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Medically Reviewed By:

Dr. Amanda Olson, DPT, PRPC
President & Chief Clinical Officer

Endometriosis vs PCOS: What's The Difference?

Endometriosis and polycystic ovary syndrome (PCOS) are both conditions that occur in women during the childbearing years and primarily involve hormone imbalances.

Both conditions can also affect the reproductive organs, cause irregular menstruation, and lead to difficulties getting pregnant. However, each condition also has exclusive symptoms and different treatment options. 

Understanding the difference between these conditions can help women to recognize the unique symptoms of each and pursue the correct treatment.    

What Is Endometriosis? 

Endometriosis is when the tissue similar to that usually lines the inner uterus (called the endometrium) grows outside the uterus. This endometrial-like tissue can grow on the ovaries, fallopian tubes, and other pelvic organs like the bladder, bowel, intestines, and rectum. 

Like the inner lining of the uterus, endometrial-like tissue outside the uterus reacts to hormone fluctuations during the menstrual cycle – swelling during ovulation then breaking down and bleeding during menstruation. For many women with endometriosis, this can result in chronic pelvic pain and worsened cramping & bloating before and during menstruation. 

Unlike the endometrium, the bleeding from endometrial-like tissue outside the uterus does not leave the body during menstruation. Instead, it forms scar tissue, lesions, cysts, and adhesions on pelvic organs. The build-up of this scar tissue often results in infertility, painful bowel movements, and pain during sex. 

What Is PCOS?

Polycystic ovarian syndrome (PCOS) is a hormonal disorder that causes the ovaries to overproduce male sex hormones known as androgens and underproduce female hormones like estrogen and progesterone. This hormonal imbalance affects the production and release of eggs from the ovaries, often resulting in anovulation, where ovulation does not occur, and missed periods. 

That said, while many women with PCOS do not menstruate very often, others experience prolonged periods. Additional symptoms include enlarged ovaries, the growth of cysts on the ovaries, infertility, insulin resistance, weight gain, hormonal acne, baldness on the head, and excess facial or body hair.

What's the Difference Between Endometriosis and PCOS?

While both conditions affect the reproductive system, endometriosis is characterized by the growth of endometrial-like tissue outside the uterus, leading to pain and potential fertility issues. PCOS, on the other hand, is a hormonal disorder that can cause irregular menstrual cycles, changes in physical appearance due to excess androgens, and fertility problems. The treatment and management strategies for each condition are different and tailored to the specific symptoms and needs of the individual.

How Are Endometriosis and PCOS Diagnosed?

Although it can sometimes take years due to the underreporting of symptoms and the similarities with other conditions, the only sure way to diagnose endometriosis is with a surgical procedure known as laparoscopy. Typically performed to diagnose and treat endometriosis at the same time, laparoscopy allows surgeons to identify endometrial implants growing outside the womb and remove them during the same procedure. 

That said, medical treatment can be prescribed to alleviate the symptoms of endometriosis without performing laparoscopic surgery. This would typically be concluded based on a patient’s symptoms and family history combined with a pelvic exam, blood test, and imaging tests.

Symptoms like irregular menstruation, the existence of excess facial or body hair, and baldness can indicate high levels of androgens that are typical of PCOS. A pelvic exam or ultrasound would then be used to confirm enlarged ovaries or ovarian cysts which are also usual with PCOS. 

Treatment for Endometriosis

There is no cure for endometriosis. However, several treatment options ranging from over-the-counter pain medication and hormone therapy to surgeries like laparoscopy and hysterectomy, can help to manage symptoms. 

Pain Medication & Hormone Therapy

The first line of treatment for endometriosis typically starts with pain medication to alleviate pelvic discomfort and hormone therapy to regulate or stop the menstrual cycle and alleviate additional symptoms.  

For women hoping to start a family, hormone contraceptives could hinder their chances of getting pregnant. Other women might not be candidates for hormone therapy that raises estrogen levels due to an increased risk of breast cancer, uterine cancer, blood clots, cardiovascular disease, or loss of bone density. In these cases, progesterone-only therapy could help regulate menstrual cycles and relieve symptoms. 

When considering hormone therapy, it is best to discuss all options and possible side effects with your healthcare practitioner.  

Physical Therapy

For women who need or wish to avoid hormone therapy, pelvic physical therapy can be incredibly helpful in relieving the pelvic pain, cramping, and bloating experienced with endometriosis. Two medical tools designed to relieve pelvic pain are also highly recommended by physical therapists to manage endometriosis flare-ups at home. These are known as pelvic wands and vaginal dilators.    

Surgery 

For women with severe endometriosis who have not found relief from pain medication, hormone therapy, physical therapy, or the regular use of pelvic wands and vaginal dilators at home, surgery is often the next step. 

Many women find relief from endometriosis symptoms after laparoscopic surgery, although statistics show that 20% of women feel no relief after surgery and 40% are known to experience recurring symptoms within five years. For this reason, women with severe endometriosis who no longer hope to get pregnant often opt for a hysterectomy. 

When it comes to a hysterectomy, medical research reveals that removing the ovaries at the same time as the uterus is the most effective type of hysterectomy when seeking relief from endometriosis symptoms.  

Treatment Options for PCOS

Similar to endometriosis, there is no cure for PCOS, however, several treatment options can help manage the symptoms. 

Hormone Therapy & Medication

Hormone contraceptives, for example, can help to balance hormone levels, regulate periods, and reduce hormonal acne. Medication can also be prescribed to reduce excessive hair growth on the face and body, and treat baldness. 

Diet & Exercise

Diet is frequently addressed with PCOS patients. Limiting refined carbohydrates, starchy foods, and sugar can minimize the insulin resistance and weight gain often symptomatic of PCOS. Regular exercise at least three times per week is also recommended to manage weight gain, improve infertility, and alleviate the depression sometimes experienced with PCOS. 

Inositol Supplements

A natural supplement that incorporates a combination of Myo and D Chiro Inositol in supplement form has proven helpful in influencing insulin use and regulating brain hormones such as serotonin and dopamine. The regulation of these hormones, in addition to improving the use of insulin in the body, has several benefits for PCOS patients. 

According to studies, a regular Myo and D Chiro Inositol supplement can help to rebalance male hormone levels, clear acne, improve ovarian health & fertility, prevent diabetes, and improve moods. 

Diabetes Medication & Fertility Treatment 

In extreme cases of insulin resistance leading to obesity, diabetes medication is recommended. Fertility drugs are often administered to women with PCOS who are hoping to get pregnant. 

Surgery

If symptoms don’t improve with the help of the above-mentioned treatment options, ovarian surgery is often the next medical step. 

Conclusion

Endometriosis and PCOS have similar symptoms as well as symptoms that are unique to each condition. Both can gravely impact the quality of women’s lives, but patients often refrain from discussing their symptoms due to shame or privacy reasons. Although there is no cure for either, both conditions can be managed through a combination of medical and natural treatments. 

If you suffer from irregular menstruation, heavy and painful periods, ongoing pelvic pain, unexplained weight gain, or difficulties getting pregnant, speak with your healthcare practitioner about the differences between endometriosis and PCOS. The sooner you understand the symptoms of each condition, the sooner you can start treatment to manage the one affecting you.    

References 

World Health Organisation – Endometriosis - https://www.who.int/news-room/fact-sheets/detail/endometriosis

Johns Hopkins Medicine – Polycystic Ovary Syndrome (PCOS) https://www.hopkinsmedicine.org/health/conditions-and-diseases/polycystic-ovary-syndrome-pcos

National Library of Medicine - Endometriosis and polycystic ovary syndrome are diametric disorders - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8288001/

National Institute of Health – What Causes PCOS - https://www.nichd.nih.gov/health/topics/pcos/conditioninfo/causes

Journal of Reproductive Healthcare and Medicine - Role of genetic, environmental, and hormonal factors in the progression of PCOS: A review - https://jrhm.org/role-of-genetic-environmental-and-hormonal-factors-in-the-progression-of-pcos-a-review/

National Center for Biotechnology Information - Effects of Inositol(s) in Women with PCOS: A Systematic Review of Randomized Controlled Trials - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5097808/