How Can I Tell if I Have PCOS, Fibroids, or Endometriosis?

PCOS, fibroids, and endometriosis are common health conditions that affect many women, but they can be hard to tell apart. They often cause similar symptoms like period problems and pelvic pain, which makes them confusing.

Even though they affect the female reproductive system, they are very different in what causes them and how they are treated. Understanding the basics of each condition can help make things clearer.

Polycystic Ovary Syndrome (PCOS) – Hormone Imbalance and Cysts

Polycystic ovarian syndrome (PCOS) is a common hormonal disorder that affects the ovarian function in women of reproductive age.

Women with PCOS often experience irregular periods or missed menstrual cycles because ovulation may not happen regularly. Other common PCOS symptoms include the presence of small fluid-filled sacs (“cysts”) on the ovaries, which can be seen during a transvaginal ultrasound, as well as elevated levels of androgen (male hormone) in the blood which may lead to symptoms like excess hair growth on the face and body. Some women may experience weight gain, thickened endometrial lining, or infertility (more difficult to get pregnant).

The exact cause of PCOS is still unknown, but it is believed to involve a combination of genetic and environmental factors that affect hormone levels. Because symptoms vary widely, PCOS could be difficult to diagnose, but women are often diagnosed with PCOS based on a combination of clinical signs, blood tests for hormone levels, and ultrasound findings.

While PCOS may affect fertility and increase risks for other health issues (like diabetes mellitus), there are ways to manage PCOS effectively through lifestyle changes, medication, and medical support.

Uterine Fibroid (Leiomyoma) – Benign but Troublesome

Fibroids are often non-cancerous tumors that grow in or around the uterus and are especially common in women during their reproductive years. They are often discovered during routine check-ups when doctors perform a pelvic exam and notice an enlarged or irregularly shaped uterus. 

The exact cause is not fully known, but they are believed to be linked to hormone levels, especially estrogen and progesterone, as well as genetics and family history. 

Fibroids can develop in different locations, i.e. within the uterine wall (intramural), on the outer surface of the uterus (subserosal), beneath the lining of the uterus (submucosal), or even within the cervix. Symptoms of fibroids vary depend on their size, number, and location. Common signs include heavy bleeding during periods, pelvic pain or pressure, frequent urination, constipation, and sometimes pain during sex. 

While many women have fibroids with no symptoms, others may experience discomfort and complications that require treatment.

Endometriosis – When Tissue Goes Rogue

Endometriosis is a chronic condition that affects many women of reproductive age.

Endometriosis occurs when tissue similar to the lining of the uterus grows outside of the uterus, where it doesn’t belong. This misplaced tissue still behaves like uterine lining. It thickens, breaks down, and bleeds with each menstrual cycle, but has no way to exit the body, leading to inflammation and scarring.

The causes of endometriosis are not fully understood, but factors such as genetics, immune system issues, and retrograde menstruation may play a role. Endometriosis symptoms can vary widely from person to person. Symptoms can include painful periods, chronic pelvic pain, pain during intercourse, painful bowel movements, and fatigue. In some cases, endometriosis may be silent and show few or no symptoms. For others, it can cause infertility by affecting the ovaries, fallopian tubes, or surrounding tissues.

Women are often diagnosed with endometriosis through imaging (like transvaginal ultrasound, MRI) or laparoscopy when symptoms suggest it. While there is no cure for endometriosis, several treatment option exist to help manage the condition. These may include hormonal therapy like birth control, pain relief medications, or surgery to remove affected tissue.

Similarities

Endometriosis and PCOS and Fibroids:

• Affect the female reproductive system and occur mainly in women of reproductive age.
• Can cause pelvic pain or discomfort, irregular or heavy menstrual bleeding, sometimes leading to severe symptoms.
• Hormonal imbalances or sensitivities play a role in their development or symptoms.
• Each can lead to fertility challenges.
• Management often involves medical treatment, lifestyle changes, and ongoing care to reduce severe symptoms.

Key Differences

Summary

• PCOS is a hormonal disorder causing irregular periods, high androgen levels, and ovarian cysts.
• Fibroids are noncancerous growths in the uterus that often cause heavy menstrual bleeding and pelvic pressure.
• Endometriosis is a condition involving uterine-like tissue outside the uterus.
• Symptoms are different for Endometriosis, PCOS, and Fibroids but they share some symptoms such as pelvic pain and irregular periods.
• Each condition has distinct treatment plans like hormonal therapy or surgery.
• Following treatment, symptom improvement varies and ongoing management may be needed.
• Symptoms related to Endometriosis include pain; PCOS involves hormonal imbalance; Fibroids cause heavy bleeding and pressure.
• People with endometriosis, PCOS, or fibroids experience unique challenges but often overlap in symptoms.

Further references:

1. International Evidence-based Guideline for the assessment and management of polycystic ovary syndrome 2023. 2023 Feb; Available from: https://www.monash.edu/__data/assets/pdf_file/0003/3379521/Evidence-Based-Guidelines-2023.pdf
2. American College of Obstetricians and Gynecologists. Polycystic Ovary Syndrome (PCOS) [Internet]. www.acog.org. 2022. Available from: https://www.acog.org/womens-health/faqs/polycystic-ovary-syndrome-pcos
3. Barjon K, Mikhail LN. Uterine Leiomyomata (Fibroids) [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546680/
4. The American College of Obstetricians and Gynecologists. Uterine Fibroids [Internet]. www.acog.org. 2022. Available from: https://www.acog.org/womens-health/faqs/uterine-fibroids
5. Tsamantioti ES, Mahdy H. Endometriosis [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK567777/
6. National Health Service. Endometriosis [Internet]. NHS. 2022. Available from: https://www.nhs.uk/conditions/endometriosis/
7. ACOG. Endometriosis [Internet]. www.acog.org. 2021. Available from: https://www.acog.org/womens-health/faqs/endometriosis

Disclaimer: This article is for educational purposes only. Please consult your healthcare provider for personalized medical advice.