Endometriosis vs. PCOS: How they’re different
Endometriosis and polycystic ovary syndrome (PCOS) are two common conditions that affect the reproductive system. The two are often mixed up, likely because they can share symptoms and both can cause significant health challenges for women. In fact, endometriosis and PCOS are completely different conditions–from how they’re diagnosed and sometimes treated, to the effects they have on a woman’s reproductive system. For someone experiencing shared symptoms of endometriosis and PCOS, it can be confusing and frustrating trying to figure out what exactly is going on in your body. Understanding the similarities and differences between these conditions is an important step in the right direction when it comes to diagnosis and treatment.
What is endometriosis?
Endometriosis is a condition that occurs when uterine tissue (also known as endometrium) begins to grow outside of the uterus. Endometriosis can occur anywhere in the pelvic region, including ovaries, fallopian tubes, and lining of the pelvic cavity.
What is PCOS?
PCOS represents a complex endocrine dysfunction of the hypothalamic-pituitary-ovarian axis which can cause multiple clinical features, such as obesity, insulin resistance, hyperandrogenism and anovulation.
Endometriosis and PCOS symptoms
Infertility is a shared symptom of endometriosis and PCOS.
Symptoms specific to endometriosis include:
- Painful periods
- Painful intercourse
- Painful bowel movements
- Digestive issues like bloating and constipation
- Frequent urination
Symptoms specific to PCOS include:
- Weight gain
- Acne
- Excess hair growth on the face and body
- Male-pattern baldness
- Irregular periods
- Heavy menstrual bleeding
Causes and risk factors of endometriosis and PCOS
The exact causes of both endometriosis and PCOS are not fully understood.
PCOS is thought to be caused by a combination of genetic and environmental factors, as well as insulin resistance. Risk factors for PCOS include:
- Family history: A family history of PCOS makes a person more likely to develop the condition.
- Obesity: Being overweight or obese increases risk for developing PCOS.
- Race/ethnicity: African American and Hispanic women are at a higher risk for developing PCOS.
- Hormonal imbalances: PCOS is often associated with the imbalance of hormones like androgen and insulin.
- Sedentary lifestyle: A sedentary lifestyle can contribute to obesity and insulin resistance, which are risk factors for PCOS.
Endometriosis is thought to be related to genetic and hormonal factors, and immune system dysfunction. Another possible cause is retrograde menstruation (when menstrual blood flows back into the pelvic cavity). Risk factors for endometriosis include:
- Family history: People who have a family history of endometriosis are more likely to develop the condition.
- Menstrual history: Menstruating at an early age, shorter menstrual cycles, or heavy and prolonged menstrual periods can be risk factors for endometriosis.
- Reproductive history: Women who have never given birth or have had trouble getting pregnant may be at a higher risk for endometriosis.
- Uterine abnormalities: Structural abnormalities in the uterus or cervix may post a higher risk of endometriosis.
- Immunological factors: Endometriosis is thought to be linked to immune system dysfunction, which may make it harder for the body to recognize and eliminate endometrial tissue growing outside the uterus.
Diagnosing endometriosis and PCOS
Diagnosis of endometriosis typically involves a combination of symptoms, physical exams, and imaging studies. It may also require surgery to confirm the presence of endometrial tissue outside of the uterus.
PCOS is typically diagnosed based on a combination of symptoms, physical exams, blood tests, and ultrasound imaging to look for cysts on the ovaries.
Unfortunately, there is no single test that can definitively diagnose endometriosis or PCOS. Misdiagnosis and delayed diagnosis are common with endometriosis; studies estimate the average delay ranges from 3 to 11 years, from the onset of symptoms to final diagnosis. A separate study found that ⅓ of women diagnosed with PCOS had to visit at least 3 health professionals over the course of two years before receiving a diagnosis.
Treating endometriosis and PCOS
Treatment for endometriosis may include pain management, hormone therapy, and surgery to remove the endometrial tissue.
Treatment for PCOS may include medication to regulate menstrual cycles and lower androgen levels.
For both conditions, certain lifestyle changes can help with managing symptoms:
- Quitting smoking: Smoking is associated with a higher risk of infertility and other health problems. Quitting smoking is one of the best things a person can do for their health, whether or not they have endometriosis or PCOS.
- Eating a balanced diet: Some people with endometriosis may find that certain foods like dairy or gluten exacerbate their symptoms, and that by avoiding trigger foods their symptoms are reduced. People with PCOS should aim for a balanced diet to help manage insulin resistance. In both cases, working with a registered dietitian to create a personalized nutrition plan may be helpful.
- Exercising regularly: Regular exercise can help reduce stress and boost overall health. People with endometriosis may find low-impact exercise like yoga and walking especially helpful. Aiming for a minimum of 150 minutes of moderate-intensity exercise per week can also improve insulin sensitivity for people with PCOS.
- Managing stress: Stress can worsen symptoms of both endometriosis and PCOS. Managing stress will look different for each person, but deep breathing, meditation, or seeking support from a mental health professional are all good places to start.
- Getting enough sleep: Aiming for 7 to 9 hours of sleep per night is important for overall health.
Endometriosis, PCOS and fertility/pregnancy
Both PCOS and endometriosis can affect fertility and make it more difficult to become pregnant, but for slightly different reasons.
Endometriosis can cause inflammation and scarring in the pelvis, which can interfere with the functioning of the fallopian tubes and ovaries. This can make it more difficult for the sperm and egg to meet, and for the fertilized egg to implant in the uterus.
PCOS can make it more difficult for women to become pregnant because of hormonal imbalances that can cause irregular ovulation or prevent ovulation entirely.
Fertility treatments for people with endometriosis may include ovulation induction with medication, intrauterine insemination (IUI), or in vitro fertilization (IVF).
Fertility treatment for people with PCOS may include fertility medications to stimulate ovulation. Assisted reproductive technologies such as in vitro fertilization (IVF) may also be recommended in some instances.
Both endometriosis and PCOS come with a slightly higher risk of preterm birth. Separately, endometriosis poses some risk of cesarean delivery, whereas PCOS poses some risk of gestational diabetes and preeclampsia. However, with the right treatment and care, women with endometriosis and PCOS are still able to conceive and have healthy pregnancies.
Endometriosis, PCOS and mental health
Chronic pain, unpredictability of symptoms, and obstacles in diagnosis can all take a toll on mental health for people with these conditions. Depression, anxiety, body image concerns, sexual dysfunction, and stress are just a few of the mental health conditions associated with endometriosis and PCOS. In addition to seeking help from a mental health professional, the following can help people with endometriosis- or PCOS-related mental health concerns better cope:
- Seeking support from friends, family, or a mental health professional
- Practicing self-care in its many forms–any activity that makes you feel good, whether a bath, taking up a new hobby, or spending time outdoors, can help.
- Be kind to yourself. Managing endometriosis or PCOS can be challenging, and it’s important to remember to be patient and compassionate with yourself.
Endometriosis and PCOS can be complicated conditions. Symptoms can look different from person to person, and these conditions can affect many facets of a person’s life. However, help is available. For starters, gaining a better understanding of how endometriosis and PCOS are similar and how they are different is a great first step in patient education. Finding providers who specialize in women’s health may also help avoid years of painful misdiagnosis and being shuffled from doctor to doctor. Finally, a care team that focuses on whole-person care, instead of treating a singular symptom, can be extremely helpful. In doing so, you’ll get a more personalized treatment plan, which is the best approach for managing endometriosis or PCOS.
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