Confusable diagnoses · PANCE / PANRE

Endometriosis vs Uterine Fibroids

Endometriosis and Uterine Fibroids are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.

Endometriosis vs Uterine Fibroids at a glance

  • Endometriosis: Ectopic endometrial-like tissue causing cyclic pelvic pain, dysmenorrhea, dyspareunia, and infertility.
  • Uterine Fibroids: Benign smooth-muscle tumors of the myometrium causing heavy bleeding, bulk symptoms, and reproductive complications.
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Side-by-side comparison

FeatureEndometriosisUterine Fibroids
At a glanceEctopic endometrial-like tissue causing cyclic pelvic pain, dysmenorrhea, dyspareunia, and infertility.Benign smooth-muscle tumors of the myometrium causing heavy bleeding, bulk symptoms, and reproductive complications.
Classic presentationReproductive-age woman with progressive secondary dysmenorrhea, deep dyspareunia, and infertility; ovarian 'chocolate cyst' on ultrasound.; Cyclic pelvic pain…Premenopausal woman with heavy menses, iron-deficiency anemia, and an enlarged irregular uterus.; Heavy menstrual bleeding (most common); prolonged or…
Workup / key labsHistorically definitive diagnosis required laparoscopic visualization with histologic confirmation; current ACOG/ESHRE guidance supports clinical diagnosis…CBC (iron-deficiency anemia common), ferritin; TSH, prolactin if irregular bleeding; Pregnancy test; Endometrial biopsy if age ≥45, risk factors for…
ImagingTransvaginal ultrasound — first-line; identifies endometriomas (homogeneous low-level echoes, 'ground glass' appearance) and deep infiltrating disease; MRI —…Transvaginal ultrasound — first-line; characterizes size, number, location; Saline-infusion sonohysterography or hysteroscopy — best for submucosal fibroids…
First-line treatmentNSAIDs — ibuprofen, naproxen — for pain; Combined hormonal contraception (COCP, patch, ring) — continuous or cyclic; first-line hormonal therapy; Progestins —…Expectant management for asymptomatic fibroids; NSAIDs for dysmenorrhea; Tranexamic acid 1.3 g TID × up to 5 days per cycle for heavy bleeding; Combined…

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Educational use only. This outline is a study aid for PA students and is not medical advice or a substitute for clinical judgment. FirstPassPA is an independent study tool and is not affiliated with, endorsed by, or sponsored by NCCPA. PANCE® and PANRE® are registered trademarks of the National Commission on Certification of Physician Assistants.