Yes, a person can have both PCOS and endometriosis.
While one does not cause the other, symptoms may overlap, exacerbating pain, infertility, or both.
A doctor’s diagnosis is necessary to determine the best course of action to improve one’s health.
PCOS Vs. Endometriosis: How to Tell the Difference
In This Article
PCOS vs Endometriosis
Polycystic ovarian syndrome, or PCOS, and endometriosis are medical conditions that affect female reproductive organs in women of childbearing age.
Both PCOS and endometriosis elevate the risk of infertility in affected individuals and may require medical management of symptoms, lifestyle changes, and supplementation.
According to the Office on Women’s Health, 1 out of 10 women in America have endometriosis.
Meanwhile, the Centers for Disease Control estimate that about 5 million American women of reproductive age have PCOS.
PCOS affects a woman’s hormone levels, with androgens, also known as “male hormones,” more elevated in women with the condition.
As such, the androgens disrupt ovulation and promote excess hair growth and acne.
Endometriosis, on the other hand, mainly affects tissues.
In women with endometriosis, tissues similar to those on the uterine lining grow on other parts outside the uterus—such as the ovaries, pelvis, and even the intestines.
PCOS and endometriosis have shared symptoms, such as menstrual problems, heavy bleeding, and infertility.
Both conditions may also be prevalent in some individuals, making it difficult to differentiate between PCOS and endometriosis.
In some cases, PCOS and endometriosis can go undiagnosed (or misdiagnosed), especially in individuals with more subtle symptoms.
As such, it’s essential to seek the help of a medical professional and get the right tests to determine whether or not one has PCOS or endometriosis.
In this article, we’ll go through the most common symptoms associated with both conditions, treatment options, tests, and other helpful information to shed light on the PCOS vs. endometriosis topic.
What is Polycystic Ovary Syndrome (PCOS)?
According to scholars, PCOS is characterized by ovarian dysfunction due to certain factors like hyperinsulinemia, or high levels of insulin in the blood; disturbances in the hypothalamic-pituitary-ovarian axis; and genetic abnormalities.
Excess production of luteinising hormone, or LH, also affects the production of androgens and egg development in women with PCOS.
Environmental factors, such as lifestyle and nutrition, may also exacerbate the expression of PCOS symptoms.
Causes and Risk Factors
The specific cause for PCOS remains unknown, but certain factors have been identified to elevate the risk of developing the condition.
These include:
High Levels of Insulin
Insulin, which is produced in the pancreas for blood sugar regulation, may cause insulin resistance.
This in turn creates higher levels of androgen.
This happens when there is too much sugar in the blood, encouraging the production of excess insulin and androgens.
The ovaries produce androgens, causing excess hair growth in areas like the face and neck in a condition called hirsutism.
Excess androgens are also responsible for the prevalence of acne in women with PCOS.
Low-Grade Inflammation
PCOS can also coexist with low-grade inflammation in the body, with white blood cells being deployed to the ovaries to fight off what the body perceives as an infection (but are actually cysts from PCOS).
Much like a chicken-and-egg situation, inflammation then encourages the ovaries to create even more androgens.
Genetics
PCOS can also be hereditary, with some studies showing that PCOS may be linked to specific genes, such as:
- CYP11a
- CYP21
- CYP17
- CYP19
- Android Receptor Gene
- Sex Hormone-Binding Globulin Gene
- Lutein Hormone and Receptor Gene
- AMH Gene
- Follicular Stimulating Hormone Receptor
- Insulin Gene
- INSR
- Insulin Receptor Substrate Proteins
- Calpain10 Gene
- FTO Gene
- PCOS1 Gene
- SRD5A2 and SRD5A1
Common Symptoms
Women with PCOS often experience irregular periods or miss their periods, as well as anovulation (not ovulating on time or at all).
Additionally, PCOS symptoms include:
- Heavy bleeding
- Ovarian cysts
- Difficulty getting pregnant
- Hirsutism
- Acne
- Oily skin
- Thinning hair
- Dark and thick skin patches
- Weight gain
Diagnostic Criteria and Methods for PCOS
The Rotterdam criteria is used to diagnose PCOS.
This involves the presence of at least two out of three criteria, with other causes already ruled out, as an indication of PCOS. These criteria are:
- The absence of menstruation or a gap of 35 days between periods (oglio-ovulation or anovulation)
- Clinical and/or biochemical hyperandrogenism
- Polycystic ovaries observed on ultrasound
The methods a doctor will employ include the following:
Physical Exam
A doctor will conduct a physical exam to measure a person’s body mass index (BMI), blood pressure, and waist size.
The doctor may also note skin conditions and the prevalence of hair on a person’s face, back, and chest.
Pelvic Exam and Ultrasound
A pelvic exam may also present indications of elevated male hormones.
This includes an enlarged clitoris, as well as enlarged ovaries.
An ultrasound will confirm the presence of underdeveloped oocytes in the ovaries, the size of both ovaries and the condition of the uterine lining.
Blood Test
A doctor may also confirm the presence of elevated androgens through a blood test and hormones that may indicate an underactive thyroid.
Treatment and Management of PCOS
A person diagnosed with PCOS may be prescribed certain medications to help regulate their hormones and periods and to prevent endometrial tissue from building up inside the uterus due to irregular menstrual bleeding.
Women not actively trying to conceive may also be prescribed contraceptives, which can induce regular periods.
It is a misconception that women with PCOS have only egg freezing or in vitro fertilization (IVF) as options for having children.
By understanding the root causes of PCOS and addressing these through lifestyle or dietary changes, women can often conceive naturally.
In most cases, doctors may prescribe supplements and medications to help regulate a woman’s hormones and insulin levels to improve overall health.
Certain lifestyle changes, like exercising and limiting the intake of highly processed foods and carbohydrates, may also help manage PCOS symptoms.
There are also high-quality supplements that consist of a blend of natural herbs, vitamins and minerals specifically curated for PCOS support.
Nourished Natural Health’s range of PCOS supplements is an excellent example of PCOS support supplements, including:
- Androgen Blocker Plus: To address excess androgen and manage PCOS symptoms
- Cycle Regulate + Ovulate: To promote healthy ovulation and menstruation
- Period + PMS Repair: To address painful period and PMS symptoms for a gentler cycle
- PCOS Blood Sugar Balance: To manage insulin levels in the blood and help reduce androgens
Nourish Natural Health also has a free PCOS root cause assessment to determine the specific type of PCOS one has.
What is Endometriosis?
In women with endometriosis, endometrial-like tissue grows in places outside the uterus. These sites could be the pelvis, ovaries, or intestines.
In rare cases, the lymphatic and circulatory system may also transport endometrial cells to more distant sites, like the pleural (chest) cavity.
However, the most common mode of transporting endometrial cells is through the fallopian tubes via retrograde flow.
The implanted cells then form tissues containing estrogen and progesterone receptors, causing them to grow and respond to hormone changes along with the menstrual cycle.
This causes inflammation and higher rates of infertility in affected women.
Causes and Risk Factors
Like PCOS, there is no known cause for endometriosis, although several theories identify the most likely ways a woman may develop endometriosis.
Retrograde Menstruation
This refers to endometrial tissue flowing back into the fallopian tube during menstruation instead of flowing out of the body. The tissue builds up, unable to leave the body.
Endometrial Cell Transportation
Endometrial cells may also be carried out of the uterus via the blood vessels or the lymphatic system to other parts of the body.
Embryonic Cell Transformation
Cells that develop during the embryonic stage may later transform into endometrial cells during puberty because of excess estrogen in the body.
Induction Theory
Scholars also highlight the possibility of peritoneal cells, or cells lining the abdomen’s interior, transforming because of hormones or immune-related issues—and becoming endometrial cells inside the abdomen.
Immune System Issues
Disorders with the immune system may also result in the body having difficulty identifying endometrial tissue outside the uterus and destroying it.
Additionally, the National Institutes of Health (NIH) has identified several risk factors that may predispose a person to endometriosis. These include:
- Infertility
- Having a period before the age of 11
- Having periods that last more than seven days
- If one’s menstrual cycle is shorter than 27 days
- A family history of endometriosis
A 2017 study has also identified the link between endometriosis and having a lean body size and tall stature during childhood, adolescence, and adulthood.
Common Symptoms
One of the most common symptoms of endometriosis is excessively painful menstruation and painful cramping before and during one’s period. Some other symptoms include:
- Pain in the abdomen and lower back
- Increased bowel movements during the period
- Other gastrointestinal issues
- Painful urination
- Chronic pelvic pain
- Pain during intercourse
- Heavy menstrual bleeding during and in between periods
- Difficulty getting pregnant
- Bloating and nausea
- Fatigue
- Anxiety and depression
Diagnostic Criteria and Methods for Endometriosis
According to the NIH, a definitive diagnosis of endometriosis can only be done through laparoscopy surgery, wherein a doctor inserts a laparoscope into the abdominal region to check for endometrial tissue.
Doctors can also make presumptive diagnoses based on patient history, imaging tests, and physical exams.
A person may also begin treatment for endometriosis even without a definitive diagnosis via laparoscopy.
The following tests may also be conducted to rule out other conditions:
- Pelvic exam: A doctor will feel for cysts and scarring behind the uterus
- Imaging test: An ultrasound or MRI can be used to examine for cysts and nodules indicative of endometriosis
Treatment and Management of Endometriosis
If a doctor does not observe any cysts or nodules, hormonal birth control may be prescribed to reduce menstrual pain and induce regularity in menstruating women.
Other treatment methods may include:
- Pain medication
- Surgery (laparoscopy or hysterectomy)
- Lifestyle changes (exercise, quitting smoking, healthy diet)
Additionally, those looking to get pregnant may be recommended for laparoscopy or in vitro fertilization (IVF).
Symptomatic Overlaps: Where Confusion Arises
While most of the symptoms differ between the two conditions, some fertility-related symptoms may overlap, as well as how a woman experiences menstruation.
For example, a woman with PCOS often has irregular or missing periods, which may cause her to have very heavy bleeding when a period does occur.
This may cause confusion, as heavy bleeding is likewise an endometriosis symptom.
Other overlapping symptoms may include pelvic pain, painful periods, irritable bowel syndrome, and pelvic inflammatory disease.
Both conditions may also cause infertility and make it challenging to conceive.
Key Differences Between PCOS and Endometriosis
The main difference, fertility-wise, is that PCOS is more of a hormonal problem.
In contrast, endometriosis is more of a physical problem because there’s an obstruction (like an overgrown lining or cysts).
As such, endometriosis may be addressed with fertility treatment and the removal of tissues outside of the uterus to avoid miscarriage.
However, a much more holistic and collaborative approach is necessary with PCOS since it affects multiple body systems.
As such, women with PCOS may do well to work with a team of professionals other than their gynecologist.
These include an endocrinologist, nutritionist, and dermatologist.
Why the Distinction Matters
It’s crucial to determine whether one has PCOS, endometriosis, or both, as this will significantly affect the treatment needed to improve a person’s well-being.
Additionally, different treatments are required to address pain and infertility linked with the two conditions.
For instance, because endometriosis is often associated with caused by high estrogen levels, doctors may will likely focus on estrogen reduction and pain management.
With PCOS, high androgens will be the main drivers of infertility and underdeveloped oocyst formation, so the focus will be on reducing androgens and managing blood sugar levels.
Emotional and Psychological Impact
Studies show that women with PCOS experience higher rates of anxiety and depression than the general population.
This is an area that women’s health advocates are also calling for more focus and research on, as support and understanding is needed to help sufferers manage the emotional and psychological effects of the condition.
The psychological effects of endometriosis have also been studied, and it has been identified that, in most cases, the manifold symptoms of the condition cause severe psychosocial effects in women with it.
It has been cited as a “disabling condition” which may affect a person’s sexuality, mental health, and social relationships.
Importance of Choosing the Right Supplements
In addition to medical guidance and treatment, women with PCOS and endometriosis are encouraged to adopt a healthy lifestyle and support bodily functions through natural supplements.
Both PCOS and endometriosis sufferers can take supplements to help alleviate symptoms, increase fertility, and improve their quality of life.
Curated, high-quality supplements like Nourished Natural Health’s supplement line for women with PCOS, for example, is a great way to supplement according to one’s specific PCOS type.
Frequently Asked Questions
Can one have both PCOS and Endometriosis?
Are there any specific age groups more prone to developing PCOS or endometriosis?
Both conditions affect people of reproductive age or women between 12 to 52 years old.
Is there a genetic predisposition to developing either PCOS or endometriosis?
Both conditions have unknown causes, but researchers have revealed genetic predispositions to developing PCOS and endometriosis, such that if a person’s mother or sister has been diagnosed with either, it elevates that person’s risk of getting diagnosed with PCOS or endometriosis.
Are there any risk factors for developing endometriosis if one already has PCOS and vice versa?
While there is no causal link between the two, both conditions can coexist in a person.
And while the literature on the topic is still thin, some research reveals that women with PCOS may have higher chances of getting endometriosis.
However, there is still no evidence revealing whether the reverse is true.
Are there tests that can accurately diagnose PCOS and endometriosis?
Yes, a combination of physical tests, blood tests, ultrasound imaging, and laparoscopy (for endometriosis) can help a doctor accurately diagnose PCOS and/or endometriosis.
How do supplements impact the management of PCOS and endometriosis?
Studies show that supplementation for PCOS and endometriosis can help women manage symptoms, in addition to lifestyle changes and medical supervision.
Natural supplements, such as this PCOS supplement line from Nourished Natural Health, can also help improve women’s quality of life.
About The Author - Tamika Woods
Tamika Woods, Clinical Nutritionist (B.HS; B.Ed), Bestselling Author
For a decade, Tamika battled chronic acne, irregular cycles, mood swings, hair loss, painful periods, severe digestive issues and Polycystic Ovary Syndrome (PCOS). You name it - she's been there!
Tam was finally able to clear her skin, regulate her cycle, be free of period pain and fall pregnant naturally with her daughter in 2020. It took Tam 10 years and tens of thousands of dollars in tertiary education to get the answers she needed to get better.
She didn’t want other women to suffer as long as she did which is why she has dedicated her life to helping women in the same position as she was.
Tam helps women interpret what their bodies are trying to communicate through frustrating symptoms, and then develop a step-by-step roadmap to find balance again. She's here to help you get on track!
Tamika Woods is the author of the Amazon best seller PCOS Repair Protocol. She holds a Bachelor of Health Science degree (Nutritional Medicine) as well as a Bachelor of Education, graduating with Honours in both.
She is a certified Fertility Awareness Method (FAM) Educator and a certified member of the Australian Natural Therapists Association (ANTA).
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About The Author - Tamika Woods
Tamika Woods, Clinical Nutritionist (B.HS; B.Ed), Bestselling Author
For a decade, Tamika battled chronic acne, irregular cycles, mood swings, hair loss, painful periods, severe digestive issues and Polycystic Ovary Syndrome (PCOS). You name it - she's been there!
Tam was finally able to clear her skin, regulate her cycle, be free of period pain and fall pregnant naturally with her daughter in 2020. It took Tam 10 years and tens of thousands of dollars in tertiary education to get the answers she needed to get better.
She didn’t want other women to suffer as long as she did which is why she has dedicated her life to helping women in the same position as she was.
Tam helps women interpret what their bodies are trying to communicate through frustrating symptoms, and then develop a step-by-step roadmap to find balance again. She's here to help you get on track!
Tamika Woods is the author of the Amazon best seller PCOS Repair Protocol. She holds a Bachelor of Health Science degree (Nutritional Medicine) as well as a Bachelor of Education, graduating with Honours in both.
She is a certified Fertility Awareness Method (FAM) Educator and a certified member of the Australian Natural Therapists Association (ANTA).