Fibroids and Endometriosis With No Symptoms: Why It Happens and What Helps

Uterine fibroids and endometriosis are among the most common gynecologic conditions. Fibroids are benign muscular tumors of the uterus, while endometriosis occurs when tissue similar to the uterine lining grows outside the uterus. Many people expect these conditions to cause severe cramps, heavy bleeding, or pelvic pain. Yet a significant number have few or no symptoms—and only discover them during routine imaging, fertility evaluations, or surgery for other reasons. Here’s why that happens, what it can mean for your health and fertility, and practical steps you can take.

Why You Might Have Few or No Symptoms

• Size and location matter (especially for fibroids). Small fibroids or those positioned within the muscular wall (intramural) or on the outer surface (subserosal) may not affect the uterine lining or nearby organs, so you may not notice bleeding or pressure. Submucosal fibroids, by contrast, often cause heavy bleeding because they distort the uterine cavity.
• Lesion placement and depth (for endometriosis). Superficial implants may cause few symptoms, particularly if they don’t inflame nerves or organs. Endometriomas (ovarian cysts caused by endometriosis) or deeply infiltrating disease are more likely to cause pain, but some people still have minimal or no symptoms even with advanced disease.
• Hormonal environment. Hormonal contraception (pills, patch, ring, injection), the levonorgestrel IUD, or pregnancy can suppress bleeding and cramps, masking symptoms from both conditions. Around menopause, naturally lower estrogen often reduces symptoms of fibroids and endometriosis.
• Gradual onset and pain perception. Symptoms can develop slowly, and pain thresholds vary. What one person describes as a mild inconvenience might be severe to another; some normalize discomfort over time and don’t seek care.
• Coexisting conditions. Bladder or bowel symptoms from fibroids or endometriosis can be misattributed to IBS, urinary issues, or stress. Conversely, people focused on fertility may miss subtle gynecologic symptoms until testing reveals an underlying condition.

Importantly, being asymptomatic does not necessarily mean the condition is insignificant. Monitoring is still reasonable, especially for larger fibroids or suspected endometriosis affecting the ovaries or bowel.

How These Conditions Are Found Without Symptoms

• Routine pelvic exam: A clinician may feel an enlarged, irregular uterus suggestive of fibroids.
• Imaging: Pelvic ultrasound is the first-line test for fibroids and ovarian endometriomas. MRI can refine fibroid mapping or assess deep endometriosis when needed. Superficial endometriosis is not reliably seen on imaging.
• Fertility evaluation or surgery: Endometriosis is sometimes discovered during evaluation for infertility or incidentally at surgery for other reasons. While laparoscopy remains the definitive way to confirm endometriosis, many guidelines support a clinical diagnosis based on history, exam, and imaging—surgery isn’t required for everyone.

Potential Health Implications Even When You Feel Fine

• Fibroids
  • Growth and pressure effects: Larger fibroids can eventually press on the bladder or bowel, cause visible abdominal fullness, or lead to back pain.
  • Bleeding and anemia: If bleeding does occur, iron-deficiency anemia can develop over time. Some people don’t recognize fatigue or brain fog as anemia.
  • Fertility and pregnancy: Certain fibroids—especially submucosal or large intramural types that distort the cavity—may affect implantation, miscarriage risk, or pregnancy outcomes.
• Endometriosis
  • Inflammation and scarring: Silent endometriosis can still cause adhesions that affect the tubes and ovaries, potentially impacting fertility.
  • Ovarian endometriomas: These cysts may reduce ovarian reserve or rarely rupture or twist (torsion). Even without pain, they merit monitoring and a surgical discussion in certain cases.

What Helps If You Have No or Mild Symptoms

The right approach depends on your goals—symptom control, fertility now or later, and your tolerance for medications or procedures. Discuss the options below with your clinician.

1) Watchful waiting with smart monitoring

• Track changes: Note menstrual flow, cramps, pelvic pressure, urinary frequency, and new pain. Report changes promptly.
• Check-ins and imaging: Periodic exams and ultrasounds can document stability or growth, especially for larger fibroids or ovarian endometriomas. Your clinician can tailor the interval to your situation.

2) Lifestyle supports (adjuncts, not cures)

• Iron and diet: If bleeding is heavy at times, ensure adequate dietary iron and discuss testing for anemia.
• Physical activity and weight management: Regular exercise supports overall gynecologic health and may help pain perception and energy levels.
• Smoking cessation and sleep: Both influence inflammation and recovery.

3) Medications for prevention or symptom control

• Nonsteroidal anti-inflammatory drugs (NSAIDs): Useful for occasional cramps or pelvic discomfort.
• Hormonal contraception: Combined pills, patch, ring, progestin-only methods, and the levonorgestrel IUD can reduce bleeding and cramping from fibroids and suppress endometriosis activity. They typically do not shrink fibroids but can improve quality of life.
• Tranexamic acid: Taken only during menses, it reduces heavy bleeding from fibroids in those who prefer a non-hormonal option and have no clotting risk factors.
• GnRH analogs and antagonists (specialist-prescribed): Short-term use can shrink fibroids and suppress endometriosis activity. FDA-approved options include elagolix for endometriosis pain and combination therapies for fibroid bleeding (elagolix/estradiol/norethindrone acetate; relugolix/estradiol/norethindrone acetate). These require monitoring for side effects like hot flashes and bone density changes; add-back hormones help mitigate these effects. They’re often used as a bridge to surgery or when other therapies aren’t suitable.

4) Fertility-sparing procedures (when intervention is needed)

• Myomectomy: Surgical removal of fibroids while preserving the uterus. Considered for cavity-distorting fibroids, fertility goals, or significant bulk symptoms.
• Uterine artery embolization (UAE/UFE): A minimally invasive radiology procedure that shrinks fibroids by cutting off their blood supply. It’s effective for symptom control; discuss risks and future fertility plans with your team.
• Endometriosis surgery: Laparoscopic excision or ablation can improve pain and, in selected cases, fertility. Surgery is individualized based on lesion location, severity, and goals.

When to Seek More Active Care

• Periods become markedly heavier or more painful, or you develop bleeding between periods.
• New pelvic pain, pain with sex, urinary frequency/urgency, constipation, or back/leg pain that persists.
• Signs of anemia (fatigue, shortness of breath, dizziness).
• Trouble conceiving after 6–12 months of trying (depending on age), or pregnancy losses.
• Rapidly enlarging abdominal girth or a mass you can feel.

While cancer arising in fibroids is rare, any rapid growth, new postmenopausal bleeding, or atypical imaging should be evaluated promptly.

Key Takeaways

• It’s common to have fibroids or endometriosis with few or no symptoms.
• Asymptomatic does not always mean inconsequential—monitoring helps protect your fertility and overall health.
• Management ranges from watchful waiting to medicines and minimally invasive procedures, tailored to your goals.
• Partner with a clinician experienced in both conditions, especially if you are planning pregnancy or have complex findings.

Trusted Sources and Further Reading

• NIH/NICHD: Uterine Fibroids Overview — https://www.nichd.nih.gov/health/topics/uterine/conditioninfo/fibroids
• NIH/NICHD: Endometriosis Overview — https://www.nichd.nih.gov/health/topics/endometri/conditioninfo
• Office on Women’s Health (HHS): Uterine Fibroids — https://womenshealth.gov/a-z-topics/uterine-fibroids
• ACOG: Uterine Fibroids FAQ — https://www.acog.org/womens-health/faqs/uterine-fibroids
• ACOG: Endometriosis FAQ — https://www.acog.org/womens-health/faqs/endometriosis
• FDA: Orilissa (elagolix) for endometriosis pain — https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/orilissa
• FDA: Oriahnn (elagolix/estradiol/norethindrone) for fibroid bleeding — https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/oriahnn
• FDA: Myfembree (relugolix/estradiol/norethindrone) approvals — fibroid bleeding and endometriosis pain — Fibroids approval | Endometriosis approval

This article is for general education and does not replace personalized medical advice. If you suspect fibroids or endometriosis—or have been told you have them—ask your clinician about the best monitoring and treatment plan for you.