PCOS is the hormonal condition of having excess androgens or male hormones. Endometriosis is an inflammatory disease that causes pelvic pain. They’re two very different conditions but they’re also both quite common. That makes it relatively easy to have both PCOS and endometriosis at the same time.
Here’s how to differentiate the symptoms of PCOS from endometriosis and where to start with treatment if you have both conditions.
PCOS is a hormonal condition that causes facial hair
PCOS is the condition of androgen excess when all other causes of androgen excess have been ruled out.
It may or may not present with “polycystic ovaries” on ultrasound but that finding means almost nothing. Why? Because polycystic ovaries are not ovarian cysts. They’re not abnormal structures like, for example, a large functional cyst. Instead, they are follicles or eggs, which are normal for the ovary. Young women have more eggs (up to 25 on each ovary) but that does not mean PCOS. Read Polycystic ovary syndrome cannot be diagnosed by ultrasound.
Also, pain is not a symptom of the hormonal condition PCOS so, if pain is your main symptom, there’s something else going on.
Endometriosis is an inflammatory disease that causes pain
Endometriosis is an inflammatory disease that causes pain and lesions and a type of ovarian cyst called an endometrioma or chocolate cyst. Endometriosis is affected by hormones but is not caused by hormones or hormone imbalance. Hormones are usually normal with endometriosis.
If you suffer severe pain, you should be assessed for endometriosis. That’s true even if you’ve already been told you have PCOS. Endometriosis cannot be ruled out by ultrasound. Read When period pain is not normal.
PCOS versus endometriosis
Here’s how to compare and contrast the symptoms of PCOS and endometriosis.
|Symptoms of PCOS||Symptoms of endometriosis|
|hormonal condition||inflammatory disease|
|pain is not a symptom||pain is the main symptom|
|androgen excess||normal hormones|
|possibly heavy periods||possibly heavy periods|
|possibly long bleeds||possibly long bleeds|
|bleeding between periods||bleeding between periods|
As you can see, the only symptoms the two conditions have in common are heavy periods, bleeding between periods, and infertility but for very different reasons.
With PCOS, abnormal bleeding and infertility are due to problems with ovulation and the solution is to restore ovulation.
With endometriosis, abnormal bleeding and infertility are due to the inflammatory disease process in the pelvis and the solution is to reduce inflammation.
If you have both endometriosis and PCOS, start with endometriosis
Treat endometriosis before PCOS because 1) endometriosis is a more serious disease and 2) treating PCOS before you treat endometriosis can increase estrogen and worsen endometriosis.
Possible treatments for endometriosis include surgery, dairy-free diet, low-nickel diet, zinc, turmeric, and N-acetyl cysteine. Read Immune treatment for endometriosis.
Once you’ve treated endometriosis, you can turn your attention to finding treatment for your type of PCOS and treating that. Of course, treating PCOS is only possible if you’re not on the pill.
Ask me in the comments.