PCOS and endometriosis are two chronic health conditions that affect women.
Even though they’re both common, they’re difficult to diagnose, and not much is understood about the underlying causes.
So, it’s completely normal to have questions like *Is endometriosis the same as PCOS?
And if not, what’s the difference between PCOS and endometriosis?
Or more pressing, can you have both?
The expert is in, so let’s get you to grips with these two misunderstood conditions.
In this article: 📝
- What’s the difference between PCOS and endometriosis?
- Endometriosis vs PCOS symptoms
- What causes PCOS and endometriosis?
- Which condition is more severe?
- Can you have PCOS and endometriosis?
What’s the difference between PCOS and endometriosis?
First things first, PCOS (polycystic ovary syndrome) and endometriosis (also known as endo) are not the same.
They both affect the female reproductive system, and there are some overlapping symptoms, but they’re caused by different things.
PCOS is an endocrine condition. It happens because your body isn’t producing hormones in the right balance it needs to keep everything working smoothly.
Specifically, the concern is the levels of androgen hormones (like testosterone) in your body.
Every woman’s body needs to produce a little testosterone to function, but when there’s too much, it can cause the symptoms of PCOS.
On the other hand, endometriosis is an inflammatory condition where endometrial tissue grows where it’s not supposed to.
Your body grows endometrial tissue to line your uterus each month in case your egg gets fertilized and you get pregnant.
This building of the endometrial issues ensures your fertilized egg has a plush lining to implant on.
But when the endometrial tissue is in the wrong place (usually inside your fallopian tubes and ovaries, around the ligaments in your pelvis, or around organs such as your bladder), it can cause problems, especially pain.
But why (oh why) pain?
As Dr. Fatema Mustansir Dawoodbhoy, O&G Academic Research Doctor explains, “while the uterine endometrial tissue can escape from the body through period blood, the other endometrial tissue does not have a place to escape, which is why terrible pain is a common symptom.”
If you’re struggling with endometriosis pain, there are some things that can help, like pain relief medication, heating pads, and even new tech like the OOVI pulse therapy kit, which our endo community of Peanut love.
Endometriosis vs PCOS symptoms
Both PCOS and endometriosis share some key symptoms:
- Bleeding between periods
- Longer, heavier periods
- Reproductive struggles
But some symptoms are also unique to each condition:
Symptoms of endometriosis
Typical endometriosis symptoms include:
- Very painful cramping a few days before and during your period
- Pain in your pelvis and back, pain when you go to the bathroom, or pain during or after sex
- Changes to bowel movement near the time of period
Symptoms of PCOS:
Meanwhile, PCOS typically presents as:
- Irregular periods
- Weight gain
- Insulin resistance
- Excess hair on your body and face
- Thinning hair on your head
- Oily skin and acne, especially around your jaw and chin
- Difficulty sleeping or sleep apnea
- Depression and anxiety
What causes PCOS and endometriosis?
Frustratingly, a lot more research is needed before we can pinpoint exactly what causes PCOS and endometriosis.
There seems to be a strong genetic component for both conditions (so, if your mother or sister has it, you’re likely to as well), but that doesn’t explain the underlying causes.
The theories around endometriosis focus on explaining how the endometrial tissue starts to grow in the wrong part of the body. It might be that:
- Retrograde menstruation (when your blood flows back into the fallopian tubes and pelvic cavity during your period) can deposit endometrial-like cells outside the uterus where it can implant and grow
- Your immune system doesn’t recognize the endometrial cells as ‘wrong’, so it doesn’t work to get rid of them. Everyone naturally has some tissue flow back into the fallopian tubes when they menstruate, but your immune system normally destroys it. The question is, why doesn’t this happen for people with endo?
- The patches of endometrial tissue might start to grow from embryonic cells left behind from the very earliest (as in, pre-birth) stages of your life.
- Your lymphatic system might carry some endometrial cells to other parts of your body, where they can implant and start to grow.
- Or it might be a case of cell transformation, where cells in other parts of your body start to behave like endometrial cells.
And then, for PCOS, the question is why the imbalance of hormones is happening in the first place.
There might even be an autoimmune component to the condition—which would mean that the hormone imbalance causes your own immune system to attack healthy cells in your body.
Or, that the hormone imbalance is a reaction to this problem with your immune system.
Which condition is more severe?
Some people ask, Which is worse, PCOS or endometriosis? And if you or someone you love has just been diagnosed, it’s natural to want to know what to expect.
The truth is that it’s difficult to say because both conditions exist on a spectrum.
The symptoms aren’t the same every day, or for every woman, and there may be times when they ‘flare up’ compared to weeks when you feel relatively normal.
But generally, endometriosis is considered more severe than polycystic ovary syndrome for two reasons:
1. Endometriosis is difficult to diagnose
PCOS can be confirmed with a blood test to check your hormone levels and an internal ultrasound to look at your ovaries.
An endo diagnosis usually involves a minor procedure called a laparoscopy, where a surgeon will look inside your abdomen to find the patches of endometrial tissue growing outside your uterus.
“If surgery is too much to put your body through, you can discuss a Pelvic MRI with your doctor,” suggests Dr. Fatema.
“It has better specificity than ultrasound and might be able to pick up small amounts of endometrial tissue in the reproductive tract.”
2. Endometriosis is painful
Pain is not a symptom associated with PCOS, whereas endometriosis pain can be severe enough that you regularly have to miss work or school, affecting your quality of life.
This means that it can be much more difficult to live with and much more disruptive to your daily life.
Can you have PCOS and endometriosis?
Unfortunately, it is possible to have both PCOS and endometriosis at the same time.
They’re both very common—around 10% of women have PCOS, and the numbers are similar for endometriosis.
Some studies have also shown a strong link between the two conditions—specifically that having PCOS means that you’re more likely to have endometriosis.
As we’ve seen above, symptoms can overlap, and typically PCOS is the easier condition to diagnose—especially if you’re on a TTC journey.
Once endometriosis is diagnosed, the priority tends to shift quickly to removing the endometrial tissue and providing relief from the pain.
That’s not to say one condition is more serious than the other.
Both can take a toll on your physical and mental health, and if trying to conceive is on the cards, the treatment and management of both are vital
Having said this, if you’re not TTC, hormonal birth control can work to reduce the symptoms of both conditions.
It stabilizes the level of estrogen in your body, which reduces the excess tissue growth associated with endo and blocks some of the excess testosterone which causes PCOS symptoms.
As well as this, your doctor might recommend an anti-inflammatory diet to control your symptoms.
This involves cutting out foods that can cause inflammation – mostly refined carbs and sugars, red meat, and processed meats – and eating lots of anti-inflammatory foods like oily fish, green leafy veggies, and foods containing turmeric.
It can also be a good idea to cut down on your alcohol intake if you have endo.
If you have PCOS, endometriosis, or both, it can feel isolating, especially if your diagnosis is new.
Remember, the Peanut Community is always here to support you.