Endometriosis and PCOS share many common symptoms. This can often lead patients to ask: do I have PCOS or endometriosis? To begin, let’s explain what PCOS and Endometriosis are.

What is Polycystic Ovarian Syndrome (PCOS)?

PCOS is a condition in which there is an imbalance of hormones in a woman during reproductive years. 

  • Women with PCOS have higher levels of male hormones, also known as androgens, from the ovaries and the adrenal glands. 
  • Small fluid-filled sacs, called cysts, form along the outer edge of the ovary.  The cysts contain immature eggs, or follicles, which fail to release.  The ovaries may appear larger due to the multiple cysts. 

Due to irregular release of eggs, a common symptom of PCOS is irregular periods.  Women either have fewer menstrual periods, less than 9 per year, or periods that last for many days.  Thus, PCOS can lead to fertility issues.  Because of the high levels of androgens, patients may develop hirsutism, or excess facial and body hair.  Other symptoms are hair loss on the head (male pattern baldness), acne, oily skin, dark thickened, velvety skin (acanthosis nigricans), weight gain and bleeding with ovulation.  

What is Endometriosis?

On the other hand, Endometriosis is when inflammatory tissue, similar to, but not the same as the lining of the uterus, grows outside of the uterus. It can grow anywhere in the body, however, most commonly around the abdominal and pelvic area, surrounding the bowels, bladder, and the pelvic floor.  The endometriosis tissue releases inflammatory compounds that can cause pain. 

The most well-known symptom of endometriosis is dysmenorrhea, also known as painful periods.  Women with endometriosis may also have abdominal pain and distention or bloating, pain during and/or after sexual intercourse, painful urination or bowel movements, bleeding between periods, urinary urgency and frequency, and severe fatigue or low energy.  In addition to these symptoms patients may also have digestive issues, such as constipation, diarrhea, or a cyclical pattern of both.  At times this pain is so debilitating that women may miss work, school or cannot participate in daily activities.  However, the severity and symptoms vary from patient to patient.  

What do both PCOS and Endometriosis have in common?

Both PCOS and Endometriosis can cause pelvic pain, difficulty getting pregnant, and heavy bleeding.  The symptoms of either PCOS and Endometriosis can be subtle, and subsequently, often misdiagnosed. 

  • It is possible to have either PCOS or Endometriosis and not have any symptoms at all. 
  • Both conditions are common – with Endometriosis prevalence of 10-15% and PCOS prevalence of 5-20%. 
  • Both PCOS and Endometriosis are associated with a family history of the condition.  

How Do Doctors Check for PCOS or Endometriosis?

The diagnosis of PCOS and Endometriosis can be tricky as your physician will not be able to make a definitive diagnosis based on clinical symptoms. 

  • Your physician may start with a thorough medical history, to look for red flags or common symptoms of PCOS or endometriosis. 
  • During the pelvic exam your physician may be able to palpate, or feel, endometrial growth or masses, cysts and/or scar tissue. 
  • Blood tests may be done to check for abnormal levels of inflammatory markers of abnormal hormones.  In contrast to PCOS, endometriosis is linked to high levels of the female hormone, estrogen. 
  • If suspecting PCOS, an ultrasound image can be done to check cysts over the ovaries.  However, it is possible to have ovarian cysts and not have PCOS
  • Imaging of the abdomen and pelvis may be done, using CT scans, ultrasound, or MRI, to check for endometriosis. 

Unfortunately, 90% of endometriosis patients have negative, or “normal,” imaging results.  A large endometrial growth may be found on imaging, however, most endometriosis tissues are too small to be seen on imaging.  The definitive diagnosis (and removal) of endometriosis is with surgery, usually done laparoscopically, by an experienced endometriosis excision specialist.  

Is it possible to have both endometriosis and PCOS?

Yes, it is possible to have both underlying conditions.  Studies have shown that women with PCOS are more likely to be diagnosed with endometriosis.  

If you think you have symptoms of PCOS or endometriosis, it’s important to talk to your healthcare provider. At PRM, our team is on the frontlines of these conditions and we can help with diagnosis and treatment – offering a multi-modal approach unlike anything offered elsewhere. 

Image of what to expect after 3 months of treatment.