Endometriosis vs PCOS: What's the Difference?

Are your periods surprising you lately? Arriving without notice—or not for months—leaving you extra bloated, or giving you gut-wrenching cramps? Extreme irregularities in your menstrual cycle, digestion, mood swings, pelvic pain and cramps mean that your reproductive system is asking for a check.

So you’re here wondering whether, like at least one of your friends, you also have PCOS (Polycystic Ovary Syndrome). Yes, it’s that common, it affects eight to 13 percent of women of reproductive age.

But before you start searching “Can PCOS be cured?” and “Can you get pregnant with PCOS?”, hold on. Let’s cover all the bases and start with the obvious—the right diagnosis (and direction).

Is it PCOS or something else with similar symptoms, such as endometriosis? Let’s dissect the differences.

What's the difference between endometriosis and PCOS?

While PCOS and endometriosis might have some similar symptoms like irregular periods and difficulty in conceiving, they’re quite different. Neither has a cure but both can be managed with the right care.

Endometriosis

Usually, the lining of your uterus sheds during your period. If you have endometriosis, the same kind of tissue grows not only inside your uterus but also in the fallopian tubes, ovaries or ligaments that support the uterus.

During your period, the tissue outside the uterus sheds, causing increased pain and more intense symptoms. These can include intense abdominal and lower back pain, diarrhea, and pain during pooping or even having sex.

What causes endometriosis?

According to Zoya Enakshi Ali, a reproductive geneticist at Hertility Health, “Endometriosis is believed to involve a combination of genetic factors, immune dysfunction, environmental causes and, possibly, bacterial origins."

How do you treat endometriosis?

Since endometriosis causes a lot of pain, doctors recommend pain-relief medicines, hormone therapy (including hormonal contraceptives and progestin-only birth control), and treatments (lasers or heat) that remove endometrial tissue.

What is PCOS?

A hormonal imbalance, PCOS leads to ovarian cysts. These cysts contain immature eggs that are not released resulting in irregular ovulation.  People with PCOS can have irregular periods and heavy bleeding that lasts for days. PCOS symptoms include excessive hair growth on the face and body, weight gain, acne and thinning hair.

What causes PCOS?

“Genetics and environmental factors play significant roles in its development but its exact cause isn’t known,” says Ali.

How do you treat PCOS?

Treating PCOS involves lifestyle management strategies such as regular exercise, diet regulation, and sometimes birth control pills (if prescribed by a gynecologist).

How do I know if I have PCOS or endometriosis?

While you can only receive an official diagnosis from a medical professional, you're probably anxious to figure it out yourself. This list of symptoms can help lead you in the right direction. Make note of the symptoms you suffer from and share them with your doctor.

For those with endometriosis, symptoms can vary in intensity but can include:

• Painful periods
• Heavy periods
• Pain during or after sex
• Bleeding between periods
• Pain when peeing or passing stools during your period
• Fatigue
• Feeling sick
• Constipation or diarrhea
• Blood in your pee or stools during your period
• Pain in your lower abdomen or back that’s usually worse during your period
• Fertility issues

Not everyone with PCOS experiences all of these symptoms, but typical symptoms include:

• Irregular or no periods at all
• Excessive hair growth (hirsutism), usually on the face, chest and back
• Hair thinning or loss
• Acne
• Dark skin patches
• Weight gain or difficulty losing weight
• Fertility issues as a result of irregular ovulation or no ovulation
• Anxiety or low mood

Can endometriosis look like PCOS on an ultrasound?

PCOS and endometriosis can be misdiagnosed, so it's important to get a comprehensive assessment. Your doctor may order an ultrasound after you share your symptoms and undergo physical exams.

“A pelvic ultrasound can diagnose endometriosis, but it may not always appear on scans. Even if you have a scan that doesn’t show any signs of endometriosis tissue, this doesn’t definitively rule endometriosis out, especially if you have symptoms,” says Ali.

Scans can show large masses of tissue or scarring, which can be signs of endometriosis, but they can’t show small cysts and tissues. Laparoscopy, a minimally invasive surgery, offers a definitive diagnosis of endometriosis.

“PCOS can also be diagnosed with a scan. PCOS is characterized by multiple small follicles (the sacs that house your eggs) that grow around the ovaries. This resembles a string of pearls on an ultrasound—called a polycystic ovarian morphology (PCOM)”, Ali says.

Which is worse for fertility PCOS or endometriosis?

Having either or both conditions doesn’t mean you can’t get pregnant. Since every person is different, it’s impossible to determine which condition is worse for fertility.

Around 30 to 50 percent of women with endometriosis symptoms may have infertility issues, which can be managed with treatments. According to Ali, endometriosis can affect fertility due to adhesions, scarring, and inflammation that can block the fallopian tubes, ovaries, and uterus. Eggs may be blocked from reaching the uterus, or sperm may be blocked from reaching the eggs.

In PCOS, your ovulation—the fertile egg release phase—is irregular, making it harder to conceive. “Some people may conceive quickly either with or without intervention, while others may require more time and assistance,” says Ali.

“With appropriate treatment and medical intervention, many women with either condition can still achieve pregnancy”, explains Ali. For instance, along with lifestyle changes, some women are prescribed clomiphene citrate, which can help women with PCOS or endometriosis. It has been proven to help 80 percent of women get pregnant. Similarly, other treatments like IVF increase the chances of conceiving.

With conditions like PCOS and endometriosis, your first step is to consult your doctor before conceiving.

FAQs

Can PCOS be mistaken for endometriosis?

Yes, PCOS can be misdiagnosed as endometriosis and vice versa, but with the appropriate tests and procedures, they can be efficiently diagnosed by healthcare providers.

Is PCOS as painful as endometriosis?

In PCOS, you generally have irregular periods. With endometriosis, you face more pain, abdominal and lower back cramps, and digestive issues.

What does a PCOS belly look like?

Since weight gain (due to excess male hormones) is one of the symptoms of PCOS, it may lead to fat accumulation in the abdomen that may even look disproportionate to the rest of your body.

Experts

• Zoya Enakshi Ali, Reproductive Geneticist, Hertility Health, UK