Endometriosis 2 and Fibroids: What to Know

Endometriosis and uterine fibroids are two common, benign gynecologic conditions that can cause pelvic pain, heavy periods, and fertility challenges. Many people have questions when they see the phrase “Endometriosis 2.” In most clinical contexts, this refers to stage 2 (mild) endometriosis. Understanding how stage 2 endometriosis compares with fibroids—how they present, how they are diagnosed, and how they are treated—can help you make informed decisions and advocate for your health.

Quick definitions

• Endometriosis: Endometrial-like tissue grows outside the uterus (for example, on the ovaries, fallopian tubes, or pelvic peritoneum), causing inflammation and pain. It affects roughly 1 in 10 reproductive-age women and others assigned female at birth, though true prevalence is hard to measure without surgery.
• Uterine fibroids (leiomyomas): Benign smooth-muscle tumors of the uterus. They are extremely common; by age 50, up to 70–80% of women will have fibroids, though not all are symptomatic.

What does “Endometriosis 2” mean?

Clinicians often describe endometriosis using the American Society for Reproductive Medicine (ASRM) staging system from I (minimal) to IV (severe). Stage 2 endometriosis is considered mild. It typically involves superficial implants and mild adhesions. Importantly, staging reflects what is seen surgically and does not always correlate with symptom severity. Someone with stage 2 disease may have significant pain, while others have few symptoms. Fertility can be affected even at earlier stages, though the risk generally increases with more extensive disease.

Symptoms: how they overlap and differ

Because both conditions can cause pelvic pain and heavy bleeding, it’s easy to confuse them. Key patterns can help:

• Endometriosis (stage 2 included): Pain that worsens around menses (dysmenorrhea), deep pain with intercourse, pain with bowel movements or urination around periods, chronic pelvic pain, spotting or heavy periods, fatigue, and sometimes infertility.
• Fibroids: Heavy or prolonged menstrual bleeding, anemia, pelvic pressure or fullness, urinary frequency or constipation from mass effect, back pain, and reproductive issues depending on fibroid size and location. Pain is less commonly cyclical unless there is degeneration or concurrent conditions.

Who is most at risk?

• Endometriosis: Family history, early first period, shorter cycles, and heavy bleeding are associated factors. Diagnosis is common in the 20s–40s but can occur earlier.
• Fibroids: Risk increases with age through perimenopause, with higher prevalence and earlier onset among Black women. Family history, obesity, and early menarche are associated factors.

Diagnosis: what to expect

• History and pelvic exam: Both conditions start with a careful symptom review and exam.
• Imaging: Transvaginal ultrasound is the first-line test for fibroids and can identify size, number, and location. MRI helps with surgical planning or when ultrasound is inconclusive. For endometriosis, imaging can detect ovarian endometriomas and deep disease but may miss superficial implants.
• Definitive diagnosis for endometriosis: Laparoscopy with biopsy is the gold standard, but many clinicians make a clinical diagnosis and begin empiric therapy to avoid surgical delays.

Treatment options

Care is individualized based on symptoms, goals (pain relief, fertility, bleeding control), age, other health conditions, and preferences. Below are evidence-based options commonly recommended by professional societies and federal health agencies.

Stage 2 endometriosis

• Lifestyle and pain management: NSAIDs (e.g., ibuprofen, naproxen) for period pain; heat; pelvic floor physical therapy for musculoskeletal contributors.
• Hormonal therapies: Combined hormonal contraceptives (pill/patch/ring) taken cyclically or continuously; progestin-only methods (norethindrone acetate, depot medroxyprogesterone, levonorgestrel IUD); and GnRH agents (agonists like leuprolide or oral antagonists such as elagolix). FDA-approved options can reduce pain but may affect bone density; “add-back” low-dose hormones are often used to protect bones.
• Surgery: Laparoscopic excision or ablation of visible lesions can improve pain and, in some cases, enhance fertility. Recurrence can occur, so combining surgery with postoperative hormonal suppression may be considered to maintain relief if pregnancy is not immediately desired.
• Fertility planning: For those trying to conceive, a tailored plan may include timed intercourse, surgical treatment of lesions/adhesions, or assisted reproductive technologies depending on age, ovarian reserve, and partner factors.

Uterine fibroids

• Watchful waiting: If fibroids are small and symptoms minimal, monitoring may be all that’s needed.
• Medical therapy for bleeding and pain: NSAIDs; tranexamic acid during menses to reduce heavy bleeding; combined hormonal contraception; levonorgestrel IUD; and GnRH agonists/antagonists (including short-term preoperative use to shrink fibroids). Oral GnRH antagonist combinations such as relugolix–estradiol–norethindrone or elagolix–estradiol–norethindrone are FDA-approved to reduce heavy menstrual bleeding associated with fibroids.
• Procedures: Myomectomy (surgical removal of fibroids) preserves the uterus and is often preferred for fertility. Uterine artery embolization and radiofrequency ablation can reduce bulk and bleeding; these are typically considered for those not seeking future pregnancy. MRI-guided focused ultrasound is a noninvasive option in select cases. Hysterectomy provides definitive relief for those who are done with childbearing.

Fertility considerations

• Stage 2 endometriosis: Even mild disease can interfere with conception by causing inflammation and subtle anatomic changes. Surgical treatment of minimal–mild disease may improve natural fertility in selected patients. Early consultation with a fertility specialist is reasonable if conception does not occur after 6–12 months, depending on age.
• Fibroids: Submucosal fibroids and large intramural fibroids that distort the uterine cavity are most strongly linked with infertility and miscarriage risk. Myomectomy can improve fertility in these scenarios.

Can you have both?

Yes. Endometriosis and fibroids can coexist. If symptoms persist after treating one condition, discuss whether the other could also be present.

When to seek care

• Pelvic pain that disrupts work, school, relationships, or sleep
• Heavy bleeding (soaking a pad or tampon every hour for several hours, passing large clots) or signs of anemia (fatigue, shortness of breath, palpitations)
• Difficulty getting pregnant after 6–12 months (earlier if you’re over 35)
• New or worsening symptoms, or pain not controlled with over-the-counter medicines

Key takeaways

• “Endometriosis 2” generally means stage 2 (mild) disease, but symptom severity varies widely.
• Fibroids are very common and often cause heavy bleeding and pressure symptoms; endometriosis more often causes cyclical pelvic pain.
• Diagnosis relies on a careful history, ultrasound for fibroids, and sometimes laparoscopy for endometriosis.
• Multiple effective treatments exist—from medicines to minimally invasive procedures and surgery—tailored to your goals and life stage.

Trusted resources and references

• CDC. Endometriosis. cdc.gov/reproductivehealth/conditions/endometriosis.html
• NIH MedlinePlus. Endometriosis. medlineplus.gov/endometriosis.html
• NIH NICHD. Uterine Fibroids. nichd.nih.gov/health/topics/uterine-fibroids
• HHS Office on Women’s Health. Uterine Fibroids. womenshealth.gov/a-z-topics/uterine-fibroids
• FDA. Approval of elagolix (Orilissa) for endometriosis pain. fda.gov
• FDA. Approvals for oral therapies to reduce heavy bleeding from fibroids (Oriahnn; Myfembree). fda.gov and fda.gov
• ACOG. FAQs: Endometriosis; Uterine Fibroids. acog.org/womens-health

This article is for educational purposes and does not replace personalized medical advice. Always discuss diagnosis and treatment with your clinician.