New Delhi: Endometriosis and Polycystic Ovarian Syndrome (PCOS) rank among the most prevalent gynecological disorders in women of childbearing age. Although each has distinct origins and features, both can impair fertility and pose long-term health risks. Dr. Kshitiz Murdia – CEO & Whole-Time Director, Indira IVF Hospital Limited, explained how fibroids and PCOS co-exist.
What Is Endometriosis?
Endometriosis occurs when tissue resembling the uterine lining (endometrium) develops outside the uterus—commonly on the pelvic wall, ovaries, or between the rectum and vagina. It affects roughly one in ten women and contributes to infertility in 30–50% of cases. Additionally, it has been linked to chronic ailments such as cardiovascular disease. Definitive diagnosis typically requires surgical evaluation, most often via laparoscopy (a minimally invasive procedure using a small camera) or, less commonly, laparotomy.
What Is Polycystic Ovarian Syndrome (PCOS)?
PCOS impacts 6–15% of women and stands as a leading cause of infertility, also elevating risks for type 2 diabetes and heart disease. No single test confirms PCOS; clinicians rely on criteria like the Rotterdam, NIH, or AE-PCOS guidelines. Per AE-PCOS standards—after excluding alternative causes—a diagnosis of PCOS is made/ confirmed when at least two of the following are present:
- Irregular or extended menstrual cycles
- Elevated androgen levels in blood tests
- Clinical signs of androgen excess (e.g., facial/body hair growth, acne, scalp hair thinning)
- Multiple small ovarian cysts are visible on ultrasound
Linking Uterine Fibroids and PCOS
Uterine fibroids are benign growths within the uterus, whereas PCOS involves ovarian cysts that hinder egg release. A six-year U.S. study of over 23,000 African American women found a 65% higher fibroid risk among those with PCOS—likely due to prolonged estrogen exposure from infrequent ovulation, which may encourage fibroid development. Conversely, some evidence indicates certain fibroid types may be less common in PCOS patients, underscoring a complex relationship that warrants further investigation. Notably, infertile women with PCOS show a significantly lower rate of non–non-cavity-distorting fibroids compared to those with unexplained infertility. While fibroids and PCOS share some characteristics, they remain distinct conditions, and expert medical guidance is vital for managing both and safeguarding reproductive health.
Treatment Approaches for Concurrent PCOS and Fibroids
Initial PCOS therapies can also alleviate early fibroid symptoms by modulating hormone levels. However, if elevated estrogen or reduced progesterone persists, fibroids may continue to grow, and symptoms—such as heavy bleeding, pelvic discomfort, or frequent urination—may become less responsive to medication.
In such cases, uterine fibroid embolisation (UFE) offers a non-surgical solution. Performed by an interventional radiologist, UFE effectively controls major fibroid symptoms in over 90% of patients. It carries fewer risks than myomectomy or hysterectomy and features a shorter recovery period—typically a 30-minute procedure followed by about one week of recuperation.
Most women with fibroids, including those with PCOS, are candidates for UFE. To determine if UFE is appropriate for your symptoms, consult a specialist in this procedure. With the right treatment, fibroid-related pain and disruptions need not be an ongoing concern.