Fibroids vs PCOS: Symptoms, Causes, & Treatment Options

Irregular periods, pelvic discomfort, bloating, or unexpected changes in your body can feel worrying, especially when you do not know what is causing them. Many women live with these symptoms for months or even years before seeking answers.

Two common causes are fibroids and polycystic ovary syndrome (PCOS). While they can sometimes overlap, they are very different conditions that need different treatment approaches.

What are uterine fibroids?

Fibroids are growths made of muscle and fibrous tissue that develop in or around your uterus. They are very common, especially in women aged 30 to 50.

Fibroids are usually non-cancerous growths, and they very rarely become cancerous. Even when they do cause symptoms, they are normally considered benign.

What causes fibroids?

Hormones are central to how fibroids develop. While the exact cause is not fully understood, fibroids are closely linked to oestrogen and progesterone, which is why they are most common during the reproductive years.

Other contributing factors may include:

• A family history of fibroids

• Starting periods at a younger age

• A higher body weight

Because hormones play a part, fibroids often shrink on their own after menopause, when oestrogen levels fall.

Symptoms of fibroids

You might have fibroids without knowing it, only discovering them during a routine scan. Some women have no symptoms at all, while others find fibroids interfere with daily life, work, comfort, or fertility. 

You might notice:

• Heavy or prolonged menstrual bleeding

• A feeling of pressure or fullness in your pelvis

• Needing to urinate more often

• Constipation and bloating

• Lower back or leg pain

• Pain during sexual intercourse

These symptoms often develop gradually, so it is not always easy to connect them to a single cause.

Types of fibroids

Knowing which type you have can help your doctor recommend the most suitable treatment.

There are four main types:

• Intramural fibroids grow within the wall of your uterus and are the most common type

• Submucosal fibroids grow into the inner cavity of your uterus and tend to cause the heaviest bleeding

• Subserosal fibroids grow outward from the outer surface of your uterus and may cause pressure or back pain

• Pedunculated fibroids are attached to your uterus by a stalk-like structure, either inside or outside

Because fibroids can affect different parts of your uterus, two people with similar-sized fibroids may still experience very different symptoms.

What is PCOS?

Polycystic ovary syndrome (PCOS) is a hormonal disorder that affects how your ovaries work. It can disrupt ovulation, which leads to irregular periods, fertility issues, and, in some cases, higher levels of androgens. 

Androgens, sometimes called "male hormones”, are hormones that everyone produces, though women with PCOS often have more of them than usual.

Despite the name, not everyone with PCOS has cysts on their ovaries. The name comes from how the ovaries can appear on a scan, not from cysts in the usual sense.

What causes PCOS?

PCOS usually develops because several hormonal and metabolic factors interact with each other. It is not caused by anything you did wrong. 

Contributing factors may include:

• Your body not responding well to insulin, which can affect hormone levels

• A hormonal imbalance, especially higher androgen levels

• A family history of PCOS

• Carrying excess weight, which can make symptoms more noticeable

Insulin resistance is considered one of the key causes. When your body does not respond well to insulin, it triggers a hormonal shift that raises androgen levels and disrupts ovulation.

Symptoms of PCOS

Because PCOS affects hormones throughout your body, your symptoms may vary. Since symptoms often develop gradually, it may take time to spot a pattern. 

You might notice:

• Irregular periods, or periods that stop altogether

• Excess hair on the face or body (hirsutism)

• Acne that is difficult to manage

• Thinning hair on the scalp

• Weight gain or difficulty losing weight

• Dark patches of skin in skin folds, which can be a sign of insulin resistance

• Difficulty getting pregnant

Not everyone with PCOS experiences all of these symptoms. You may only find out you have PCOS when you have difficulty conceiving and seek further tests.

Hormonal imbalances, irregular periods, and symptoms like excess hair or acne may indicate PCOS. Request an appointment with Thomson Medical to get a personalised assessment, explain the factors behind your symptoms, and guide you on treatment options tailored to your needs.

Fibroids vs PCOS: What’s the difference? 

Although fibroids and PCOS can both affect your periods and fertility, they develop differently and affect your body in different ways. 

Here is a comparison:

While the conditions are different, both can benefit from early diagnosis. An earlier assessment may give you more options for managing symptoms and better support for your fertility goals.

Can you have both at the same time?

Yes, it is possible to have both fibroids and PCOS. Although they are separate conditions, having symptoms of one does not rule out the other. 

That said, as fibroids and PCOS are separate conditions with different causes, a full assessment will look at both rather than focusing on just one.

Having one does not necessarily mean you are more likely to have the other. If both are present, your treatment will be tailored to each condition. In some cases, hormonal treatments may help improve symptoms of both.

How are fibroids and PCOS diagnosed?

Because fibroids and PCOS can both affect your periods, your doctor will need to do a few checks to understand what is causing your symptoms.

Your doctor may:

• Carry out a pelvic ultrasound scan to look for fibroids or changes to the ovaries

• Order blood tests to check hormone and androgen levels

• Carry out a physical examination

• Ask about your menstrual history in detail

For PCOS, diagnosis follows internationally recognised guidelines known as the Rotterdam Criteria.

You usually need to meet at least 2 of these 3 criteria:

1. Irregular or absent ovulation

2. Signs of high androgen levels, either from symptoms or a blood test

3. Polycystic ovaries seen on an ultrasound

Tracking when your period starts and ends, how heavy it is, and any associated symptoms gives your doctor a clearer picture to work from when determining the suitable treatments.

What are the treatments?

There is no single approach that works for everyone. Your treatment experience depends on your symptoms, age, future pregnancy plans, and how much the condition is affecting your quality of life. 

Treating fibroids

Treatment options range from medication to surgical procedures, and your doctor will consider the size and location of your fibroids alongside your fertility goals.

Medication options may include:

• Hormone pills or a hormonal coil to manage bleeding

• Hormone injections that temporarily shrink fibroids before a procedure

• Tranexamic acid to reduce heavy bleeding during your period

Procedures or surgery may include:

• Uterine artery embolisation, which cuts off the blood supply to fibroids to shrink them

• Myomectomy, which removes fibroids surgically while keeping your uterus intact. This is an option to explore if you still want to get pregnant

• MRI-guided focused ultrasound, which uses sound waves to break down fibroid tissue without surgery

• Hysterectomy, which involves removing your uterus. This is usually considered when other options have not worked and you are not planning a future pregnancy

There is a chance fibroids may return after a myomectomy, particularly if you are still in your reproductive years. It is worth discussing this with your doctor, as it may mean more regular follow-up scans going forward.

Managing PCOS

PCOS is a long-term condition, but symptoms can often be managed very effectively through a combination of lifestyle changes and medication. 

Lifestyle changes that may help include:

• Regular physical activity supports hormone balance and how your body responds to insulin

• A balanced diet lower in refined sugars may ease a number of symptoms over time

Medications your doctor may consider include:

• The contraceptive pill to regulate periods and reduce androgen levels

• Metformin to help your body respond to insulin more effectively

• Anti-androgens to manage excess hair and acne

• Fertility medications such as letrozole or clomiphene if you are trying to conceive

Because PCOS affects everyone differently, your treatment plan may change over time. Symptoms often shift at different life stages, and what works well at one stage may need adjusting as your life changes.

FAQ

Can fibroids cause weight gain like PCOS?

Fibroids do not typically cause metabolic weight gain. However, huge fibroids can increase abdominal size or cause a feeling of pressure or fullness. In contrast, PCOS more commonly leads to weight gain due to insulin resistance.

Do fibroids or PCOS affect fertility more?

PCOS is more likely to affect fertility because it can prevent regular ovulation. Fibroids may also affect fertility, particularly submucosal types, which can distort the uterine cavity and make implantation more difficult.

Can PCOS cause fibroids to develop?

There is no strong evidence that PCOS directly causes fibroids. The two conditions develop through different hormonal pathways, some women may have both conditions.

Can birth control help with both fibroids and PCOS?

Yes. Birth control pills can help regulate menstrual cycles in PCOS and reduce heavy bleeding caused by fibroids. They do not eliminate fibroids, but they can be a useful part of managing symptoms for both conditions.

Is surgery necessary for fibroids or PCOS?

Surgery may be recommended for fibroids if symptoms become severe or difficult to manage. For PCOS, surgery is rarely needed, although a procedure called ovarian drilling, where small punctures are made in the ovary to stimulate ovulation, may be considered in specific fertility cases.

Can diet and exercise help manage fibroids or PCOS?

Diet and exercise play an important part in managing PCOS, and there is good evidence that they can help improve symptoms. For fibroids, lifestyle changes may help ease symptoms, but they will not eliminate existing fibroids.

The information provided is intended for general guidance only and should not be considered medical advice. For personalised recommendations and tailored advice based on your unique situations, please consult a specialist at Thomson Medical. Request an appointment with Thomson Medical today.

Reference:

Williams, T., Mortada, R., & Porter, S. (2016, July 15). Diagnosis and treatment of polycystic ovary Syndrome. AAFP. https://www.aafp.org/pubs/afp/issues/2016/0715/p106.html