PCOS vs. endometriosis: What's the difference?

If you have ever dived into the world of reproductive health, chances are you have come across polycystic ovary syndrome (PCOS) and endometriosis. While both cases can take years to detect and can have overlapping symptoms that affect people who menstruate, they are two different disorders with separate diagnoses and treatment.

In this article, we will be exploring the distinctions and connections between PCOS and endometriosis.

Read on to learn the following:

• What is PCOS? What is endometriosis?
• What are the differences between PCOS and endometriosis?

PCOS and endometriosis

What is PCOS?

PCOS is a common hormonal disorder that affects 10% of menstruating people during their reproductive years. It accounts for nearly 70% of infertility cases, making it the leading cause of conceiving struggles (1). Besides infertility, people with PCOS are more prone to develop other chronic medical conditions such as diabetes, heart disease, endometrial cancer, mental health issues - and endometriosis. 

For more information on PCOS, check out this blog that provides an overview of PCOS.

What is endometriosis? 

Endometriosis is a gynecological condition that affects 10% of reproductive-aged menstruating people globally. 

Endometriosis is a condition in which tissues similar to the lining of your uterus, called the endometrium, grow outside the uterus.When you have endometriosis, endometrial tissue can grow on your ovaries, fallopian tubes, intestinal tract, and the lining of your pelvis. While seen less frequently, endometrial tissue can even spread outside your pelvic area. 

Endometrial tissue that grows outside of the uterus is known as an endometrial implant. As a result of hormonal changes during the menstrual cycle, misplaced endometrial tissue becomes inflamed and painful (2).

The symptoms of endometriosis may vary from person to person. For instance, some people experience no symptoms, while others experience a variety of symptoms (2). 

Common symptoms of endometriosis include: 

• Painful periods
• Heavy menstrual bleeding
• Pain with bowel movements and urination
• Pain during intercourse
• Infertility
• Back pain

Because these symptoms can often be dismissed as “a bad period,” it can take years before a proper diagnosis is made. In fact, it takes the average person over 7 years to be diagnosed with endometriosis (3). To make an accurate diagnosis, a laparoscopic surgery is needed and this procedure can be a major deterrence as it is physically and financially costly.

You can check out this article for more information on endometriosis.

The difference between PCOS and endometriosis

Although PCOS and endometriosis both affect female reproduction and may cause infertility, they are two separate conditions. 

You can, however, have endometriosis and PCOS simultaneously. In fact, people who have PCOS are more likely to have endometriosis than those without (4).

Endometriosis can only be diagnosed accurately with laparoscopic surgery. PCOS, however, can be diagnosed through a pelvic examination, ultrasound, and blood tests, making it a more straightforward condition to pinpoint (4). When considering the definition of each condition, an imbalance in hormones is responsible for PCOS, while abnormal cell growth outside the uterus causes endometriosis. However, they are similar in the sense that they are both complex issues: PCOS can be catalyzed by metabolic, genetic, or inflammatory root causes, and while endometriosis is not a hormone imbalance by its textbook definition, having imbalanced hormones (e.g., high estrogen levels) can make one’s case more severe, and research also suggests it manifests due to a combination of inflammation, autoimmune, and genetic factors.

Symptoms may overlap when it comes to how the conditions impact fertility or menstruation. Both PCOS and endometriosis can make it more difficult to get pregnant, and while endometriosis is known for causing painful and heavy periods, PCOS patients can also see this as a result of imbalanced hormones and a buildup of the uterine lining that occurs from not having a consistent period.. 

In both cases, medical attention is required for a proper diagnosis and treatment plan. 

How are PCOS and endometriosis treated? 

Because PCOS and endometriosis are separate disorders, each condition is treated differently. However, there is some similarity between the two when it comes to aiming for hormone balance and inflammation reduction.

At present, endometriosis cannot be cured, but there are several treatment options available. Pain experienced due to endometriosis may be treated with hormone therapy such as birth control, anti-inflammatory medications, and surgical treatment to remove patches of endometriosis.

Treatment for infertility related to endometriosis is also available. In most cases, laparoscopic surgery is recommended to vaporize the growth of endometriosis and improve fertility. In vitro fertilization (IVF) may be the best option if pregnancy is not achieved after surgery (5).

There are two main areas of treatment for PCOS. The first one is related to "acute" issues such as menstrual cycle regulation and treatment of hirsutism, and the second is related to "chronic" issues such as infertility management. Among these options are hormonal birth control, hormone therapy to reduce testosterone production, metformin to manage insulin resistance, and diet and lifestyle changes such as incorporating body movement and an anti-inflammatory diet (6).

While there are clearly distinct treatments for endometriosis and PCOS, many lifestyle habits relating to nutrition, exercise, and stress management apply to improving symptoms of both.

What if I have both PCOS and endometriosis?

If you have either PCOS or endometriosis, you are at a heightened risk of developing the other.

Being diagnosed with endometriosis and PCOS can be challenging and overwhelming. In both cases, there may be painful and uncomfortable symptoms, and knowing there is no one cure can take a toll on your mental health.

If you have been diagnosed with both PCOS and endometriosis the following tips may help you: 

• Consider joining a support group: By speaking to other people affected by PCOS and endometriosis, you may feel less alone and more supported in your journey. Simply knowing there are others who share a similar experience with you can make a huge difference!
• Find a supportive doctor: Your doctor should understand the nuances of PCOS and endometriosis and be able to listen to your concerns to find a sustainable way to manage your symptoms while staying aligned with your lifestyle. 
• Take it one day at a time: Some days may be harder than others and that is okay! Be kind to yourself and be aware of how environmental factors affect your wellbeing. Each day is a new opportunity for you to learn what triggers and improves your symptoms. 
• Incorporate self-care: It may be helpful to incorporate yoga, meditation, or other self-care techniques such as a warm bath in your routine to help manage symptoms and stress associated with the conditions.

While it may be discouraging to know that there is no cure for both conditions, you can still maintain quality of life by managing symptoms through your lifestyle. Having the knowledge and understanding of the disorders puts you in a place to better advocate for yourself and your health. Whether it means seeking out specialists or adjusting your daily habits, being well informed of how PCOS or endometriosis affects your body can empower you to take back some control over your symptoms.

If you are a Pollie member, you can speak to your nutritionist or health coach for additional support. 

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Bibliography

1. PERLA Health. “Endometriosis & PCOS: Is There a Connection?” PERLA Health, 3 Feb. 2021, https://perlahealth.com/endometriosis-pcos/. 
2. Mohamed, Abdul Wadood. “Endometriosis: Causes, Complications, and Treatment.” Healthline, 15 Dec. 2021, https://www.healthline.com/health/endometriosis#symptoms. 
3. M.S. Arruda, C.A. Petta, M.S. Abrão, C.L. Benetti‐Pinto, Time elapsed from onset of symptoms to diagnosis of endometriosis in a cohort study of Brazilian women, Human Reproduction, Volume 18, Issue 4, April 2003, Pages 756–759, https://doi.org/10.1093/humrep/deg136
4. “PCOS vs. Endometriosis: What's the Difference?” Hackensack Meridian Health, 10 Aug. 2021, https://www.hackensackmeridianhealth.org/en/HealthU/2021/06/11/pcos-vs-endometriosis-whats-the-difference#.YjCjVxPMI3Q. 
5. “What Are the Treatments for Endometriosis?” Eunice Kennedy Shriver National Institute of Child Health and Human Development, U.S. Department of Health and Human Services, 21 Feb. 2020, https://www.nichd.nih.gov/health/topics/endometri/conditioninfo/treatment. 
6. Artini, P. G., Di Berardino, O. M., Simi, G., Papini, F., Ruggiero, M., Monteleone, P., & Cela, V. (2010). Best methods for identification and treatment of PCOS. Minerva ginecologica, 62(1), 33.

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