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
| Feature | Endometriosis | Uterine Fibroids |
|---|---|---|
| At a glance | Ectopic 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 presentation | Reproductive-age woman with progressive secondary dysmenorrhea, deep dyspareunia, and infertility; ovarian 'chocolate cyst' on ultrasound.; Cyclic pelvic pain that worsens with menses (secondary dysmenorrhea); Deep dyspareunia; Dyschezia, cyclic rectal bleeding, or dysuria (depending on implant location); Infertility (often the… | Premenopausal woman with heavy menses, iron-deficiency anemia, and an enlarged irregular uterus.; Heavy menstrual bleeding (most common); prolonged or intermenstrual bleeding; Pelvic pressure or fullness, bloating, increased abdominal girth; Urinary frequency or hesitancy (anterior fibroids on bladder); Constipation or tenesmus… |
| Workup / key labs | Historically definitive diagnosis required laparoscopic visualization with histologic confirmation; current ACOG/ESHRE guidance supports clinical diagnosis and empiric treatment when imaging and history are consistent, reserving surgery for refractory cases or when histology will change management.; Pregnancy test, urinalysis, GC/CT… | CBC (iron-deficiency anemia common), ferritin; TSH, prolactin if irregular bleeding; Pregnancy test; Endometrial biopsy if age ≥45, risk factors for hyperplasia, or persistent abnormal bleeding |
| Imaging | Transvaginal ultrasound — first-line; identifies endometriomas (homogeneous low-level echoes, 'ground glass' appearance) and deep infiltrating disease; MRI — for surgical planning, deep infiltrating endometriosis, or extra-pelvic disease; Empiric medical therapy may be initiated without surgical confirmation if clinical picture is… | Transvaginal ultrasound — first-line; characterizes size, number, location; Saline-infusion sonohysterography or hysteroscopy — best for submucosal fibroids and cavity distortion; MRI — pre-operative mapping, suspected adenomyosis, or assessment before uterine artery embolization |
| First-line treatment | NSAIDs — ibuprofen, naproxen — for pain; Combined hormonal contraception (COCP, patch, ring) — continuous or cyclic; first-line hormonal therapy; Progestins — norethindrone acetate, medroxyprogesterone, dienogest, levonorgestrel IUD | Expectant management for asymptomatic fibroids; NSAIDs for dysmenorrhea; Tranexamic acid 1.3 g TID × up to 5 days per cycle for heavy bleeding; Combined hormonal contraception or progestin-only options for bleeding control; Levonorgestrel IUD — effective for heavy menstrual bleeding when cavity not significantly distorted; Iron… |
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