Women who have symptomatic leiomyoma, or abnormal growths inside or on their uterus, may be at higher risk for endometriosis as well, according to a study published in the Journal of the Society of Laparoscopic Surgeons.

“This finding highlights the importance of maintaining a high level of suspicion for endometriosis before and during surgery in these women, with the goal of treating both [conditions] in a single surgery,” the researchers said in their study, “Strong Association Between Endometriosis and Symptomatic Leiomyomas.”

They noted that failure to diagnose and treat both conditions at the same time could lead to women having continued pain and fertility problems, and may necessitate further surgery.

For the study, researchers led by Dr. Farr Nezhat of the Center for Special Minimally Invasive and Robotic Surgery in Palo Alto, California, analyzed 244 women suspected of having leiomyoma. Of that total, 208 had undergone surgery to remove the growths, or their uterus, and were included in the study.

While only 27 of these women (around 13%) had leiomyoma only, 181 (more than 87%) also had a diagnosis of endometriosis. And among the 27 with leiomyoma, nine also had adenomyosis, in which the endometrial tissue that normally lines the uterus grows into the muscular wall of the uterus.

The researchers also found that the group of women with leiomyoma were, on average, four years older than women with both conditions, and that women with both conditions were more likely to have pelvic pain and to have never sustained a pregnancy beyond 20 weeks.

According to the team, physicians should be especially mindful of young patients with uterine growths, abnormal bleeding, and low fertility, and of those who have never completed a pregnancy. Women reporting more pain than seems likely for the size of their growths should also be considered for the presence of endometriosis.

Both leiomyoma and endometriosis can cause considerable pain and fertility problems in women. To date, the relationship between the two conditions has been poorly understood. The researchers suggest that more work is needed to further validate and quantify the association between these conditions.