Fibroids, Endometriosis, and Painful Periods: Understanding the Differences

Abstract

Many women worldwide experience pelvic pain, heavy bleeding, and menstrual difficulties without fully understanding the cause. Fibroids, endometriosis, and painful periods (dysmenorrhea) are three common yet distinct conditions affecting the uterus and surrounding organs. Although symptoms often overlap, proper diagnosis and management depend on distinguishing between them. This paper aims to humanize, explain, and differentiate these conditions by combining evidence-based research with real-world examples, focusing especially on African and global perspectives. Using simple international English and African English expressions, this paper offers practical insights into how women, families, and healthcare providers can better recognise and address these challenges.

Introduction

In many communities, especially in Africa, women grow up believing that painful periods are “normal” and must simply be endured (Mbonye et al., 2020). Yet, not every pain is ordinary. Sometimes, what feels like a bad period could be a sign of deeper problems like fibroids or endometriosis.

Understanding the difference between common menstrual cramps (dysmenorrhea), fibroids, and endometriosis is critical for improving women’s health outcomes. Left untreated, these conditions can affect fertility, quality of life, and mental wellbeing (Bulun, 2019).

This paper uses simple, real-world language, explains the detailed pathophysiology, shares case studies, and guides readers on recognising when to seek medical help.

Background and Epidemiology

Fibroids

Uterine fibroids (leiomyomas) are benign (non-cancerous) tumours made of muscle and fibrous tissue that grow inside or around the uterus. According to Stewart et al. (2017), fibroids affect up to 70% of women by the age of 50, with Black women being three times more likely to develop them compared to White women.

Endometriosis

Endometriosis happens when tissue that looks and acts like the lining inside the uterus (endometrium) grows outside the uterus — often on the ovaries, fallopian tubes, and other pelvic structures. It affects about 10% of reproductive-aged women worldwide (Zondervan et al., 2020).

Painful Periods (Dysmenorrhea)

Dysmenorrhea refers to painful menstruation. There are two types:

• Primary dysmenorrhea: Painful periods without any underlying condition.
• Secondary dysmenorrhea: Painful periods due to conditions like fibroids or endometriosis (Iacovides et al., 2015).

Pathophysiology

Fibroids

Fibroids begin when a single muscle cell in the uterus grows abnormally and forms a tumour. High levels of oestrogen and progesterone hormones encourage fibroid growth. When oestrogen levels are high — like during pregnancy or before menopause — fibroids tend to grow faster (Stewart et al., 2017).

Fibroids can be:

• Submucosal (inside the uterine cavity)
• Intramural (within the uterine wall)
• Subserosal (on the outer surface of the uterus)

Depending on size and location, fibroids cause pressure symptoms, heavy bleeding, infertility, or even miscarriage.

Endometriosis

The exact cause of endometriosis is not fully understood. The most accepted theory is “retrograde menstruation” — when menstrual blood flows backwards into the pelvis instead of leaving the body (Sampson, 1927). However, genetics, immune system problems, and environmental factors also play a role.

The endometrial-like tissue outside the uterus reacts to monthly hormonal changes, thickens, breaks down, and bleeds — but unlike regular menstrual blood, it has nowhere to go. This trapped blood causes inflammation, pain, and the formation of scar tissue (adhesions).

Painful Periods (Dysmenorrhea)

Primary dysmenorrhea is caused by the overproduction of prostaglandins — chemicals that cause the muscles of the uterus to contract strongly. These contractions cut off blood supply briefly, leading to pain. In secondary dysmenorrhea, the pain comes from other conditions like fibroids or endometriosis (Iacovides et al., 2015).

Clinical Presentation

Real-World Case Studies

Case Study 1: Amina’s Story (Fibroids)

Amina, a 35-year-old woman from Lagos, noticed that her periods were lasting almost ten days. She also felt a heavy pressure in her lower belly. After visiting a clinic, an ultrasound showed multiple fibroids, some the size of oranges.

Amina was advised to undergo a myomectomy (surgical removal of fibroids) because she still wanted to have children.

Lesson: Heavy bleeding, prolonged periods, and a feeling of heaviness can suggest fibroids.

Case Study 2: Thandiwe’s Journey (Endometriosis)

Thandiwe from Johannesburg suffered from terrible period pains since her teenage years. The pain worsened with time, and she also found sexual intercourse very painful. Doctors initially dismissed it as “normal,” but after a laparoscopy (keyhole surgery), she was diagnosed with stage III endometriosis.

She started hormonal treatment and eventually underwent surgery to remove the scar tissue.

Lesson: Long-term, worsening pelvic pain, painful intercourse, and fertility issues may indicate endometriosis.

Case Study 3: Rose’s Experience (Primary Dysmenorrhea)

Rose, a 19-year-old student from Nairobi, complained of painful cramps during her periods but no pain at other times. Examination and ultrasound were normal. She was prescribed NSAIDs (like ibuprofen) and advised on exercise and a healthy diet.

Lesson: Normal scans and history of pain only during periods suggest primary dysmenorrhea.

Diagnostic Approach

• History and Physical Exam: Crucial first steps. Details about bleeding, pain, fertility issues, and family history.
• Ultrasound: Useful for seeing fibroids.
• MRI: Sometimes needed for detailed pictures.
• Laparoscopy: The gold standard for diagnosing endometriosis — a tiny camera is inserted into the belly.
• Blood Tests: Can help rule out infections or anaemia from heavy bleeding.

Management

Treatment should always be tailored to a woman’s desire for fertility, severity of symptoms, and overall health (Bulun, 2019).

Cultural and Social Considerations

In African settings, menstrual issues are often hidden due to cultural taboos and stigma (Mbonye et al., 2020). Many women suffer in silence, believing that severe pain is simply part of being a woman. Education and open dialogue are essential to empower women to seek timely help.

Faith healers and traditional medicine are often consulted first. While traditional support systems can be comforting, delaying medical diagnosis can worsen outcomes. Integrating respectful cultural understanding into healthcare delivery can bridge these gaps.

Conclusion

Fibroids, endometriosis, and painful periods all involve pain and bleeding but stem from different causes. Knowing the differences is life-changing. Women need to be heard, believed, and supported to seek proper care. Early diagnosis and individualised treatment can greatly improve quality of life, fertility, and emotional wellbeing.

Women, healthcare workers, policymakers, and families all have a role to play in making menstrual health a public health priority. Pain should never be normalised — it should be understood.

References

• Bulun, S. E. (2019). Endometriosis. New England Journal of Medicine, 380(13), 1244–1256. https://doi.org/10.1056/NEJMra1810764
• Iacovides, S., Avidon, I., Bentley, A., & Baker, F. C. (2015). Dysmenorrhea and associated health complaints: A prospective study. British Journal of Obstetrics and Gynaecology, 122(5), 623–633. https://doi.org/10.1111/1471-0528.13284
• Mbonye, A. K., Sentongo, M., Mukasa, G., Byamugisha, J., & Wabwire-Mangen, F. (2020). Cultural perceptions and health-seeking behavior for dysmenorrhea and other menstrual problems among women in Uganda. BMC Women’s Health, 20(1), 18. https://doi.org/10.1186/s12905-020-00913-4
• Sampson, J. A. (1927). Peritoneal endometriosis due to menstrual dissemination of endometrial tissue into the peritoneal cavity. American Journal of Obstetrics and Gynecology, 14(4), 422–469.
• Stewart, E. A., Laughlin-Tommaso, S. K., Catherino, W. H., Lalitkumar, P. G., Gupta, D., & Vollenhoven, B. (2017). Uterine fibroids. Nature Reviews Disease Primers, 3(1), 17043. https://doi.org/10.1038/nrdp.2017.43
• Zondervan, K. T., Becker, C. M., & Missmer, S. A. (2020). Endometriosis. New England Journal of Medicine, 382(13), 1244–1256. https://doi.org/10.1056/NEJMra1810764