Uterine fibroids are non-cancerous growths consisting of muscle and fibrous tissue that develop in the uterine wall. Fibroids are common: an estimated 70% of women will develop them before menopause.1 Most uterine fibroids do not show symptoms; however, symptoms may occur if the fibroid is sufficiently large and in the right location. The most common symptom is abnormal uterine bleeding, but women may also experience:
Heavy, painful, or prolonged periods, or spotting between menses; women with excessive bleeding may develop iron deficiency anaemia
Severe localized pain in the abdomen or lower back
A frequent need to urinate, constipation, pain, or discomfort during intercourse
In rare cases, uterine fibroids may lead to complications during pregnancy or cause infertility
Uterine fibroids are usually diagnosed by an ultrasound, but in some cases further tests such as an MRI may be required. One-third of reproductive-age women receive treatment for uterine fibroids,3 which generally focuses on shrinking the fibroids by reducing oestrogen levels.2 Women may have to stop or change their contraceptive medicine or may be prescribed oestrogen-lowering treatments such as gonadotrophin-releasing hormone (GnRH) agonists.2 Certain procedures can also be performed to restrict blood flow or ablate the fibroids.2 However, severe cases may require surgical removal of the fibroids or a hysterectomy.3
The endometrium forms the lining of the uterus, and thickens in response to oestrogen in preparation for pregnancy. When pregnancy does not occur, the endometrium sheds, leading to menstrual bleeding. In endometriosis, endometrial tissue is found outside the uterus, typically in the pelvis. Despite being in the wrong location, the endometrial tissue retains its normal function of thickening and shedding in response to natural fluctuations in oestrogen. This can cause debilitating pain that may affect daily life, disturbances in the menstrual cycle, pain during intercourse and, in some cases, endometriosis may lead to infertility4. Endometriosis is estimated to affect 6-10% of reproductive-age women, 50 to 60% of women and teenage girls with pelvic pain, and up to 50% of women with infetility.5
On average, diagnosis of endometriosis takes 10 years from symptom onset.4 Women are often misdiagnosed because endometriosis is underreported and under-recognized.6 Imaging tests, such as an ultrasound or MRI can aid diagnosis but do not provide definitive confirmation of endometriosis.4 Formal diagnosis of endometriosis is usually confirmed by a laparoscopy.4 Endometriosis is usually treated with pain medication, contraceptive medicine that reduces menstrual bleeding, and gonadotrophin-releasing hormone (GnRH) agonists, which reduce oestrogen and interrupt the menstrual cycle.4,5
Stewart EA, et al. BJOG 2017; 124: 1501-12.
WebMD Treatments for Uterine Fibroids. https://www.webmd.com/women/uterine-fibroids/understanding-uterine-fibroids-treatment#1 (accessed July 2019).
Boosz AS. et al. Dtsch Arztebl Int 2014; 111: 877–83.
Endometriosis Foundation of America. https://www.endofound.org/endometriosis (accessed July 2019).
Giudice LC. New Eng J Med 2010; 362: 2389-98.
Moradi M, et al. BMC Womens Health 2014; 14: 123.