Endometriosis vs. Fibroids: Symptoms, Fertility & Treatment
UPDATED ON 6 OCT. 2026
Endometriosis and fibroids are different gynaecological conditions, although both can cause pelvic pain, changes in periods, and difficulty conceiving.
Fibroids are non-cancerous growths that develop in or around the uterus, while endometriosis occurs when tissue similar to the uterine lining grows outside the uterus.
Because some symptoms overlap, it can be difficult to know which condition may be causing your symptoms. This guide explains the key differences between endometriosis and fibroids, their symptoms, how they can affect fertility, how they are diagnosed and what treatment options may be considered.
Are Fibroids and Endometriosis the Same?
No. Endometriosis and uterine fibroids are not the same condition.
Fibroids, also called uterine leiomyomas or myomas, are growths that develop from the muscle and connective tissue of the uterus. They can grow within the uterine wall, into the uterine cavity, or on the outer surface of the uterus.
Endometriosis occurs when tissue similar to the lining of the uterus grows outside the uterus. It may affect the ovaries, fallopian tubes, and other areas of the pelvis.
A woman can have fibroids, endometriosis, or both conditions at the same time.
AUTHOR
Medically reviewed by Dr Jay Mehta, MBBS, DNB
Scientific Director & Fertility Specialist—Shree IVF Clinic, Mumbai
MMC Reg. No.: 2011/05/1297
Expert in Reproductive Immunology, Endometriosis, and Advanced IVF
15+ years experience | 12308+ IVF cycles | 16000+ Endometriosis Surgeries | 2721+ male fertility surgeries
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Key Differences Between Fibroids and Endometriosis
While fibroids and endometriosis share some similarities, their key differences are important for both diagnosis and management. Here’s a side-by-side look to help you understand how they differ:
| Feature | Uterine Fibroids | Endometriosis |
|---|---|---|
| What is it? | Non-cancerous growths that develop in or around the uterus | Tissue similar to the uterine lining growing outside the uterus |
| Origin | Benign tumors of the smooth muscle of the uterus (myometrium), also called leiomyoma or myoma of the uterus | Growth of tissue similar to the uterine lining (endometrium) outside the uterus |
| Common locations | Within the uterine wall, inside the uterine cavity or on the outer surface of the uterus | Ovaries, fallopian tubes and other pelvic tissues |
| Common symptoms | Heavy periods, prolonged bleeding, pelvic pressure and urinary symptoms | Severe period pain, pelvic pain, pain during sex and bowel or bladder pain around periods |
| Fertility | Some fibroids can affect the uterine cavity or reproductive anatomy | May affect the ovaries, fallopian tubes and pelvic anatomy |
| Diagnosis | Ultrasound is commonly used; MRI may be recommended in selected cases | Assessment may include symptoms, examination, ultrasound, MRI and, in selected cases, laparoscopy |
| Treatment | Depends on symptoms, location, size and fertility plans | Depends on symptoms, extent of disease, fertility plans and previous treatment |
What Are the Symptoms of Fibroids?
Some women with fibroids do not have any symptoms. When symptoms occur, they may include:
- Heavy or prolonged menstrual bleeding
- Passing blood clots during periods
- Pelvic pressure or heaviness
- Abdominal fullness or bloating
- Frequent urination
- Constipation or pressure on the bowel
- Pelvic discomfort or pain
- Difficulty conceiving in some cases
Symptoms can vary depending on the size, number, and location of the fibroids.
For example, a fibroid that grows into the uterine cavity may affect menstrual bleeding, while a larger fibroid may cause pressure on the bladder or bowel.
What Are the Symptoms of Fibroids?
Endometriosis can cause different symptoms in different women. Common symptoms include:
- Severe period pain
- Pelvic or lower abdominal pain
- Pain during or after sexual intercourse
- Pain during bowel movements, particularly around periods
- Pain while urinating, particularly around periods
- Heavy or irregular menstrual bleeding in some women
- Bloating
- Chronic pelvic pain
- Difficulty conceiving
The amount of pain does not always reflect the extent of endometriosis. Some women have significant symptoms, while others may have few or no noticeable symptoms.
If you are experiencing these symptoms along with difficulty conceiving, a detailed endometriosis and fertility evaluation may help identify the factors affecting your chances of pregnancy.
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Endometriosis vs Fibroids: Which Symptoms Are More Common?
Some symptoms overlap, but certain patterns are more commonly associated with each condition.
Symptoms more commonly associated with fibroids
- Very heavy or prolonged periods
- Passing blood clots
- Pelvic pressure or heaviness
- Frequent urination
- Constipation caused by pressure from a larger fibroid
Symptoms more commonly associated with endometriosis
- Severe period pain
- Pain during sex
- Pain during bowel movements around menstruation
- Pain while urinating around menstruation
- Recurring or persistent pelvic pain
Symptoms that can occur with both
- Pelvic pain
- Painful periods
- Changes in menstrual bleeding
- Difficulty conceiving
- Abdominal discomfort or bloating
Symptoms alone cannot confirm whether you have fibroids or endometriosis. A gynaecological evaluation may be needed to identify the underlying cause.
Can You Have Endometriosis and Fibroids at the Same Time?
Yes. Some women have both endometriosis and fibroids.
Having one condition does not mean that it directly causes the other. They are separate conditions, although both may be influenced by hormonal factors.
When both are present, treatment planning may need to consider:
- Your main symptoms
- The size and location of fibroids
- The location and extent of endometriosis
- Your age
- Ovarian reserve and other fertility factors
- Whether you are planning pregnancy
- Previous treatment or surgery
When fertility is a priority, your doctor may need to decide whether the fibroid, endometriosis, both, or neither require treatment before trying to conceive.
Can Endometriosis or Fibroids Affect Fertility?
Both conditions can affect fertility, but they may affect reproductive health in different ways.
How Can Fibroids Affect Fertility?
Some fibroids can affect fertility depending on their size and location.
Fibroids may sometimes:
- Alter the shape of the uterine cavity
- Affect implantation
- Change the anatomy of the uterus
- Affect the fallopian tubes depending on their location
However, not every fibroid affects fertility, and not every fibroid needs treatment.
The decision to treat a fibroid depends on factors such as its location, size, symptoms, and your pregnancy plans.
How Can Endometriosis Affect Fertility?
Endometriosis may affect fertility through inflammation, adhesions and changes involving the ovaries, fallopian tubes and other pelvic structures.
The effect can vary depending on:
- The location and extent of endometriosis
- Ovarian involvement
- Tubal involvement
- Ovarian reserve
- Age
- Other fertility factors
This is why fertility treatment should be planned according to the individual rather than based only on an endometriosis diagnosis.
Can You Have IVF With Endometriosis or Fibroids?
Yes. IVF may be considered for some women with endometriosis or fibroids.
However, having either condition does not automatically mean that IVF is required.
A fertility specialist may consider:
- Age
- Ovarian reserve
- Fallopian tube status
- Sperm factors
- Duration of infertility
- Previous fertility treatment
- Location and extent of endometriosis
- Size and location of fibroids
- Previous pelvic surgery
- Overall reproductive goals
In some patients, treatment of a fibroid or endometriosis may be considered before fertility treatment. In others, proceeding directly to fertility treatment may be appropriate.
For women with endometriosis, the question is often whether IVF should be done before or after endometriosis treatment or surgery. The decision depends on factors such as age, ovarian reserve, symptoms, disease extent, and previous treatment. Read more about IVF for endometriosis and when surgery may be considered.
How Are Fibroids and Endometriosis Diagnosed?
The diagnostic approach depends on your symptoms, medical history, and examination findings.
1. Medical History
Your doctor may ask about:
- Your menstrual cycle and bleeding pattern
- Period pain
- Pelvic pain
- Pain during sex
- Bowel or bladder symptoms
- Previous pregnancies
- Difficulty conceiving
- Previous pelvic surgery or treatment
2. Clinical Examination
A gynaecological examination may help identify pelvic tenderness or changes in the size or position of the uterus.
3. Ultrasound
Pelvic or transvaginal ultrasound is commonly used to assess the uterus and ovaries and can identify many fibroids.
Depending on the expertise and type of ultrasound, it may also help identify certain forms of endometriosis, including ovarian endometriomas and some deep lesions.
4. MRI
MRI may be recommended when more detailed imaging is needed, particularly for complex fibroids or suspected deep endometriosis.
5. Laparoscopy
Laparoscopy may be considered in selected patients with suspected or known endometriosis, particularly when surgical treatment is being considered.
Not every woman with suspected endometriosis needs surgery. The appropriate diagnostic approach depends on the individual situation.
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How Are Fibroids Treated?
Fibroid treatment in Mumbai depends on symptoms, size, location, age, overall health, and fertility plans.
Depending on the situation, management may include:
- Monitoring when symptoms are mild or absent
- Medicines to manage symptoms
- Procedures or surgery when indicated
- Fertility-focused treatment when pregnancy is a priority
Surgery may be considered for selected patients, including procedures such as myomectomy. The appropriate procedure depends on the location and characteristics of the fibroid.
How Is Endometriosis Treated?
Endometriosis treatment in India depends on symptoms, disease extent, fertility plans, and previous treatment.
Depending on the individual situation, treatment may include:
- Pain management
- Hormonal treatment
- Monitoring in selected cases
- Laparoscopic surgery when appropriate
- Fertility treatment, including IVF, when indicated
Treatment decisions should consider both symptom control and reproductive goals.
Which Is Worse: Endometriosis or Fibroids?
There is no simple answer because neither condition is automatically worse than the other.
Endometriosis can cause significant period pain, chronic pelvic pain and fertility problems. Fibroids can cause heavy menstrual bleeding, pelvic pressure and, depending on their location, problems involving the uterine cavity or fertility.
The impact of either condition depends on its location, extent, symptoms and your individual health and fertility goals.
When Should You See a Gynaecologist?
You should consider a gynaecological evaluation if you have:
- Severe or worsening period pain
- Very heavy or prolonged periods
- Persistent pelvic pain
- Pain during sex
- Pain during bowel movements or urination around your periods
- Difficulty conceiving
- A known fibroid
- Suspected endometriosis
- Repeated fertility treatment failure along with suspected endometriosis or fibroids
If you have already had unsuccessful IVF treatment, it may be helpful to review the previous cycle rather than automatically repeating the same approach.
Dr Jay Mehta, fertility and endometriosis specialist at Shree IVF Clinic, Mumbai, can assess your symptoms, previous investigations, and fertility history to help identify what may need further evaluation.
A specialist can recommend appropriate investigations and discuss treatment or fertility options based on your individual situation rather than relying on symptoms alone.
Call 1800-268-4000 to schedule a consultation
FAQs About endometriosis and fibroids?
Can a small fibroid cause severe pain?
Yes, the size of a fibroid does not always determine how much discomfort it causes. Its location and relationship with nearby structures can also affect symptoms. However, severe pain with a small fibroid does not necessarily mean that the fibroid is the only cause. Endometriosis, adenomyosis or another pelvic condition may also need to be considered.
If I have fibroids, could I still have endometriosis?
Yes. Having fibroids does not rule out endometriosis. Some women have both conditions, and their symptoms can overlap. If your symptoms seem more severe or different from what would normally be expected from the fibroid, your doctor may consider whether another condition could be contributing to the pain.
Can ultrasound miss endometriosis even if it detects fibroids?
Yes. Ultrasound can identify many fibroids, but a normal or inconclusive ultrasound does not necessarily exclude endometriosis. Some forms of endometriosis can be difficult to detect on imaging, particularly when specialised imaging or expertise is not available. Depending on your symptoms, your doctor may consider further assessment or an MRI.
If my ultrasound shows a fibroid, how do I know whether my pain is from the fibroid or endometriosis?
It may not be possible to tell from the ultrasound finding alone. Your doctor may consider the location and size of the fibroid together with the pattern of your pain. Severe period pain, pain during sex, or bowel or bladder pain that becomes worse around menstruation may raise suspicion of endometriosis, while heavy bleeding and pressure symptoms may be more commonly associated with fibroids. Both conditions can also occur together.
Can endometriosis be mistaken for fibroids?
The symptoms of endometriosis and fibroids can overlap, which can make the underlying cause difficult to identify from symptoms alone. Imaging may provide important information, but the diagnostic approach depends on the symptoms and suspected type of disease. If symptoms continue despite treatment for a diagnosed fibroid, a further gynaecological assessment may be appropriate.
Why do I still have pelvic pain after fibroid treatment?
Persistent pelvic pain after fibroid treatment does not necessarily mean that the treatment has failed. Fibroids may not have been the only cause of pain. Endometriosis, adenomyosis, pelvic adhesions or other conditions can also cause pelvic pain. If pain continues, your doctor may need to reassess the possible cause rather than assuming it is still due to the fibroid.
AUTHOR
Medically reviewed by Dr Jay Mehta, MBBS, DNB
Scientific Director & Fertility Specialist—Shree IVF Clinic, Mumbai
MMC Reg. No.: 2011/05/1297
Expert in Reproductive Immunology, Endometriosis, and Advanced IVF
15+ years experience | 12308+ IVF cycles | 16000+ Endometriosis Surgeries | 2721+ male fertility surgeries
