The Difference of Endometriosis & PCOS + Can You Have Both?

An estimated 1 in 10 women are affected by endometriosis or PCOS at some point in their lives.

While each condition has its own distinct causes and symptoms, both conditions can potentially be painful, disrupt the menstrual cycle, and cause difficulties with getting pregnant.

In some cases, it is possible to have both conditions simultaneously – which can not only make life painful, but can also make you feel upset, confused, and isolated.

To help you navigate both PCOS and endometriosis, here is a look at the difference between the two, potential symptoms to expect, and treatment options available. Endometriosis and PCOS can be challenging diagnoses without the right information, but we’re here to help.

Understanding Endometriosis 

Endometriosis is a painful condition in which tissue similar to the lining of the uterus (a.k.a. the endometrium) grows outside the uterus. This tissue most frequently grows on the uterine tubes and ovaries. However, it’s also possible to have extra-pelvic endometriosis — in fact, endometriosis has been found on every organ and anatomical structure in the body except the spleen.

Because the tissue builds up and bleeds in the same way that the endometrium does during your period, it can cause widespread inflammation in the body.

Understanding PCOS

Polycystic ovarian syndrome (PCOS) is a hormonal condition primarily affecting women of reproductive age, though its effects can last beyond the reproductive years. Women with PCOS experience hormone imbalance and specifically make excess male sex hormones called androgens.

PCOS may also cause the ovaries to become enlarged and develop multiple cysts.

Symptoms of Endometriosis vs. PCOS

Symptoms of endometriosis and PCOS may overlap. Here’s a closer look at the distinct symptoms of each.

Common symptoms of endometriosis

Women with endometriosis may experience debilitating pain before and during their period, throughout their cycle, and/or while having sexual intercourse. Other women have no symptoms at all, yet can still have the disorder. The severity of symptoms does not correlate with the extent of the disease.

Other symptoms you might experience with endometriosis, besides pain, are:

• Heavy menstrual periods
• Infertility
• Bloating (sometimes called “endo belly”)
• Painful urination
• Painful bowel movements
• Constipation and/or diarrhea
• Rectal bleeding, especially during your period
• Nausea and/or vomiting, especially during your period
• Fatigue

Common symptoms of PCOS

The hormonal imbalance caused by PCOS can lead to cysts growing on the ovaries (polycystic ovaries), irregular or missing periods, and high androgen levels.

Other common symptoms of PCOS include:

• Excessive body and facial hair
• Thinning hair and hair loss
• Acne
• Insulin resistance
• Fatigue
• Pelvic pain

Some women may have no symptoms, yet still experience the effects of PCOS, such as difficulties with getting pregnant.

Key differences in symptoms

Endometriosis is a condition that causes abnormal tissue, similar to uterine lining, to grow around the pelvic organs outside the uterus. This in turn can cause severe pain before and during menstruation, intercourse, and throughout the menstrual cycle. PCOS on the other hand is a hormonal condition that affects the ovaries and can interfere with ovulation.

While the symptoms of both PCOS and endometriosis may overlap, the underlying causes and methods of treatment are much different. 

Causes of Endometriosis vs. PCOS

While the exact cause of endometriosis and PCOS is still uncertain, medical experts believe the following factors may play a role.

Causes of endometriosis

According to the Office on Women’s Health, endometriosis may be caused by:

• Retrograde menstrual flow – for example, when uterine tissue released during your period flows through the uterine tubes.
• Genetics – endometriosis is known to run in families.
• Immune system problems – a faulty immune system may fail to find and destroy endometrial tissue growing outside of the uterus. Immune system disorders and certain cancers are more common in women with endometriosis.

Other potential causes of endometriosis include surgical errors and coelomic metaplasia

Causes of PCOS

For PCOS, the Office on Women’s Health names the following as potential causes:

• Heightened levels of male sex hormones – for example, testosterone, which can prevent ovulation and cause unwanted hair growth, acne, and male pattern baldness.
• Heightened levels of insulin – if your insulin levels are too high due to insulin resistance, this can cause the ovaries to produce more androgens.

Other potential causes of PCOS include excess inflammation and genetics.

Comparing the causes

PCOS and endometriosis have some causes in common, but they are distinct conditions. Hormones and genetics seem to play a role, but more research is needed to investigate the causes of both and the possibility of a link between the two.  

Diagnosing Endometriosis and PCOS

Because symptoms of endometriosis and PCOS can be similar, doctors must look beyond the symptoms to determine whether you have endometriosis, PCOS, or both.

Diagnostic methods for endometriosis

Endometriosis can only be officially diagnosed via laparoscopic surgery, though your doctor may use imaging like an ultrasound and MRI to aid in the diagnosis. Laparoscopic surgery is a minimally invasive procedure where a doctor creates small incisions in your abdomen and uses a camera called a laparoscope to view your organs. If they find endometriosis, they can also use special tools to remove the lesions (called excision) and treat the disease.

Diagnostic methods for PCOS

Your doctor can determine if you are experiencing symptoms of PCOS by using a blood test to check your hormone levels. They may also order an ultrasound to inspect your ovaries to see if they are polycystic.

How hormone testing assists in diagnosing

Endometriosis and polycystic ovary syndrome are inherently hormonal conditions and consistent hormone testing can help identify patterns and symptoms that may then require further investigation.  

Mira’s own hormone monitoring device measures key fertility hormones and their metabolites in your urine. By tracking these hormones over time, individuals can gain insights into their fertile window, ovulation patterns, and general reproductive health. Our companion app makes it easy to share this information with your healthcare provider to show subtle hormone changes and patterns detected in real-time.   

Overlapping diagnostic challenges

The symptoms of endometriosis vs. PCOS can make diagnosing these two distinct conditions a challenge. For example, PCOS may mean missed periods and then when you do have one, the bleeding may be heavy or excessive. Heavy bleeding is also a symptom of endometriosis so it can be difficult to tease apart what is happening. Despite their shared symptoms, research on the overlapping prevalence of these two disorders is limited and presents a diagnostic challenge for healthcare providers.  

Treatment Options for Endometriosis and PCOS

There are a number of different treatments available for those with PCOS or endometriosis. Here is a closer look at some of the most common treatments.

Treatment for endometriosis

Endometriosis can be treated with a range of medications or surgery. There are also a variety of complementary therapies, such as Traditional Chinese Medicine, that help many people find relief.  

Laparoscopy is the gold standard of treatment for endometriosis. You should look for a skilled surgeon who specializes in excision (or cutting out endometriosis lesions), rather than ablation (or burning endometriosis lesions), as burning the lesions can cause scarring that may worsen infertility. An excision specialist will also make sure not to leave any endometriosis behind during surgery, as this can cause the endometriosis lesions to regrow and cause more pain.

Treatment for PCOS

PCOS is treated by focusing on the symptoms that are bothering you. If you are experiencing PCOS pain or PCOS symptoms pain your treatment may look different than someone not experiencing that pain.  

Popular treatments for PCOS include medication to induce ovulation, hormonal birth control, metformin, and lifestyle changes. In fact, lifestyle changes like maintaining a healthy weight and staying active are on the frontline of PCOS treatment, but this can include nutrient supplementation therapy.  

Several vitamins and minerals help regulate hormonal imbalances and promote ovulation, which can be especially helpful for those with PCOS. Mira’s own PCOS supplements support ovarian health, promote hormonal balance, and assist metabolic function to help restore hormonal balance and feel in sync with your body. It’s always best to speak to your doctor before taking any supplement, especially if you are trying to conceive or hope to conceive in the future.     

Combined treatment approaches

If you have PCOS and endometriosis together, treatment approaches may benefit one or both conditions. Endometriosis and PCOS are separate conditions that share many symptoms so a combined treatment approach may be the best option. Speak to your healthcare provider to find what will work best for you.  

Some women prefer a natural approach to managing endometriosis and/or PCOS. Maintaining a healthy lifestyle with a balanced PCOS diet and regular exercise routine can potentially boost your fertility. For PCOS in particular, gradual weight loss may help you regain your period and start ovulating regularly.

When it comes to endometriosis, you should look into adopting an anti-inflammatory diet rich in antioxidants. Many women with endo also experience relief of symptoms from going on a gluten-free diet (more on endometriosis diets here).

Can You Have Both Endometriosis and PCOS?

Although rare, it is possible to have both PCOS and endometriosis at the same time.

Coexistence of endometriosis and PCOS

Having PCOS and endometriosis at the same time is not considered common, although it does happen. For example, one study found that women with PCOS are considered at a greater risk of developing endometriosis. In another study, women with PCOS were more likely to have endometriosis compared to women without PCOS.

How to manage both conditions

The emotional toll of being diagnosed with both PCOS and endometriosis can feel overwhelming. Many women talk about feeling angry, depressed, or hopeless about their diagnoses.

Both disorders can cause painful, uncomfortable, and embarrassing symptoms. Living with these symptoms, yet knowing there is no cure for them, can be frustrating and saddening. The following tips can help you manage the emotional toll of both PCOS and endometriosis:

• Find a support group. Whether online or in-person, meeting other women with the same disorder(s) may help you feel less alone.
• Choose a skilled and supportive doctor. The right medical professional will listen to your concerns, take you seriously, and be up-to-date on the latest research.
• Take things one day at a time. Some days you may need to rest more, while other days you may have more energy. Plan your daily activities around how you’re feeling as much as possible to avoid burnout and fatigue.

Another option for managing these disorders is health coaching. At Mira’s Hormone Health Clinic for Fertility, you can learn everything about the disorders and their influence on your hormones. Hormone Health Coaches specialized in PCOS and endometriosis can help with managing techniques, mental health support, effective dosage of supplements, as well as preparing a plan (if this is your goal) to get pregnant naturally and faster. 

Impact on Fertility and Overall Health

If you are trying to conceive (TTC), having endometriosis and PCOS may make getting pregnant naturally difficult. Here is how each condition may impact your fertility.

Fertility concerns

Endometriosis

An estimated 30-50% of women with endometriosis may have difficulties becoming pregnant. This is because endometriosis physically interferes with your reproductive organs, which may lead to any of the following:

• Tissue similar to uterine lining developing around the ovaries, uterine tubes, and pelvis
• Uterine tube scarring
• Pelvic inflammation
• Fluctuations in hormones and
• Weakened immune system functioning

Any of the above can cause disruptions with ovulation, fertilization, and implantation.

PCOS

Those with PCOS may also have difficulties with getting pregnant. This is because PCOS can cause a hormonal imbalance, which impacts your ability to ovulate naturally. Specifically, this includes your body’s ability to:

• Have a regular menstrual cycle
• Successfully release an egg
• Allow for implantation to occur

Without ovulation, pregnancy is not possible and working with your doctor to manage the cause of your hormonal imbalance is key to getting pregnant with PCOS.

Long-term health implications

Although not everyone will develop these, it’s important to be aware of the long-term health implications of both endometriosis and PCOS. If you’ve been diagnosed with PCOS it comes with increased risks such as infertility, endometrial cancer, diabetes, and cardiovascular risks to name a few. 

Endometriosis is a chronic disease that comes with an increased risk of some chronic diseases, infertility, severe pain, and certain cancers. Research has shown a link between endometriosis and other health implications including autoimmune diseases, allergies, and chronic fatigue.   

Frequently Asked Questions