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What to Know About PCOS and Endometriosis

last year6 min read
Last updated: Jan 20 2023

PCOS and endometriosis are two chronic health conditions that affect women.

Even though they’re both common, they’re considered difficult to diagnose, and not much is understood about the underlying causes.

So, it’s completely normal to have questions: Is endometriosis the same as PCOS? If not, what’s the difference between PCOS and endometriosis? And can you have both?

PCOS and Endometriosis

In this article: 📝

  • What’s the difference between PCOS and endometriosis?
  • 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 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 you get pregnant and your body needs to carry a baby.

But when it’s 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.

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:

  • Fatigue
  • Bleeding between periods
  • Longer, heavier periods
  • Reproductive struggles

But some symptoms are also unique to each condition.

For endometriosis:

  • Very painful cramping before and during your period
  • Pain in your pelvis and back, pain when you go to the bathroom, or pain during or after sex


  • 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 is PCOS?

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:

  • 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. Why?

  • First, endo is more 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.
  • Second, pain is not a symptom of PCOS, whereas the pain associated with endo can be severe enough that you regularly have to miss work or school. This means that it can be much more difficult to live with and much more disruptive for 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.

Often, doctors will prioritize treating endometriosis before PCOS. There are two reasons for this:

  • First, endo is generally considered a more serious condition.
  • Second, treating PCOS will often raise your estrogen levels, which can make the symptoms of endometriosis worse.

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.

💡 More from The 411:
PCOS Hair Loss: Everything You Need to Know
Getting Pregnant with PCOS: What You Need to Know
9 Low Progesterone Symptoms
Is PCOS an Autoimmune Disease?
What to Know About PCOS Acne
About Endometriosis and Pregnancy
Femara vs. Clomid: All You Need to Know
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