Fibroids and Ease Endometriosis Pain: Why It Happens and What Helps

Uterine fibroids and endometriosis are two of the most common gynecologic conditions, and both can cause significant pelvic pain, heavy bleeding, and disruption to daily life. Fibroids are noncancerous growths of the uterine muscle, while endometriosis occurs when tissue similar to the uterine lining grows outside the uterus. These conditions can occur separately or together, and their symptoms often overlap—making diagnosis and treatment feel complicated. This guide explains why pain happens with fibroids and endometriosis, how they can interact, and which treatments can help, based on evidence from trusted sources.

Why the pain happens

Fibroids: pressure, bleeding, and inflammation

Fibroids (also called leiomyomas) are very common—by age 50, an estimated 20% to 80% of women will have them, though not everyone has symptoms (U.S. Office on Women’s Health). Pain can arise from:

• Uterine cramping and heavy bleeding: Fibroids can increase menstrual volume and prostaglandin release, intensifying cramps.
• Size and location: Large or multiple fibroids can stretch the uterus and press on nearby organs (bladder, bowel), causing pelvic pressure, back pain, or pain with sex.
• Degeneration or torsion: When a fibroid outgrows its blood supply, it can cause acute, localized pain.

Endometriosis: cyclic inflammation and nerve sensitization

Endometriosis affects about 1 in 10 people of reproductive age (NIH/NICHD). Endometriosis tissue outside the uterus responds to hormones, leading to:

• Cyclic inflammation and bleeding that irritate surrounding tissues and can form scar tissue (adhesions).
• Nerve growth and sensitization within lesions, which may amplify pain signals over time.
• Deep pelvic pain during periods, sex, bowel movements, or urination, and sometimes chronic daily pain.

When both conditions coexist

Fibroids and endometriosis can occur in the same person. Both can cause heavy, painful periods and pelvic pressure, so symptoms often overlap. While fibroids do not cause endometriosis, the combination can intensify overall pain and bleeding burden—heavy periods from fibroids may worsen cramps and anemia-related fatigue, while endometriosis can heighten pain sensitivity. Because features can be similar, careful evaluation is essential.

Getting the right diagnosis

A thorough history and exam guide testing. Common tools include:

• Pelvic ultrasound to identify fibroids and assess size and location (MedlinePlus).
• MRI when imaging needs more detail or to plan procedures.
• Diagnostic laparoscopy to confirm endometriosis and treat lesions at the same time (NIH/NICHD).

Other conditions such as adenomyosis, pelvic floor dysfunction, or gastrointestinal and urologic disorders can mimic these symptoms, so a broad view is helpful.

What helps: evidence-based options

Treatment is personalized to your symptoms, goals (including fertility), and any coexisting conditions. Many people try conservative measures first and escalate as needed.

Self-care and over-the-counter strategies

• NSAIDs such as ibuprofen or naproxen can reduce cramping and pelvic pain when started 1–2 days before the period and taken regularly during the heaviest days (MedlinePlus).
• Heat therapy (heating pad, warm baths) relaxes uterine muscle and can ease cramps.
• Regular physical activity and stress-reduction techniques (e.g., breathing exercises) may help some individuals manage chronic pain.
• Pelvic floor physical therapy can address muscle spasm and tenderness that often accompany chronic pelvic pain.

Hormonal therapies

• Combined hormonal contraceptives (pill, patch, ring) can lighten and regulate periods and reduce cramps for both conditions (Office on Women’s Health).
• Progestin-only options (pills, depot medroxyprogesterone injections, or a levonorgestrel-releasing IUD) can thin the uterine lining to reduce bleeding from fibroids and improve endometriosis-related pain. An IUD may be less effective if large submucosal fibroids distort the uterine cavity.

GnRH modulators (with “add-back” therapy)

These medicines temporarily lower estrogen to reduce bleeding and pain. Because low estrogen can cause side effects (hot flashes, bone loss), they’re often paired with low-dose hormone “add-back” therapy and used for limited durations, per labeling.

• GnRH agonists (e.g., leuprolide acetate) have long been used for both conditions (MedlinePlus).
• GnRH antagonists include:
  • Elagolix (Orilissa) for moderate to severe endometriosis pain (FDA).
  • Relugolix–estradiol–norethindrone acetate (Myfembree) for endometriosis pain and for heavy menstrual bleeding associated with fibroids (FDA).
  • Elagolix–estradiol–norethindrone acetate (Oriahnn) for heavy menstrual bleeding due to fibroids (FDA).

Nonhormonal prescription option for heavy bleeding

• Tranexamic acid is a nonhormonal medicine taken only on heavy days to reduce menstrual blood loss, including in people with fibroids (MedlinePlus (NIH)).

Procedures for fibroids

• Myomectomy surgically removes fibroids and preserves the uterus; approach depends on fibroid size and location (hysteroscopic, laparoscopic, or open).
• Uterine artery embolization (UAE) shrinks fibroids by blocking blood flow; it can improve bleeding and pressure symptoms for many people (MedlinePlus).
• MR-guided focused ultrasound may be an option for selected patients to ablate fibroid tissue.
• Hysterectomy is definitive for fibroid-related symptoms in those who do not desire future pregnancy.

Procedures for endometriosis

• Laparoscopic excision or ablation of endometriosis lesions and lysis of adhesions can reduce pain and may improve fertility (NIH/NICHD).
• In severe, refractory cases, hysterectomy (with or without removal of ovaries) may be considered after shared decision-making, especially if adenomyosis is also present.

Fertility and family planning

Both conditions can impact fertility. Some fibroids—especially those that distort the uterine cavity—can interfere with implantation or increase miscarriage risk; myomectomy may improve outcomes in selected cases. Endometriosis can affect egg quality, tubal function, and pelvic anatomy. If pregnancy is a goal, discuss the timing of treatment and the role of assisted reproductive technologies with your clinician (NIH/NICHD).

When to seek care

• Periods that are very painful, last more than seven days, or involve passing large clots.
• Pelvic pain that disrupts work, school, sleep, sex, or daily activities.
• Symptoms of anemia (fatigue, shortness of breath, dizziness) from heavy bleeding.
• Concerns about fertility or pregnancy planning.

Bottom line

Fibroids and endometriosis are distinct but sometimes overlapping causes of pelvic pain and heavy bleeding. Accurate diagnosis guides treatment, which ranges from self-care and medicines to minimally invasive procedures or surgery. Many people find significant relief with a stepwise approach tailored to their goals and life stage. Partner with a clinician you trust to create a plan that addresses pain, bleeding, and fertility—so you can get back to living well.

Trusted resources

• NIH/NICHD: Endometriosis Overview – https://www.nichd.nih.gov/health/topics/endometriosis
• U.S. Office on Women’s Health: Uterine Fibroids – https://www.womenshealth.gov/a-z-topics/uterine-fibroids
• U.S. Office on Women’s Health: Endometriosis – https://www.womenshealth.gov/a-z-topics/endometriosis
• MedlinePlus (NIH): Uterine Fibroids – https://medlineplus.gov/uterinefibroids.html
• MedlinePlus (NIH): Endometriosis – https://medlineplus.gov/endometriosis.html
• FDA: Orilissa (elagolix) – https://www.fda.gov/drugs/.../orilissa-elagolix
• FDA: Myfembree (relugolix/estradiol/norethindrone acetate) – https://www.fda.gov/drugs/.../myfembree
• FDA: Oriahnn (elagolix/estradiol/norethindrone acetate) – https://www.fda.gov/drugs/.../oriahnn
• MedlinePlus (NIH): Tranexamic Acid – https://medlineplus.gov/druginfo/meds/a612021.html

This article is for educational purposes and does not replace personalized medical advice. Always consult your healthcare professional about your symptoms and treatment options.