Endometrial Cancer vs Uterine Fibroids: What’s the Difference?

Heavy bleeding, pelvic pain and changes to your cycle can point to either uterine fibroids or endometrial cancer, which is why the two are often mentioned together. Though they’re very different conditions. Fibroids are benign growths of muscle tissue in the wall of the womb and are common conditions, particularly in the years leading up to menopause. 

Endometrial cancer is a malignant growth that starts in the lining of the womb, and it most often appears after menopause. An assessment with a doctor will be able to tell the conditions apart, but the difference in how they present, who they affect and how they’re treated are worth understanding. Here’s how endometrial cancer and uterine fibroids differ in their risk factors, diagnosis and treatment.

What is endometrial cancer?

Endometrial cancer is a type of gynaecological cancer that develops in the endometrium, the inner lining of the uterus (womb). It is one of the most common gynaecological cancers and typically occurs after menopause, though it can also affect younger women.

Although this cancer is often referred to as uterus or uterine cancer, the two terms are not exactly the same. Uterus cancer is a broader term that describes cancers originating in the uterus, including endometrial cancer and the much rarer uterine sarcoma, which develops in the muscle or supporting tissues of the uterus.

What are uterine fibroids?

Uterine fibroids are non-cancerous growths that develop in or around the uterus. Also known as leiomyomas or myomas, they are made up of smooth muscle and fibrous tissue and are one of the most common growths affecting women of reproductive age.

Fibroids can vary greatly in size and may develop as a single growth or in clusters. Some remain small and do not cause any noticeable problems, while larger fibroids may affect the shape of the uterus and cause symptoms depending on their size and location.

Risk factors for endometrial cancer vs uterine fibroids

While endometrial cancer and uterine fibroids can both affect the womb, they are different conditions with their own risk factors. Here are the risks associated with each condition:

Endometrial cancer

You may be at a higher risk of developing endometrial cancer if you are over 55, particularly after the menopause.

This increased risk is linked to longer exposure to oestrogen (the hormone that helps the uterine lining grow and thicken), especially when its effects are not adequately balanced by progesterone (the hormone that supports the menstrual cycle and early stages of pregnancy).

The likelihood of developing this condition also increases if you:

• Experience polycystic ovary syndrome (PCOS), infertility, or irregular menstrual cycles.

• Have endometrial hyperplasia, a condition where the endometrium grows excessively thick, which can increase the risk of endometrial cancer if left untreated.

• Experience metabolic conditions, including type 2 diabetes, high blood pressure, and metabolic syndrome.

Uterine fibroids

You may be at a higher risk of developing uterine fibroids if you are of reproductive age, typically between 30 and 50 years old.

While the exact cause is not fully understood, fibroids develop when cells in the muscle of the uterus begin to grow abnormally and form non-cancerous growths. These growths may grow larger during periods when hormone levels are higher, such as during pregnancy, and often shrink after menopause when oestrogen and progesterone levels naturally decrease.

The likelihood of developing this condition also increases if you:

• Have had longer exposure to reproductive hormones, such as starting menstruation at a younger age, reaching menopause later, or never having been pregnant.

• Consume a diet that is high in red meat and low in green vegetables.

• Have a vitamin D deficiency.

Despite these differences, the two conditions also share a few common risk factors. These include obesity and having a family history with either condition.

What are the symptoms of endometrial cancer and uterine fibroids?

Although these are two different conditions, they share some similar symptoms, making it difficult to tell them apart based on symptoms alone. Both conditions may cause:

• Abnormal or heavy vaginal bleeding

• Pelvic pain or pressure

• A feeling of fullness in the lower abdomen

• Pain during sexual intercourse

• Enlarged abdomen

• Changes in bowel or bladder habits

However, there are also some symptoms that are specific to either condition. For example, endometrial cancer is more likely to cause vaginal bleeding after the menopause, unusual vaginal discharge, and unexplained weight loss.

Uterine fibroids, on the other hand, are more likely to cause painful or prolonged menstrual periods as well as constipation that's caused by fibroids pressing against the bowel.

If you experience any of the symptoms mentioned above, you may consider consulting a doctor for an assessment. Schedule an appointment with Thomson Medical.

How are endometrial cancer and uterine fibroids diagnosed?

To diagnose endometrial cancer and uterine fibroids, your doctor will typically start by asking about your symptoms, medical history, and family history, followed by a physical and pelvic examination. 

Diagnosing endometrial cancer

Common tests used to diagnose endometrial cancer include:

• Pelvic examination:

  • During a pelvic exam, your doctor will examine the vagina, cervix, uterus and surrounding areas to check for any unusual changes, lumps, or swelling.

• Endometrial biopsy:

  • Endometrial biopsy is the main test used to confirm endometrial cancer. Your doctor takes a small sample of tissue from the lining of the uterus through the cervix and examines it under a microscope for cancer cells.

• Transvaginal ultrasound:

  • During a transvaginal ultrasound, your doctor gently inserts an ultrasound probe into the vagina to create detailed images of the uterus. 

  • This procedure helps assess the thickness of the endometrium and identify any areas that may need further investigation.

• Dilation and curettage (D&C):

  • If an endometrial biopsy does not provide enough tissue or the diagnosis remains unclear, your doctor may recommend a dilatation and curettage. 

  • This procedure involves gently widening the cervix to collect tissue from the lining of the uterus for further examination.

• Hysteroscopy:

  • During a hysteroscopy, your doctor passes a thin, lighted instrument called a hysteroscope through the vagina and cervix to look directly inside the uterus. 

  • If they find an abnormal area, they may take a small tissue sample for testing. In some cases, hysteroscopy is performed together with a D&C procedure.

• Imaging tests:

  • Once your doctor confirms endometrial cancer, they may recommend imaging tests to assess the size and location of the tumour. These tests can also check whether the cancer has spread beyond the uterus. 

  • Depending on your individual conditions, these may include CT scans, MRIs, PET scans, and chest X-ray tests.

Diagnosing uterine fibroids

Uterine fibroids and endometrial cancer share some diagnostic methods, including pelvic examinations, transvaginal ultrasound, hysteroscopy, and MRI. However, fibroids can often be diagnosed from their appearance on imaging alone, without a tissue biopsy. 

Your doctor may recommend further testing if a growth looks unusual or to rule out another type of abnormal tissue. Below are some of the tests commonly used to diagnose uterine fibroids:

• Abdominal ultrasound:

  • For an abdominal ultrasound, your doctor moves a probe over the abdomen to produce images of the uterus and surrounding pelvic organs. This may be recommended for a wider view of the pelvic area or to assess larger fibroids.

• Sonohysterogram:

  • During a sonohysterogram, your doctor gently places a small amount of saline into the uterus before performing an ultrasound. The saline expands the uterine cavity, allowing your doctor to see inside more clearly and identify fibroids that may be growing.

What are the treatment options for each condition?

The treatment approach for endometrial cancer and uterine fibroids is different because they are two different conditions. Endometrial cancer is a type of cancer that requires treatment to remove or control cancer cells, while fibroids are non-cancerous growths that may only need treatment if they cause worrying symptoms or affect fertility. 

Endometrial cancer treatment

Treatment for endometrial cancer depends mainly on the stage, type, and characteristics of the cancer, as well as your overall health. Treatment options may include:

• Hysterectomy:

  • Hysterectomy is the main surgical treatment for endometrial cancer, especially when the cancer is diagnosed at an early stage and remains within the uterus.

  • The primary aims of surgery are to remove the cancer and to assess whether it has spread (metastasised) to nearby tissues or lymph nodes.

• Radiotherapy:

  • Radiotherapy is a cancer treatment that utilises high‑energy radiation to destroy cancer cells, reduce the risk of the cancer recurring, or control cancer in specific areas such as the pelvis or vaginal vault (the upper part of the vagina that surrounds the cervix).

• Chemotherapy:

  • Anti‑cancer medicines that travel through the bloodstream to destroy cancer cells that may have spread beyond the uterus or to treat higher‑risk or recurrent cases.

• Hormone therapy:

  • Hormone therapy may be suitable for certain endometrial cancers that respond to hormones. 

  • It can provide a temporary alternative to hysterectomy for women who wish to preserve their fertility.

• Immunotherapy:

  • This treatment works by helping the immune system recognise and attack cancer cells. This treatment may be recommended for some patients with advanced, recurrent, or metastatic endometrial cancer.

• Targeted therapy:

  • This treatment uses medicines that target specific genes that enable cancer cells to grow and survive.

  • These drugs are usually offered to selected patients with advanced or recurrent disease, often in combination with other cancer treatments

For higher or advanced stages of endometrial cancer, treatment is often more complex. It typically involves a combination of surgery, radiotherapy, chemotherapy, hormone therapy, or newer options such as immunotherapy or targeted therapy.

Uterine fibroid treatment

Treatment for uterine fibroids depends on their size, location, symptoms, and whether you plan to have children. Small fibroids that do not cause symptoms may only require monitoring. 

A hysterectomy, which removes the uterus, is also used to treat endometrial cancer but may be recommended for fibroids when symptoms are severe or other treatments have not worked. Other treatment options include:

• Medications:

  • Hormonal medicines, oral contraceptives, tranexamic acid, or non-steroidal anti-inflammatory drugs (NSAIDs) may help manage symptoms such as heavy menstrual bleeding and pelvic pain. 

  • These medications help control symptoms but do not permanently shrink fibroids, so the fibroids and related symptoms may return after you stop treatment.

• Non-surgical procedures:

  • Some women may be suitable for uterine artery embolisation (UAE), which reduces the blood supply to the fibroids and helps them shrink over time.

• Myomectomy:

  • Myomectomy is a surgical procedure that removes the fibroids while keeping the uterus intact. It may be an option for women who wish to preserve their fertility or become pregnant in the future.

If you are unsure which treatment may be suitable for your condition, consult with a specialist to help you make a more informed decision about your care. Schedule an appointment with Thomson Women's Clinic for a consultation with our gynaecologist.

What is the expected result of each condition after treatment?

The outcome of endometrial cancer treatment is generally higher when the cancer is detected early and remains confined to the uterus, with around 86-95% of women remaining healthy five years after diagnosis. However, when the cancer has spread to distant organs such as the lungs, liver, or bones, the outcome is less favourable, with around 18-26% of women remaining healthy five years after diagnosis.

Uterine fibroids are non-cancerous, and many women have no symptoms or long-term health problems, while others may experience heavy periods, pelvic discomfort, or fertility and pregnancy-related complications. Treatment can usually manage these symptoms, although fibroids may grow again after treatment. 

FAQ

Can you have both uterine fibroids and endometrial cancer at the same time?

It is possible to have both uterine fibroids and endometrial cancer at the same time, although they are separate conditions that develop in different parts of the uterus. Uterine fibroids are non-cancerous growths that arise from the muscle layer of the uterus, whereas endometrial cancer develops from the endometrium.

Can uterine fibroids turn into cancer?

Uterine fibroids do not develop into endometrial cancer because the two conditions arise from different types of tissue within the uterus. However, further assessment may be recommended if a fibroid grows rapidly, particularly after menopause.

Do fibroids increase your risk of getting endometrial cancer?

Can uterine cancer be misdiagnosed as fibroids?

The information provided is intended for general guidance only and should not be considered medical advice. For personalised recommendations and advice based on your individual circumstances, schedule an appointment with Thomson Medical today.

Reference

Mager KL, McLean K. Endometrial Cancer: A Review. JAMA. 2026;335 (18):1616-1627. doi:10.1001/jama.2026.2248