Understanding Endometriosis vs. PCOS

It is Endometriosis Awareness Month this month. Endometriosis affects about 1.5 million women in the UK, but it remains one of the most under-diagnosed conditions. 

While we are PCOS specialists here at PCOS Clinics, we often see women with endometriosis as well as PCOS in clinic. So, what’s the difference?

Endometriosis and polycystic ovary syndrome (PCOS) are two common conditions that affect women. While both conditions can cause menstrual irregularities and fertility challenges, they differ in their underlying hormonal imbalances, symptoms, and treatment approaches. Understanding these differences is key to seeking the right diagnosis and treatment.

Endometriosis vs. PCOS: How They Differ

Both conditions can lead to heavy menstrual bleeding and issues with fertility, but they have distinct causes and symptoms:

• Endometriosis is linked to high levels of oestrogen, leading to the growth of uterine-like tissue outside the uterus.
• PCOS is caused by an overproduction of androgens (male hormones), leading to ovarian cysts, irregular periods, and other metabolic effects.
• It is possible to have both conditions simultaneously, complicating diagnosis and treatment.

Symptoms of Endometriosis vs. PCOS

Prevalence of Endometriosis and PCOS

• Endometriosis affects approximately 10–15% of women and up to 70% of those experiencing chronic pelvic pain.
• PCOS is more common, affecting 5–20% of women of reproductive age, with around 80% of ovulation-related infertility cases linked to PCOS.

What Causes Endometriosis and PCOS?

Endometriosis Causes

While the exact causes are not yet known, the following hypotheses have been put forward:

• Retrograde menstruation: Uterine tissue moves into the pelvic cavity instead of exiting the body.
• Immune system dysfunction: The immune system fails to eliminate misplaced endometrial cells
• Cell transformation: Some cells outside the uterus may transform into endometrial-like cells.
• Post-surgery implantation: Uterine cells may spread after surgeries like a hysterectomy or C-section.

PCOS Causes

• Genes: PCOS is a genetic condition
• Hormonal imbalance: High levels of testosterone and other androgens affect ovarian function
• Insulin resistance: High levels of insulin use can increase androgen production.
• Inflammation: Chronic inflammation contributes to excessive androgen levels.
• Stress: high levels of stress hormones can contribute to excessive androgen production.

Who is at Risk?

Risk Factors for Endometriosis

• Family history of endometriosis
• Early menstruation (before 11 years old)
• Short menstrual cycles (<27 days)
• Heavy, prolonged periods (>7 days)
• Infertility

Risk Factors for PCOS

• Family history of PCOS
• Insulin resistance or diabetes
• High levels of stress
• High levels of inflammation

Can You Have Both Conditions?

Yes. Studies suggest a strong link between PCOS and endometriosis, particularly in individuals experiencing pelvic pain or infertility. 

High androgen and insulin levels in PCOS may contribute to anovulatory periods (periods where we don’t ovulate), which may lead to higher levels of oestrogen, potentially exacerbating endometriosis.

Conventional Treatment Options for Endometriosis and PCOS

Endometriosis Treatment

• Hormonal therapy: Birth control or hormonal treatments to lower oestrogen levels
• Pain management: Over-the-counter pain relievers
• Surgery: Removal of endometrial tissue or, in severe cases, a hysterectomy
• Lifestyle changes: A balanced diet and exercise to help manage symptoms

PCOS Treatment

• Hormonal therapy: Birth control to regulate hormones
• Fertility treatments: Ovulation-inducing medication for those trying to conceive
• Diabetes medication: Helps manage insulin resistance
• Acne and hair treatments: Medications to manage excess hair growth and acne
• Lifestyle changes: A balanced diet and exercise to help manage symptoms

When to See a Doctor

Seek medical advice if you experience:

• Pelvic pain or abnormal menstrual bleeding
• Pain during or after intercourse
• Irregular or absent periods
• Difficulty conceiving
• Signs of excess androgen (e.g., excess hair growth, acne, hair loss)

Early diagnosis is crucial for symptom management. A gynaecologist or endocrinologist can provide a tailored treatment plan.

Final Thoughts

Endometriosis and PCOS are distinct but often misunderstood conditions that can significantly impact overall health. 

While endometriosis results from excessive oestrogen and misplaced uterine tissue growth, PCOS stems from an overproduction of androgens, leading to metabolic and reproductive complications. If you suspect you have either condition, early medical intervention can help manage symptoms and improve quality of life. And don’t forget the power of diet and lifestyle changes – if you’d like to know more, get in touch.