Fibroids and Endometrial Lesion Symptoms: Why It Happens and What Helps

September 13, 2025

Fibroids and Endometrial Lesion Symptoms: Why It Happens and What Helps

Heavy periods, pelvic pain, bleeding between periods, or pressure symptoms can feel confusing and alarming. Two common culprits are uterine fibroids and endometrial lesions (such as polyps, endometrial hyperplasia inside the uterus, and endometriosis lesions outside the uterus). Understanding why these symptoms occur and which treatments actually help can make decisions clearer and safer.

What are fibroids and endometrial lesions?

Uterine fibroids (leiomyomas) are benign growths of the muscle wall of the uterus. They are very common—by age 50, most women will have at least one. Fibroids may grow within the uterine wall, push into the cavity (submucosal), or bulge outward (subserosal), and they can be single or multiple. Many are silent; others cause heavy bleeding, pain, or pressure symptoms. Trusted overviews: MedlinePlus (NIH); ACOG.

Endometrial lesions include several conditions affecting the uterine lining or endometrial-like tissue:

Endometrial polyps: small, usually benign overgrowths of the lining that can cause irregular or heavy bleeding.
Endometrial hyperplasia: thickening of the lining due to excess estrogen relative to progesterone; symptoms include heavy or unpredictable bleeding. Some types (with atypia/EIN) carry a higher risk of progressing to cancer and require close management. See ACOG.
Endometriosis lesions: endometrial-like tissue outside the uterus (on ovaries, pelvic peritoneum, etc.). These implants are inflammatory and hormonally responsive, often causing pelvic pain, painful periods, painful intercourse, and sometimes infertility. Learn more at ACOG and HHS Office on Women’s Health.

Why do these symptoms happen?

Symptoms arise from a mix of hormone effects, inflammation, and anatomy:

Heavy menstrual bleeding (HMB): Fibroids that distort or enlarge the uterine cavity increase the bleeding surface and disrupt normal uterine contractions that limit blood loss. Polyps and hyperplasia create fragile, irregular lining tissue that bleeds easily. Inflammatory mediators (like prostaglandins) can further amplify bleeding. See ACOG: Abnormal Uterine Bleeding.
Pain: Fibroids can cause cramping from increased uterine workload and bulk-related pressure on the bladder, bowel, or pelvic nerves. Endometriosis lesions trigger inflammation and nerve sensitization, leading to painful periods, chronic pelvic pain, and pain with sex.
Fertility effects: Submucosal fibroids and polyps can interfere with implantation; endometriosis can cause scarring or affect egg quality and pelvic function.

Common symptoms to watch for

Heavy or prolonged periods (soaking a pad/tampon every 1–2 hours, passing clots)
Bleeding between periods or after sex
Pelvic pressure, bloating, urinary frequency, constipation, low back pain
Severe menstrual cramps or pelvic pain; pain with intercourse
Fatigue or shortness of breath from anemia
Difficulty conceiving or recurrent pregnancy loss

How clinicians make the diagnosis

Evaluation starts with your history, a pregnancy test when appropriate, and a pelvic exam. Depending on your symptoms and risk factors, your clinician may recommend:

Blood tests: Complete blood count and ferritin (to check for iron-deficiency anemia).
Transvaginal ultrasound: First-line imaging to identify fibroids, polyps, and endometrial thickness.
Saline infusion sonohysterography or hysteroscopy: Best for seeing and removing cavity lesions like submucosal fibroids or polyps.
MRI: Helpful for mapping fibroids pre-surgery or when ultrasound is unclear.
Endometrial biopsy: Recommended for abnormal uterine bleeding at age ≥45, or younger if bleeding is persistent or risk factors exist (e.g., obesity, PCOS, tamoxifen use). This rules out hyperplasia or cancer. Guidance: ACOG.
Laparoscopy: Sometimes used to confirm and treat endometriosis.

What helps: evidence-based options

Treatment is individualized based on your goals (symptom relief, fertility, uterine preservation), the size and location of growths, age, and other health considerations.

Self-care and nonhormonal medicines

NSAIDs (e.g., ibuprofen, naproxen) can reduce menstrual pain and modestly decrease bleeding by lowering prostaglandins. Use as directed and with food to protect the stomach.
Tranexamic acid taken only during menses is effective for heavy bleeding when hormones aren’t an option. Ask whether it’s right for you if you have a history of clots. See ACOG.
Iron supplementation if you have anemia, along with an iron-rich diet.

Hormonal options

Combined hormonal contraception (pill, patch, ring) or progestin-only methods (pill, shot, implant) can lighten and regulate periods and improve cramps.
Levonorgestrel-releasing intrauterine device (LNG-IUD) is highly effective for heavy bleeding, including with some fibroids, if the cavity isn’t significantly distorted. It also treats certain forms of endometrial hyperplasia without atypia. References: ACOG; ACOG.
GnRH agonists (e.g., leuprolide) can temporarily shrink fibroids and reduce bleeding, and they are effective for endometriosis pain. Because they lower estrogen, clinicians often add back a small amount of estrogen/progestin to reduce side effects and bone loss; they’re usually used short term.
Oral GnRH antagonists with add-back therapy are FDA-approved for heavy menstrual bleeding due to fibroids (e.g., elagolix combination, relugolix combination) and for endometriosis pain (specific indications vary). These can significantly reduce bleeding and pain but have use-duration limits due to bone health. FDA announcement for elagolix combination: FDA.

Procedures and surgeries

Hysteroscopic polypectomy or submucosal fibroid resection removes cavity lesions through the cervix, often resolving bleeding and improving fertility.
Uterine artery embolization (UAE) blocks fibroid blood supply to shrink them and reduce bleeding/pressure. It’s uterus-sparing but not recommended for people planning pregnancy soon. Discuss with a gynecologist and interventional radiologist. See options overview at ACOG.
MRI-guided focused ultrasound is a noninvasive technique for select fibroids.
Myomectomy (surgical fibroid removal) preserves the uterus and can be done hysteroscopically, laparoscopically, or via open surgery depending on size/location; often preferred if fertility is desired.
Endometrial ablation reduces or stops bleeding by destroying the lining. It is not for those who may want future pregnancy and is contraindicated with suspected hyperplasia or cancer.
Hysterectomy definitively treats fibroids and some endometrial conditions when other treatments fail or aren’t appropriate.
Endometriosis surgery (laparoscopic excision/ablation) can reduce pain and improve fertility in selected cases.

When to seek care—fast

Soaking through a pad/tampon every hour for several hours
Severe pelvic pain, fainting, dizziness, chest pain, or shortness of breath
Positive pregnancy test with bleeding or pain
Fever with pelvic pain or foul discharge

Partner with your clinician

There isn’t a one-size-fits-all plan. Your best approach depends on your symptoms, life plans (including pregnancy), medical history, and the exact diagnosis. Start with a careful evaluation, then consider stepwise treatments—from medicines to procedures—balancing benefits, risks, and personal preferences.

This article is for general education and does not replace personalized medical advice. If you have concerning symptoms, schedule an appointment with a qualified clinician.