Endometriosis vs PCOS: Symptoms, Causes, Diagnosis, And Treatment

Both endometriosis and polycystic ovary syndrome (PCOS) are disorders that affect the reproductive system and may result in heavy bleeding. About 10% of women of reproductive age experience these abnormalities at some point in their life. It is possible for some women to have both conditions.¹

If you have either of these conditions, you may experience menstrual complications, which could lead to fertility issues and potentially result in difficulties getting pregnant.

Although both conditions are linked to hormonal imbalance and may present with similar symptoms, they call for different treatment options. While endometriosis is caused by an increased production of estrogen, PCOS is triggered by an increase in the production of the androgen hormone. Also, there are symptoms that are specific to each condition.  

Here, we explore the difference between the two reproductive disorders regarding symptoms, causes, diagnosis, and treatment.

What is endometriosis?

Endometriosis is a condition affecting the female reproductive system where cells that resemble the uterine lining grow beyond the uterine wall. These cells behave just like your endometrium lining, which often breaks down during each menstrual cycle, resulting in bleeding.²

This is what causes heavy bleeding during menstruation. 

This condition may affect surrounding organs, including ovaries, fallopian tubes, and the pelvis, which could cause fertility issues. In rare cases, more distant organs such as the gut, bladder, kidneys, lungs, and skin can be affected. 

Causes of endometriosis

Although the actual cause of this condition is not known, genetics play a key role in the development of endometrial cells outside the uterine lining. This abnormality may run in certain families as an inherited condition. 

There are certain factors that may trigger endometriosis, such as:

• Disorder of the immune system

• Transportation of the endometrial cells — your blood vessels may transport endometrial cells to different parts of your body

• Scars that result from surgery in the abdominal area, such as C-section and hysterectomy

• Hormonal imbalance — excess production of estrogen may trigger endometriosis

• Reverse menstruation — this happens when the endometrial tissue flows through the fallopian tube into the pelvic cavity instead of flowing outside the body. These tissues grow and thicken over time.

Risk factors associated with endometriosis 

Known risk factors associated with the development of endometriosis include the following:

• Family history

• Age

• Age at the time of first menstruation

• Late menopause

• Exposure to chemicals linked to endocrine disorders

• Sitting for long periods of time

• A history of infertility

Symptoms

Notable signs include:

• Heavy menstrual bleeding

• Severe pelvic pain

• Difficulty falling pregnant 

• Pain during bowel movement, especially during menstruation

• Fatigue during menstruation

• Digestion problems such as bloating and constipation mostly occur during menstruation

• Spotting between menstrual periods

• Severe pain during or after sex 

While you may not experience all these symptoms at once, chronic pelvic pain may be an indication of this condition. It’s recommended to consult your doctor for diagnosis and treatment.

Diagnosis

If you present possible symptoms of this condition, your doctor may order one of the following tests.

• Imaging tests such as ultrasound and magnetic resonance imaging (MRI) — these tests will take pictures of your reproductive system to identify abnormal cell growth beyond your uterus.

• Pelvic exam — your doctor may perform a vaginal examination using gloved fingers to help identify the size, shape, and location of the growths outside your uterus. However, this may not identify smaller growths.

• Surgery — if the above tests are not conclusive, your doctor may recommend a laparoscopy to check your uterus. Doctors may see the growths with their naked eyes or may have to use a microscope to study a sample tissue.

Sometimes, your doctor may recommend multiple tests, especially when one test does not provide reliable data. This helps rule out other reproductive disorders, such as PCOS, so your doctor can give the most suitable treatment option.   

Treatment

Although there is no known cure for endometriosis, the symptoms can be managed to reduce pain and improve the quality of your life. It’s best to consult your doctor, who can conduct a test and determine the most appropriate way to manage the symptoms. Treatment options for endometriosis may depend on the cause as well as individual goals, such as trying to get pregnant.

Here are some of the most common treatment options for endometriosis:

Hormone therapy

This is the first-line treatment option for people who are not trying to get pregnant. Your doctor will take into consideration many factors, such as your age, severity of symptoms, and your history of other medical conditions, before deciding what type of birth control to prescribe. 

In broad terms, the main types of birth control include progestin-only contraception, combined hormonal contraception (which includes both estrogen and a type of progestin), as well as gonadotropin-releasing hormone (GnRH) agonists or danazol, which is a synthetic hormone similar to testosterone. 

Laparoscopic surgery

If you present with severe symptoms, such as severe pain, excessive bleeding, or difficulties falling pregnant, then this minimally invasive keyhole procedure may be the most appropriate remedy. Surgery is recommended when other treatment options fail.

Your doctor will locate the growths and remove them through an incision, after which you can restart the hormone treatment. However, if you are trying to get pregnant, you do not have to restart the hormone treatment. There is a high likelihood of the endometrial growths regrowing if hormonal treatment is not taken post-surgery. 

Key differences between endometriosis and PCOS

What is PCOS?

PCOS affects about 6–12% of women in the US. It is a condition that affects the female reproductive system, leading to excess production of the male sex hormone, testosterone.³

In PCOS, there is an imbalance in the levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). LH is responsible for triggering the release of an egg from the ovary, called ovulation. FSH is responsible for stimulating the growth of follicles in the ovaries so they can form mature eggs. 

In women with PCOS, there is an elevated level of LH in relation to FSH, which disrupts the formation of follicles and can lead to the formation of multiple small cysts on the ovaries. 

What causes PCOS?

The exact cause of polycystic ovary syndrome is not entirely understood, but it is thought to be a combination of genetic, environmental, and lifestyle factors. Insulin resistance, where the body’s cells do not respond to insulin properly, is thought to play a key role in the development of this condition. In addition, chronic low-grade inflammation has also been identified as a trigger for PCOS. This condition is thought to run in families, and certain lifestyle conditions that are associated with obesity may also play a role in the development of PCOS. 

Risk factors associated with PCOS

Though the exact cause of PCOS is unknown, there are some common risk factors that align with PCOS diagnosis. These include:

• Family history and genetics

• Diabetes

• Excess androgen

• Certain ethnicities — some studies have suggested that PCOS is more common among women of South Asian and Middle Eastern descent.

Symptoms of PCOS

Some symptoms may be similar to those of endometriosis, such as heavy or irregular periods, pelvic pain, or difficulty getting pregnant, so you need to consult your doctor for a diagnosis to rule out other possible reproductive health issues. 

Symptoms of PCOS include:

• Heavier or lighter periods

• Irregular periods

• Missed periods

• Pelvic pain

• Oily skin

• Excess hair growth in a male-like pattern

• Difficulty falling pregnant

• Excess weight gain, especially around the abdomen

• Hair loss

• Acne

• Dark patches at the back of your neck or on areas with folds or creases, such as in the armpit or under the breast

How is PCOS diagnosed?

If you have concerns about having PCOS, your doctor will take a full medical history and conduct an abdominal examination as well as an internal pelvic examination. Your doctor will then recommend one of the following tests:

• Ultrasound — this test provides a picture of your reproductive system to check the condition of your ovaries and whether you have cysts. Also, this test will check the condition of your endometrium.

• Blood test — your doctor will take a blood sample to check the levels of blood glucose and other hormones in your body. These tests will also look at your sugar and cholesterol levels.

Treatment options

While there is no cure for PCOS, your doctor may recommend ways to help manage the condition. Some of the most common treatment and diseases management options include:

Hormone therapy

Birth control pills can help regulate the menstrual cycle and reduce the level of androgens (male hormones) in the body. Other hormonal treatments, such as anti-androgens and progestins, may also be used to address specific symptoms.

Medication

Metformin is a medication commonly used to treat type 2 diabetes. But it can also be used to help improve insulin resistance and assist with weight loss and fertility issues in women with PCOS. Other medications, such as spironolactone, may be used to help with issues such as excessive hair growth. 

Lifestyle changes

Losing weight, eating a healthy diet, and getting regular exercise can help to improve symptoms of PCOS and lower the risk of associated health problems, such as diabetes and high blood pressure.

Fertility treatments

For women with PCOS who want to conceive, fertility treatments such as ovulation induction and assisted reproductive technologies may be used.

Surgery

Surgery may be an option for women with PCOS who have cysts on their ovaries. Ovarian drilling, a procedure that uses heat or a laser to destroy a small portion of the ovary, may be used to improve ovulation and fertility.

When to see a doctor

If you have concerns about your menstrual cycles, are experiencing pelvic pain, or are concerned about fertility issues, it is important to see a doctor. 

The lowdown

It is worth noting that you can have either endometriosis or PCOS but present no possible signs. Both conditions affect women in their reproductive age and can cause infertility. 

It’s important to consult your healthcare provider to learn how to minimize the risk factors. Although certain causes may be preventable, some are natural and cannot be controlled. If the condition runs in your family, you may be at a higher risk of having it and there isn't much you can do to control the condition.

However, there are treatment options for both endometriosis and PCOS to help you manage the symptoms. If you want to get pregnant, you can work with a professional healthcare provider. They will offer invaluable advice on how to manage your symptoms, diet, and general health.

To address the issue of infertility, hormone therapy or surgery may need to be considered. 

Frequently asked questions

Can I get endometriosis and PCOS at the same time?

It is possible to be diagnosed with both PCOS and endometriosis. Your doctor will recommend a treatment option that addresses both conditions.

Is there a cure for endometriosis?

Endometriosis has no cure, but your doctor will help you manage the symptoms.

Are PCOS symptoms always obvious? 

Some symptoms of PCOS may be visible, such as excessive hair growth in a male-like pattern, hair loss, skin discoloration, and acne, and these may require the attention of a dermatologist. Other symptoms, such as period irregularity, may not be so obvious.