Polycystic Ovary Syndrome (PCOS) and endometriosis are two unique reproductive health conditions that affect millions of women worldwide. While both can impact fertility and cause irregular periods, they have very different causes, symptoms, and treatments.
Endometriosis is characterized by the growth of endometrial-like tissue outside the uterus, often leading to severe pelvic pain, heavy bleeding, pain during sex, and gastrointestinal issues, among other symptoms.
PCOS, on the other hand, is a hormonal disorder often causing ovarian cysts and typically resulting in irregular or absent periods, excess acne and hair growth, and metabolic problems causing issues with weight gain.
Key Similarities
- Menstrual Patterns:
- Despite endometriosis and PCOS stemming from separate causes, both can cause skipped, irregular, or sporadic periods, heavy or continuous bleeding, spotting, etc.
- Cyst Formation:
- While PCOS is more commonly associated with cyst formation, there are some cases in which endometriosis patients form bumps or cysts on pelvic organs and on the ovaries.
- Mental Health Issues:
- Both conditions increase the risk of depression and anxiety. Additionally, those with PCOS are more likely to suffer from bipolar disorder and OCD, while those with endometriosis are genetically predisposed to eating disorders.
- Infertility:
- PCOS and endometriosis can both cause issues with fertility.
Key Differences
- Hormonal Imbalances:
- PCOS: Characterized by excess androgens, like testosterone
- Endometriosis: Associated with excess estrogen
- Primary Symptoms:
- PCOS: Irregular periods, acne, excess hair growth, weight gain
- Endometriosis: Severe pelvic pain, painful periods, pain during intercourse
Menstrual Irregularities: PCOS vs Endometriosis
It’s common for endometriosis patients to experience heavy periods, whereas PCOS patients might experience lighter or missed periods. However, both PCOS and endometriosis have been known to cause irregular periods and/or heavy bleeding, and symptoms can vary among individuals.
PCOS vs Endometriosis Symptoms
PCOS Symptoms
The symptoms of PCOS stem from excess androgens, which are hormones like testosterone. Androgens are typically associated with male reproductive hormones, contributing to lighter and less frequent periods sometimes seen in those with PCOS. Although men typically have more testosterone, it’s a misconception that this hormone is only relevant to men’s health. In fact, testosterone is a precursor to estrogen and it plays an important role during the ovulation window of the menstrual cycle. When produced in excess in women, however, excess androgens like testosterone can cause the symptoms associated with PCOS:
- Skipped or absent periods
- Very heavy periods
- Infertility or difficulty getting pregnant
- Weight gain
- Acne or oily skin
- Excessive hair growth or hair loss
- Ovarian cysts
High levels of androgens and irregular periods may be enough to make a diagnosis in some women.
Endometriosis Symptoms
Endometriosis symptoms are mainly associated with pain from excess endometrial-like tissue outside of the uterus. Painful symptoms occur because the hormones and chemicals released by the misplaced endometrial tissue can lead to inflammation and irritation in the pelvic organs. Typical symptoms of endometriosis include:
- Chronic pelvic pain
- Severe period pain (dysmenorrhea)
- Abdominal pain
- Pain during sex (dyspareunia)
- Painful bowel movements (dyschezia)
- Gastrointestinal issues
- Pain during urination (dysuria)
Can You Have Endometriosis and PCOS?
Yes, you can have endometriosis and PCOS, although the rate of co-occurrence is low. Recent research found that between 2% and 5% of menstruating women have both conditions. This is perhaps due to each being rooted in the opposite hormonal imbalances.
This 2023 study explored how often PCOS and endometriosis occur together. Among menstruating women receiving gynecological care via diagnostic or therapeutic surgery (laparoscopy/laparotomy), 1 in 20 were newly diagnosed with both conditions. For comparison, when the researchers looked only at MRIs—a less invasive but less accurate diagnostic method—on menstruating women not receiving gynecological care, they found that 1 in 50 women with endometriosis also had PCOS.
This low co-occurrence rate aligns with the theory that endometriosis and PCOS stem from opposing hormonal imbalances. PCOS involves excess ovarian testosterone production, while endometriosis is characterized by low testosterone levels relative to estrogen.
Diagnosis
PCOS Diagnosis
Compared to endometriosis, PCOS is relatively clinically apparent, making diagnosis more straightforward once other conditions have been ruled out. It still takes 4.3 years on average, however, from the first time seeking medical care for PCOS-related symptoms to receiving a diagnosis. To be diagnosed with PCOS, you need to have at least two of four diagnostic criteria:
- Either infrequent or prolonged periods
- Excess androgens in the blood
- Excess facial/body hair, excessive acne, or thinning scalp hair
- Cysts on one or both ovaries
Despite its name, you don’t have to have ovarian cysts to have PCOS. Alternatively, ovarian cysts don’t always indicate PCOS.
Endometriosis Diagnosis
To diagnose endometriosis, doctors often rely on a combination of symptom assessment, medical history, and imaging techniques such as ultrasound or, occasionally, MRI to identify potential masses of endometrial tissue in the pelvic or vaginal region. While these methods can suggest a diagnosis, the ‘gold standard’ for ruling out endometriosis is a surgical examination, typically via laparoscopy. Laparoscopic surgery involves a small abdominal incision to directly visualize and confirm the presence of endometrial tissue outside the uterus. Laparotomic surgery, which requires a larger incision, is less commonly used for diagnostic purposes due to its invasiveness.
It’s important to note that surgical diagnosis is not always necessary to diagnose endometriosis. There are significant risks associated with pelvic and abdominal surgery, such as complications or prolonged recovery time, however, it’s a useful tool for accurate diagnosis. Advances in non-surgical diagnostic methods aim to reduce reliance on surgery, providing safer options for patients while still addressing their symptoms. As of 2020, the global diagnostic delay for endometriosis remained lengthy, averaging between 7 and 9 years, highlighting the need for more accessible and efficient diagnostic resources.
Treatment for PCOS vs Endometriosis
PCOS Treatment
Management of PCOS focuses on alleviating symptoms, restoring hormonal balance, and addressing fertility concerns. Key treatment strategies for PCOS include:
- Lifestyle Modifications: Engaging in regular physical activity and adopting a balanced diet can help manage weight, improve cycle regularity, improve insulin sensitivity, and alleviate other symptoms associated with PCOS.
- Hormonal Contraceptives: Combined oral contraceptives are commonly prescribed to regulate menstrual cycles and decrease androgen levels, which can help alleviate acne and excess hair growth.
- Metformin: This medication improves insulin sensitivity and can aid in regulating menstrual cycles and overall improvement in symptoms, although it’s not cleared by the FDA to treat PCOS specifically.
Endometriosis Treatment
Treatment for endometriosis aims to relieve pain, slow the growth of or remove endometrial-like tissue, and enhance fertility outcomes. Options include:
- Pain Management: Nonsteroidal anti-inflammatory drugs (NSAIDs) are often the first line of treatment to alleviate pain associated with endometriosis. In severe cases, however, more specific treatment may be necessary to relieve symptoms.
- Gonadotropin-Releasing Hormone (GnRH) Agonists: These medications reduce estrogen production, leading to a reversible menopausal state that can decrease or eliminate menstruation and associated pain.
- Oral Contraceptives: Combination birth control pills with estrogen and progestin can help make periods lighter, more regular, and reduce endometriosis pain. In some cases, progestin-only birth control is used, which reduces or stops periods to relieve symptoms.
- Surgical Interventions: In cases where medication is ineffective, surgery may be performed to remove or destroy endometrial growths, which can alleviate pain and improve fertility.
In Summary
PCOS and endometriosis both impact reproductive health and fertility but differ in causes, symptoms, and treatments. PCOS stems from hormonal imbalances like excess androgens, while endometriosis involves endometrial-like tissue growing outside the uterus, causing pain and inflammation. Diagnosis and treatment also vary, with PCOS managed through hormonal balance and lifestyle changes, and endometriosis focusing on pain relief and sometimes surgical intervention.
