With women becoming more open about their health struggles across social media, you’ve most likely heard one or both of the terms polycystic ovary syndrome (PCOS) and endometriosis – or even know someone who struggles with one of these conditions.
But while PCOS and endometriosis are the two reproductive conditions that get the most attention (even though incredibly tough to diagnose), it can be easy to confuse the two if you don’t know enough about them.
While both PCOS and endometriosis have some characteristics and symptoms in common, they’re not the same. Polycystic ovarian syndrome is a hormonal disorder, affecting 8–13% of reproductive age women, with around 21% of Indigenous women affected, according to The Medical Journal of Australia. Endometriosis is slightly more common, impacting 1 in 7 (14%) of women, girls and those assigned female at birth (AFAB) by the age of 44 to 49, according to Endometriosis Australia.
Both conditions are notoriously tough to diagnose, given that their symptoms could be caused by a range of different issues. That doesn’t mean it’s impossible for a doctor to make the right diagnosis—it just can take a little more time and detective work than with some other conditions.
Here’s what you need to know about the differences between PCOS and endometriosis.
What is PCOS?
Calling PCOS ‘complex’ is kind of an understatement. In fact, a definition has only just been officially agreed on. We’re talking about a multisystem syndrome with reproductive, metabolic and emotional implications. At the highest level, PCOS is a health problem caused by an imbalance of reproductive hormone. That hormonal imbalance creates problems in the ovaries, which make an egg that’s released each month as part of a menstrual cycle. When you have PCOS, the egg might be develop the way it should or it might not be released during ovulation.
The most common PCOS symptoms
1. Irregular periods
2. Excess hair growth on the face, chest, abdomen, or upper thighs
3. Severe acne, or acne that doesn’t respond to typical treatments
4. Oily skin
5. Patches of thick, velvety, darkened skin
6. Ovarian cysts
What is endometriosis?
During a normal menstrual cycle, the lining of your uterus thickens and then sheds when a fertilised egg doesn’t attach, resulting in your period. But when this lining starts to grow outside of the uterus—like on your ovaries or inside the pelvic cavity—it becomes inflamed, grows, and essentially has nowhere to go, says Ghadir. The result is severe pelvic pain, usually during your period, along with significant scarring to the surrounding tissue. It may also lead to large cysts on your ovaries called endometriums, which are filled with endometrial fluid. And sadly, doctors still aren’t sure what causes the disease, though they know estrogen plays a role.
The most common endometriosis symptoms
1. Chronic pelvic pain, especially before and during your period
2. Pain during sex
3. Pain when you poop
4. Pain when you pee
5. Heavy bleeding during your period
*Worth noting: Many women with endometriosis don’t have symptoms
What are the key differences between the two conditions?
Both endo and PCOS can be painful, and make it difficult to fall pregnant depending on how severe the conditions are. They both need long-term symptom management often involving several different health specialists such as gynaecologists, dieticians, endocrinologists, and a psychologist.
When it comes down to the differences, a lot of it comes down to symptoms, Christine Greves, MD tells Women’s Health. “Typically, if you have a lot of pelvic pain, that would make me think that you might have endometriosis,” she says. “But irregular bleeding tends to be more of a sign of PCOS.”
It’s true that people with PCOS can also experience pelvic pain, Dr. Greves points out, but “it’s not typical pain associated with periods, like patients who have endometriosis experience.”
Ultrasounds can also be used to help diagnose both conditions, which look different through imaging: with PCOS the ultrasound would pick up multiple cysts, however if there is a cyst with endometriosis, it will be usually one and have characteristics different than PCOS.
The only way to know if a woman definitely has endometriosis is through a surgical procedure called a laparoscopy, where a fiber-optic instrument is inserted through the abdominal wall to view the organs in the abdomen, per ACOG. PCOS, on the other hand, is usually diagnosed through a pelvic exam, ultrasound, and blood work.
How do I know if I have PCOS or endometriosis?
A good indicator would be monitoring your period and pain levels. “Track periods for regularity and also pain to help determine possible differences that will help a doctor pinpoint which one it might be,” Jessica Shepherd, MD, an ob-gyn tells Women’s Health. If you regularly have intense pain leading up to your period and during it, it could be a sign you’re dealing with endometriosis, she says.
But, if your periods are irregular, and you’re dealing with the other symptoms listed above, it could be PCOS. Either way, your GP will most likely offer a pelvic exam, blood work or an ultrasound.
Can you have both PCOS and endometriosis?
While not common, it is definitely possible. Having one does not increase the chance of having the other, but one is also not protective of the other, meaning that having PCOS won’t keep you from developing endometriosis, and vice versa.
