A minimally invasive procedure that cuts off the blood supply to fibroids, causing them to shrink. UFE is a non-surgical treatment that keeps the uterus intact, has a lower risk of complications, quick recovery time, and is less invasive – requiring only a small incision. The procedure has an 85% to 90% success rate in reducing and eliminating fibroid symptoms and women have had successful pregnancies after the procedure. 

Endometriosis

Endometriosis is a chronic condition where tissue similar to the lining inside the uterus (endometrium) grows outside the uterus. This tissue responds to the menstrual cycle hormones and sheds blood during menstruation, causing inflammation, pain, and sometimes the formation of scar tissue.

Stages of Endometriosis

Endometriosis is classified into four stages (I to IV) based on the location, extent, depth, and size of the endometrial tissue. Stages do not necessarily correlate with the severity of symptoms some women may experience. 

• Stage I (Minimal): Few superficial endometrial tissue implants.
• Stage II (Mild): More and deeper implants.
• Stage III (Moderate): Many deep implants, small cysts on one or both ovaries, and some scar tissue.
• Stage IV (Severe): Many deep implants, large cysts on one or both ovaries, and extensive scar tissue.

Endometriosis Causes

The exact cause of endometriosis is also unknown, but the leading theory is retrograde menstruation – where menstrual blood backs up through the fallopian tubes and implants itself outside the uterus. Other factors that may increase the risk for endometriosis include: 

• Starting menstruation early (before age 11)
• Short menstrual cycles (less than 27 days)
• Heavy or prolonged menstrual periods (more than 7 days)
• Family history of endometriosis 
• High levels of estrogen 

Endometriosis Symptoms 

It is common for women experiencing endometriosis to not have any symptoms, but symptoms can range from mild to severe and some may be similar to uterine fibroids. Symptoms of endometriosis may include: 

• Heavy or prolonged menstrual bleeding
• Irregular menstrual bleeding 
• Spotting or bleeding between periods
• Pelvic and lower back pain 
• Lower abdomen pain
• Painful intercourse 
• Fatigue and low energy
• Bloating, gas, and nausea
• Constipation and diarrhea during period 
• Discomfort during urination or bowel movements

Endometriosis Diagnosis 

The only way to confirm a diagnosis of endometriosis is through surgery. The most common surgery to diagnose endometriosis is a laparoscopy, which allows your doctor to see inside your abdomen and pelvis directly. This test lets your doctor identify endometrial tissue implants, scarring, and other signs of endometriosis. During a laparoscopy, your doctor takes a tissue sample (biopsy) of any suspicious areas. This sample is then examined under a microscope to confirm the presence of endometrial tissue, definitively diagnosing endometriosis.

Endometriosis Treatments

Treatment options for endometriosis focus on pain relief and improving fertility, if you wish to get pregnant in the future. The choice of treatment depends on the severity of your symptoms. Endometriosis treatments may include: 

Pain Management

• NSAIDs: Nonsteroidal anti-inflammatory drugs can help manage pain and reduce inflammation.
• Pain Relievers: Over-the-counter or prescription pain medications can be used for pain management.

Hormonal Therapies

• Hormonal Contraceptives: Birth control pills, patches, and vaginal rings can reduce or eliminate menstruation, relieving pain.
• GnRH Agonists and Antagonists: These drugs reduce estrogen levels, creating a temporary menopause-like state that shrinks endometrial tissue.

Surgery

• Laparoscopy: Minimally invasive surgery to remove endometrial tissue implants, scar tissue, and adhesions – improving symptoms and fertility.
• Laparotomy: A more invasive surgical option used for severe cases of endometriosis.

What’s the Difference Between Fibroids and Endometriosis?

Both endometriosis and uterine fibroids are common conditions affecting the reproductive system, and they can cause a lot of confusion. They share some symptoms, but they’re actually quite different. Here are some key distinctions between these two conditions.

• Origin: Fibroids originate from the uterine muscle tissue, while endometriosis involves tissue similar to the uterine lining growing outside the uterus.
• Location: One key difference between uterine fibroids and endometriosis is their location within the reproductive system. Fibroids grow within the uterine walls, whereas endometrial tissue can be found around other pelvic organs like ovaries or fallopian tubes. 
• Nature: Fibroids are benign growths, whereas endometriosis involves tissue that responds to hormonal changes, causing inflammation and scarring.
• Symptoms: While both can cause pelvic pain and menstrual irregularities, fibroids often present with heavy bleeding and pressure symptoms, whereas endometriosis tends to involve more cyclical pain and gastrointestinal symptoms.

Take Control of Your Reproductive Health Today!

It is important to understand the differences between uterine fibroids and endometriosis to effectively manage your health. By recognizing symptoms early and discussing your concerns with a healthcare professional, you can pursue personalized treatment plans to meet your needs.
American Fibroid Centers is easily accessible throughout the NYC metropolitan area, with convenient locations in New York and New Jersey. We provide specialized care and uterine fibroid embolization for patients experiencing symptoms of uterine fibroids. Please do not hesitate to reach out and schedule an appointment with one of our affiliated fibroid specialists today!