PCOS vs Endometriosis: What You Need to Know

Originally published 02/04/2023. Updated for accuracy and relevancy on 10/26/2023.

PCOS and endometriosis are both common conditions for women, but what makes them different? Is it possible to have PCOS and endometriosis? Continue reading to find out more. 

By Dr. Kenosha Gleaton, OBGYN and fertility expert 

Polycystic ovary syndrome (PCOS) and endometriosis are two very different conditions, but they do share a few symptoms and other factors. Let’s talk about the similarities and differences between endometriosis and PCOS. 

Can You Have Both PCOS and Endometriosis?

The incidence is about the same for both conditions, occurring separately in about 10% of reproductive aged women. [1] Research is mixed on how frequently the two conditions can coexist. Some data shows that women with PCOS and struggling with infertility are more likely to have endometriotic lesions. [2] In fact, a study found that 77% of women with PCOS did have evidence of lesions, and 27% were confirmed to have endometriosis. Other studies suggest a much lower incidence of the two conditions coexisting. [3] More research is needed to give a conclusive answer, but we do know it’s possible to have both PCOS and endometriosis. 

What Is PCOS?

PCOS is a common endocrine disorder that’s characterized by a cluster of symptoms. [4] These symptoms include increased male hormones, irregular menstrual cycles, and polycystic ovaries. PCOS is a common cause of infertility in women and is also known for symptoms like excessive hair growth and weight gain. 

What Is Endometriosis?

Endometriosis is a condition in which the endometrium (uterine lining), spreads outside of the uterus, along the pelvis or other organs. [5] This tissue is also referred to as implants, and has been found covering the bladder, fallopian tubes, and the rectum. Most commonly, implants are found on the ovaries and form what is known as a chocolate cyst. [5] Chocolate cysts are cysts filled with old blood, giving them a dark and almost tar like appearance. There are varying degrees of endometriosis based on the implants and scaring observed, from stage one with minimal implants, to stage four with widespread implants, cysts, and scarring. [5] 

PCOS and Endometriosis Symptoms

Symptoms of PCOS and endometriosis can vary from person to person. There are some similar symptoms observed in both conditions, such as:

Heavy Menstrual Periods

PCOS can cause irregular menstrual cycles, including menstrual bleeding that lasts for longer than a typical seven day cycle, or heavy bleeding during a usual cycle. [6] Endometriosis is also commonly associated with heavy menstrual periods and bleeding in between periods. [7] 

Infertility

Infertility is defined as the inability to conceive after 12 months of unprotected sex. PCOS is one of the most common causes of infertility in women, and endometriosis isn’t far behind. [8] Studies show that anywhere between 25% to 50% of women experiencing infertility have endometriosis, and approximately 40% of women with endometriosis are infertile. [8] 

If you are looking for natural supplements to support your fertility journey, you might consider exploring a d-chiro-inositol supplement. Studies have indicated that d-chiro-inositol may help improve hormonal imbalances associated with PCOS and support better reproductive outcomes. There are ways to manage infertility if you have PCOS or endometriosis, so be sure to speak with your healthcare provider if you’re hoping to conceive now or in the future.

Learn more about getting pregnant with endometriosis and getting pregnant with PCOS. 

PCOS Specific Symptoms

PCOS and endometriosis impact the body very differently. The hormonal imbalance and metabolic disruptions related to PCOS can cause symptoms such as [9]:

Abnormal Menstrual Cycles 

Frequently missed periods, anovulatory periods, and so on. 

Weight Gain

It is common for those with PCOS to be overweight or obese and have a difficult time losing weight. 

Acne

Oily skin and persistent acne are two common symptoms of PCOS. Typically, PCOS acne will not respond well to treatment and may be late on-set. 

Hair Growth

Excessive hair growth can occur on the face, chest, legs, and other parts of the body. This is due to increased male hormones 

Dark, Velvety Skin

A condition known as acanthosis nigricans refers to areas of skin near the armpits, neck, and groin, that are thicker, darker, and may be velvety to the touch. [10] 

Endometriosis Specific Symptoms

Endometriosis symptoms are mostly caused by implants of endometrial tissue located in other parts of the body bleeding and swelling, as they would inside of the uterus during menstruation. [5] Some endometriosis symptoms include [5]:

Pelvic Pain and Cramping

Pelvic pain can occur outside of menstruation or during menstruation. Pain can be severe cramping as well as shooting, sharp pains. It’s also normal to experience painful ovulation. 

Abdominal and Lower Back Pain

Aching or painful back pain and abdomen pain can be associated with endometriosis. This is especially common if implants have grown near the kidneys. [11]

Painful Sex

Dyspareunia refers to pain experienced during, before, or after sexual intercourse and is commonly seen in those with endometriosis. 

Painful Urination and Defecation

Painful urination (dysuria) and defecation (dyschezia) may be a symptom of endometriosis and can be described as painful, strained, or obstructed flow of urine or defecation. 

Nausea, Bloating, and Fatigue

Menstruation when dealing with endometriosis can be especially painful and may cause other symptoms such as nausea, constipation, diarrhea, bloating, fatigue, etc. Shop fiber supplements. 

How to Test for PCOS 

There isn’t a single test that can be done to diagnose PCOS. The “S” stands for syndrome, which refers to a cluster of specific symptoms. For PCOS, these symptoms include high androgens levels, polycystic ovaries, and irregular menstrual cycles. [9] In order to look further into these symptoms, your healthcare provider will likely ask for a medical history, and may conduct the following exams and tests:

Blood Testing

You can measure hormone levels in your blood to determine the amount of androgens and other reproductive hormones. An increased level of male hormones may be indicative of PCOS.  

Pelvic Examination

Some cysts can be felt during a pelvic exam and may prompt diagnostic tests such as an ultrasound to get more information. 

Ultrasound

Imaging tests like ultrasounds can give your healthcare provider a better idea of what your ovaries and uterus look like. This can give a better idea of what ovarian cysts may look like, including the size, location, and amount. Ovarian cysts are fairly common and can go untreated, but PCOS patients will usually have multiple cysts on each ovary that could be causing infertility or regular anovulation. 

How Do I Know if I Have Endometriosis or PCOS?

There isn’t a single test to diagnose endometriosis either, but you will likely go through a similar process as PCOS to get a diagnosis. First, healthcare providers will ask for a breakdown of symptoms and medical history. There are ways to surgically remove and test tissue, but this is usually not the practical decision. Many patients are able to be diagnosed with a combination of symptoms and imaging findings. Some tests and examinations conducted include:

Pelvic Examination

Palpating the pelvic area for any abnormal growths or scarring is likely the first step. Some growths may not be felt through a pelvic exam, but cysts can sometimes be caught before an ultrasound or other imaging test.

Ultrasound

An ultrasound can give your healthcare provider a better idea of where cysts may be, how many you may have, the size, etc. Ultrasounds may be able to show if cysts are chocolate cysts aka endometriomas or not based on their appearance. [5] 

MRI Exams and Laparoscopy

Magnetic resonance imaging gives a more detailed view of the organs and tissues and may be able to show endometrial implants in the body. Laparoscopy is a surgical procedure that allows a surgeon to view any potential endometrial tissues outside of the uterus and in some cases this tissue can be removed. It’s not likely that you will need to have an MRI or surgery in order to get a diagnosis, but it is an option. 

How Do You Manage PCOS and Endometriosis?

There is no cure for PCOS or endometriosis, although both are treatable conditions. Treatment is usually focused on your reproductive goals and the symptoms you’re experiencing. 

Treatment Options for PCOS Include:

• Lifestyle changes, including weight reduction and increased physical activity.
• Dietary supplements that have been shown to help reduce PCOS symptoms may be beneficial, but be sure to speak with your healthcare provider before taking any supplements or medications. [12] 
• Prescription medications, including hormonal birth control, anti-androgens, and insulin-sensitizing medications. These can aid in increasing estrogen and progestin levels and decreasing androgen levels, as well as aid in insulin resistance seen in many women with PCOS.
• Fertility treatments such as ovulation induction.
• Treatments for acne or unwanted hair growth.

Treatment Options for Endometriosis Include:

• Pain medication such as nonsteroidal anti-inflammatory drugs (NSAIDs) including Advil, Aleve, etc. to help manage painful cramps during or around menstruation.
• Prescription medications such as hormonal birth control to help control hormones responsible for the buildup of endometrial tissue. Hormonal contraceptives may also help to shorten or stop menstrual periods and help to relieve pain. Other drugs like gonadotropin-releasing hormone agonists and antagonists can prevent menstruation and cause endometrial tissue to shrink.
• Surgery, including a full hysterectomy to remove the uterus and ovaries, or conservative surgery to remove endometrial tissue and preserve the reproductive organs. Surgery to remove the implants alone can improve pain and bleeding, but there is a potential for implants to return. 
• Fertility treatments, including ovulation induction and other methods, may be helpful if you’re TTC with endometriosis. 

Speak with your healthcare provider about specific treatment options for your specific symptoms and reproductive goals.

Key Takeaways

• PCOS and endometriosis are seen separately in up to 10% of women of reproductive age.
• More research is needed on how common it is to have PCOS and endometriosis at the same time, but we do know that it’s possible. 
• Infertility and heavy menstrual bleeding are two symptoms that PCOS and endometriosis have in common.
• PCOS is characterized by polycystic ovaries and high androgen levels, whereas endometriosis is characterized by the growth of endometrial tissue outside of the uterus.
• Symptoms of PCOS are weight gain, acne, unwanted hair growth, and abnormal menstrual cycles.
• Symptoms of endometriosis are painful periods, pain during sex, painful urination and defecation, and bleeding between periods.
• Testing for PCOS and endometriosis are relatively similar and include a detailed history, pelvic examination, and ultrasound. In some cases, surgery or additional imaging tests may be recommended. 
• Treating PCOS and endometriosis is largely around treating the symptoms of both conditions and may include hormonal birth control, other prescription medications, fertility treatments, and lifestyle changes. 

Sources:

1. Dinsdale NL, Crespi BJ. Endometriosis and polycystic ovary syndrome are diametric disorders. Evol Appl. 2021;14(7):1693-1715. Published 2021 May 14. doi:10.1111/eva.13244
2. Holoch, K. Svaris, R. Forstein, D. Miller, P. Coexistence of Polycystic Ovary Syndrome and Endometriosis in Women with Infertility. June 2014. Journal of Endometriosis 6(2):78-83. DOI:10.5301/je.500181
3. Hager M, Wenzl R, Riesenhuber S, et al. The Prevalence of Incidental Endometriosis in Women Undergoing Laparoscopic Ovarian Drilling for Clomiphene-Resistant Polycystic Ovary Syndrome: A Retrospective Cohort Study and Meta-Analysis. J Clin Med. 2019;8(8):1210. Published 2019 Aug 14. doi:10.3390/jcm8081210
4. McGowan MP. Polycystic ovary syndrome: a common endocrine disorder and risk factor for vascular disease. Curr Treat Options Cardiovasc Med. 2011;13(4):289-301. doi:10.1007/s11936-011-0130-0
5. Tsamantioti ES, Mahdy H. Endometriosis. [Updated 2023 Jan 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK567777/
6. Heavy Menstrual Bleeding. Centers for Disease Control. June 2023. https://www.cdc.gov/ncbddd/blooddisorders/women/menorrhagia.html
7. Endometriosis. Mayo Clinic. October 2023. https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656
8. What are some possible causes of female infertility? NIH Office of Communications. January 2017. https://www.nichd.nih.gov/health/topics/infertility/conditioninfo/causes/causes-female#f7
9. What are the symptoms of PCOS? NIH Office of Communications. September 2022. https://www.nichd.nih.gov/health/topics/pcos/conditioninfo/symptoms
10. Acanthosis nigricans. Mayo Clinic. June 2022. https://www.mayoclinic.org/diseases-conditions/acanthosis-nigricans/symptoms-causes/
11. Machairiotis, N., Stylianaki, A., Dryllis, G. et al. Extrapelvic endometriosis: a rare entity or an under diagnosed condition?. Diagn Pathol 8, 194 (2013). https://doi.org/10.1186/1746-1596-8-194
12. Alesi S, Ee C, Moran LJ, Rao V, Mousa A. Nutritional Supplements and Complementary Therapies in Polycystic Ovary Syndrome. Adv Nutr. 2022;13(4):1243-1266. doi:10.1093/advances/nmab141