The Endometriosis Network Canada and Fibroids: What to Know

Pelvic pain and heavy periods are common, but they are not normal. Two of the most frequent culprits are endometriosis and uterine fibroids. While they are different conditions, they can coexist and often cause overlapping symptoms that delay diagnosis and treatment. This article explains the connection, outlines evidence-based care options, and highlights how The Endometriosis Network Canada (TENC) can help you navigate your journey.

Endometriosis and Fibroids 101

Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus, triggering inflammation, scarring, and pain. It affects an estimated 10% of reproductive-age women and people assigned female at birth, and is a leading cause of chronic pelvic pain and infertility.

Fibroids (uterine leiomyomas) are noncancerous growths of the uterus that respond to hormones like estrogen and progesterone. By age 50, most people with a uterus will develop fibroids; many have no symptoms, but some experience significant bleeding, pain, or fertility challenges. Fibroids are more likely to be severe and to occur earlier among Black women, reflecting complex genetic, biologic, and social determinants of health.

Why They’re Confused—and How They Can Coexist

Endometriosis and fibroids are different diseases, but they can produce similar symptoms:

• Heavy or prolonged menstrual bleeding
• Pelvic pain, cramping, low-back pain
• Pain with sex
• Urinary frequency or constipation (from pressure effects, more typical of fibroids)
• Fertility challenges

Some people have both conditions. Coexisting disease can intensify symptoms and complicate diagnosis. If you’ve been treated for one condition but still have pain or heavy bleeding, ask your clinician to reassess for the other.

Getting a Diagnosis in Canada

Start with your primary care provider and request referral to a gynecologist if symptoms persist. Documenting your symptoms—pain days, bleeding volume (e.g., number of pads/tampons or flooding), missed activities, and any bowel or bladder issues—can speed evaluation.

For fibroids, clinicians typically use a pelvic exam and imaging:

• Transvaginal or transabdominal ultrasound is the first-line test.
• Saline infusion sonohysterography can better visualize the uterine cavity for submucosal fibroids.
• MRI helps with complex cases or surgical planning.
• Hysteroscopy may be used to look inside the uterus and treat certain fibroids.

For endometriosis, diagnosis is often clinical (based on history and exam), supported by imaging when relevant (for example, ovarian endometriomas on ultrasound). Laparoscopy can confirm and treat endometriosis, but many people are offered medical therapy without surgery first, depending on their goals and severity of symptoms.

Treatment Options: Evidence-Based and Individualized

Your plan should reflect your symptoms, goals (pain control, fertility, uterine preservation), other health conditions, and personal preferences. Shared decision-making with your clinician is essential.

For Fibroids

• Watchful waiting for mild symptoms, particularly if fibroids are small or near menopause.
• Medications to manage bleeding and pain: nonsteroidal anti-inflammatory drugs; hormonal contraception (pill, patch, ring); progestin IUD; tranexamic acid for heavy menstrual bleeding; and hormone-modulating therapies (for example, GnRH agonists or antagonists) that can shrink fibroids and reduce bleeding. Some are used short-term due to side effects and the need for add-back therapy.
• Procedures when symptoms are moderate to severe or unresponsive to medications: uterine artery embolization (shrinks fibroids by cutting off their blood supply), radiofrequency ablation, myomectomy (surgical removal of fibroids, uterus preserved), or hysterectomy (removal of the uterus), which is definitive for fibroids but not appropriate for those desiring pregnancy.

For Endometriosis

• Medications to reduce pain and suppress disease activity: NSAIDs; combined hormonal contraception; progestins (including IUDs); and in some cases GnRH agonists or antagonists with add-back therapy to mitigate side effects.
• Surgery (often laparoscopic excision or ablation) to remove endometriosis lesions, break adhesions, and improve pain. Outcomes are best when performed by surgeons with specialized endometriosis expertise.
• Comprehensive care that may include pelvic floor physiotherapy, diet and lifestyle strategies, mental health support, and pain rehabilitation. Fertility plans may involve timing of surgery, ovulation induction, or assisted reproductive technologies.

Both conditions benefit from individualized care and regular follow-up, especially if symptoms change or new goals (such as pregnancy) arise.

How The Endometriosis Network Canada Helps

The Endometriosis Network Canada (TENC) is a national, patient-led charity focused on education, support, and advocacy for people with endometriosis. While TENC does not diagnose or treat fibroids, many community members live with multiple gynecologic conditions, including fibroids. If you have fibroids, you may still find TENC helpful for:

• Peer support: Facilitated support groups and community forums that validate experiences, reduce isolation, and share practical coping strategies for pelvic pain and heavy bleeding.
• Education: Webinars, patient guides, and awareness campaigns that explain symptoms, treatment options, and how to prepare for appointments—useful skills even if your pain is from fibroids, endometriosis, or both.
• Advocacy: National efforts to improve timely diagnosis, equitable access to care, and research funding for endometriosis—progress that often benefits people with overlapping gynecologic conditions.

Explore resources and upcoming events at endometriosisnetwork.ca.

Navigating Care in Canada: Practical Tips

• Track symptoms with a diary or app. Note bleeding volume, pain scores, and triggers.
• Bring your goals to visits—pain control, fertility, keeping your uterus, recovery time, or minimizing side effects.
• Ask about all options, including medications, uterine-sparing procedures (for fibroids), and specialist referral for complex endometriosis.
• Request copies of imaging and reports; they can speed second opinions.
• Address anemia if heavy bleeding is present; iron studies and treatment can improve fatigue and cognition while you pursue definitive care.

When to Seek Urgent Help

• Soaking through a pad or tampon every hour for several hours
• Severe, unrelenting pelvic pain, fever, fainting, or dizziness
• Signs of significant anemia (shortness of breath, chest pain, extreme fatigue, paleness)

Call your clinician, visit an urgent care clinic, or go to the emergency department if these occur.

Questions to Ask Your Clinician

• Could I have both fibroids and endometriosis? How will that change my care?
• What tests are needed now, and what can wait?
• What are the benefits, risks, and recovery times of my treatment options?
• How will this plan affect my fertility now or later?
• What is our follow-up schedule, and how will we measure success?

Trusted Sources and Further Reading

• U.S. Office on Women’s Health: Uterine fibroids and Endometriosis
• National Institutes of Health (NIH), NICHD: Endometriosis overview and Fibroids
• Society of Obstetricians and Gynaecologists of Canada (SOGC): Patient resources
• Health Canada: Drugs and health products (safety information on medications)
• The Endometriosis Network Canada: Support, education, and advocacy

No article can replace medical advice. If symptoms are affecting your life, seek evaluation. With the right information, support, and care team, most people find a plan that reduces pain, controls bleeding, and aligns with their goals.