What If You Have Both PCOS and Endometriosis?

pcos and endometriosisPCOS 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 PCOSSymptoms of endometriosis
hormonal conditioninflammatory disease
pain is not a symptompain is the main symptom
androgen excessnormal hormones
possibly heavy periodspossibly heavy periods
possibly long bleedspossibly long bleeds
bleeding between periodsbleeding between periods
infertilityinfertility

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.

Dr Lara Briden

52 thoughts on “What If You Have Both PCOS and Endometriosis?”

  1. Hey everyone,
    Reading everyone’s story’s I can relate to.
    I’m now 38 with a daughter of the age of 14 so blessed as told I couldn’t have children.

    My problems started at 17 out of no where, up till then I had normal periods I was a normal teenager.

    Just started my first job full time and things change.
    Weight gain, missed periods,spots, greasy skin,hair growth,up and down behavior then the pain started omg.

    In and out of hospital once or twice a month couldn’t move with the pain. It’s like someone with a knife in your lower half just turning and stabbing.

    The sad thing was no one believe me doctors family friends or work.

    It then started to play with my mental health and my relationship.

    I had scans after scans it went on just after I was 18 I beg the doctors to do more do they gave me key hole surgery to have a good look.

    Finally I got a answer.

    Polycystic ovaries and endometriosis I was covered they done laser surgery there and then.

    But my ovaries were bad.

    I got told I might not have children.

    Year later I was back and had another key hole this time they removed a massive lump of a build up of endometriosis.

    Year later the same in end I had five operations last one they said no more u have to have a hysterectomy I was 25 😟 on waiting on my appointment I had not had a period for 3 months which was normal for me but my mum and sister made me to a test.

    I was pregnant I found out I was 2 months gone.

    My story is don’t give up things do get better.

    Since having my daughter my pains are so much more manageable.

    I never thought I would be happy or normal like my friends and even thought of ending my life but I’m glad I didn’t.

    It’s a horrible illness that is not known more x

    Reply
  2. Hello I have PCOS & recently got diagnosed Endometriosis. Had lap for endo few days back, planning to conceive.
    What supplements should I take for both of the condition???
    Diet wise whay shoud I avoid to reduce estrogen excess & increase progesteron ??
    There’s lot of Info online asking to avoid walnuts, legimes , lentils , cucumber, kiwis , cinnamon. No ideas what to follow.
    Please help. Thanks in advance 😊

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  3. Just wondering if there are any side effects or cons to having surgery to diagnose endometriosis, if I’m planning to try for a baby in the near future? I was told I have PCOS following an ultrasound a few years ago.

    Reply
  4. Hi Lara,
    I really dont know if I have PCOS or what my case is.
    I have my 1st Transviganal Ultrasound last November 2019 and I have immature follicles, the OB prescribe metformin and follic acid for 2months, I take the meds, on February 2020, i have my 2nd TransV ultrasound, again my follicles are still immature for both ovarie, same medications were prescribed ans a glutathione. No other lab. Tests was done.

    I have regular period, monthly period. I do not know if I ovulate.

    I am trying to conceive.

    What do you advice.

    Thank you.

    Reply
  5. I am sorry to hear you have all 3 as well! Genetics, fun stuff. So I will say managing all 3 continues to be struggle. I cannot even imagine how hard it is with reactive hypoglycemia on top of everything else. I agree, I do feel better being gluten, dairy, processed food free as well. And yes, sugar is so hard to break!

    So it has been a brutal 1.5 years with 5 failed transfers, 5 retrievals. I’m tired of IVF.

    I wish you luck in your health journey, if you happen to find something that helps, let me know! I will say I feel much better on low dose natrexon (LDN). My joints stopped aching and i need to take it in the morning so i can sleep (it can cause insomnia). I’ve been trying to meditate and take a more holistic approach. I’m going to take a break from IVF and focus on eastern medicine (Chinese herbs and acupuncture) for a year or so. There is quite a bit of scientific literature showings its efficacy in pain management and improved fertility. If you ever try conceiving, i hope it is not a struggle for you. best of luck!!!

    Reply
  6. Having both is difficult! I had surgery, to remove my chocolate cyst on my right ovary that was the size of an avocado. It was so large that it was Shifting my uterus to push into my left ovary. In surgery, they confirmed stage 4 endometriosis and removed it all! They also discovered my left ovary to be taken over by groupings of chocolate cysts. Due to the severity, They placed in the mirena iud to prevent endometriosis from reoccurring. Now that I have that under control, it has been a battle treating the PCOS. I have done the metformin which didn’t work and I have been battling insurance for them to recover the insulin resistance ($700 per 90 day supply). I hope one day they can discover a cure for both that don’t negatively affect each other. This is not an easy journey.

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  7. Have you had a chance to try some gut health treatments? I think the gut connection with endometriosis is quite promising! Do you experience any digestive symptoms?

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  8. I have both and Endometriosis definitely needs attention first, you have to try to get as far ahead as you can, if that’s even possible with this disease.

    Reply
  9. Hello! Reading your posts and these commentsI am so interested- what is HA?

    I have been diagnosed PCOS (via blood test and symptoms) and deep infiltrating stage 4 endometriosis. I, like many others, went through a horrible process of testing bc pills and horomones to find things just getting worse. I am not able to have an excision surgery.

    I now am doing so-so on an anti inflammatory, natural, gluten/dairy/soy free diet, with a Mirena IUD and natural progesterone cream. The past few weeks I have been on one long, slow, unending period. Typically, I barely have periods at all, but then a few times a year get one so bad I wind up in the ER.

    I am so, so tired all the time lately. I tend to be happy and optimistic, but lately waves of depression and hopelessness hit full force out of nowhere. I feel thirsty and hungry all the time, but also too nauseous to eat much. I am dizzy at times from this tiredness and pain.

    What else can I do? I feel like I have tried everything but it always comes back!

    Reply
  10. I have both conditions and I don’t know what to do. Both diets for each condition suggest different things. I’m just trying out what will work because my stomach immediately bloats whenever I eat/drink something it doesn’t like. So far gluten and dairy and sugar are 100% irritants. Still testing out caffeine but am lowering my intake. I work at Starbucks so that part is so hard! Recently I’ve been racked with migraines so I’m trying to chill the inflammation. I’ve basically started eating a dairy-free keto diet. Thank you for writing this article. It’s hard to find anything about both conditions as they relate to each other. Doctors are no help. They have told me “well, you have lean PCOS so consider yourself lucky.” “It’s possible to have high estrogen AND high testosterone.” “Huh, you have high cholesterol but you’re only 15 pounds overweight… so just lose weight.” I take BC cos my periods without it debilitate me. Hopefully more research will be done. We need answers.

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  11. I was diagnosed with PCOS at age 16. Around age 18 I gained over a 100lbs in a year (combination of binge eating, depression, not knowing how to cope with an abusive relationship, being in college/unrestricted for the first time, no longer playing sports after having reconstructive knee surgery, etc) and proceeded to try to lose the weight for over 10 years before finally deciding to get the gastric sleeve. My bariatric surgeon explained that the part of the stomach they remove helps regulate hormones, so a lot of women with PCOS do well because it’s like a “biochemical reset”. Since the sleeve, my periods are relatively “normal” for the first time in my life, but now are incredibly painful. Way more painful than when my cysts were acting up, and the pain is in a different area. This statement: “As long as you had active PCOS or were on the pill, your estrogen was relatively low so endometriosis stayed dormant. As soon as you moved into healthy regular cycling, your estrogen went higher so endometriosis could activate.” is absolutely amazing to me! It’s the first time I’ve seen something like this because I’ve had this niggling suspicion the last few months that I developed endometriosis as a result of my weight loss surgery. But there is so little research done on this. Thank you for your input! I just moved to a new city and I have a gyn appointment in June. I look forward to exploring your website more.

    Reply
  12. Thank you for your information! I listend to a podcast and bought your book! About your request for comments about pcos and endometeiosis, here is my story: after coming off the pill (14-26) I did not get a period, after 6 months I was diagnosed “pcos”. I dont know if I really have it now… i am normal weight, had some acne, the “cists” but I don’t know the testresults on hormones.
    After another 6 months of denial and feeling broken, hoping it was not true we tried CLOMID. After 7 long cycles I was pregnant but miscarriaged. After that I dit not become pregnant, I dit IUI, and after some time (on my request) surgery to find out I hade DE endometriosis. We tried IVF and after that a major cleanup surgery. I had pain somewhere halfway clomid, it got worse with IUI. I had a difficult time choosing IVF first or cleanup surgery. Doctors and hospitals have total diffrent visions about endometriosis treatment… IVF did no good for my health and did not get me pregnant so I did the surgery. So yes, pain got worse after treatment for pcos.

    Can you please write about medical menopause? I had it two times for three months (Lucrin/decapeptyl). Last one before surgery, and I am so tired! I am on the pill again to not feel like a 60 year old. But I want to heal 🙂 and have a normol period 😉 so how?

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  13. Hi Lara! First off I read your book, period repair manual in like 2 days! I couldn’t put it down. I’m so excited to start the natural treatments. Basically I have been diagnosed with PCOS ( I think I may have the inflammatory type but I’m not 100 percent sure) and I’m on a combo pill. However just recently I have experienced intermittent pelvic pain daily and believe it to be deep infliterating Endo on my bowel even though my gyno does not suspect it (she thinks it’s gastrointestinal related). I am going to talk to Endo specialist to see what he thinks. In regards to the treatment, should I stop taking the birth control before possibly laparoscopic surgery and then heal that way? What is your advice? I’m still very young (22) but really want kids someday in the future. I’m just trying to be the most proactive about all of this! Thank you so much

    Reply
  14. This is very interesting! I seem to be bucking some the trends- with having Lean PCOS, normal TSH even tho i have Hashimotos, and endo. I have not heard of anyone having all three diseases at once.

    Two years I miscarried early in my second trimester, after trying again for a while, nothing. Having horrible cycles for the past 7 years, i thought nothing of it and just thought that was “normal”. I was eventually referred to an IVF clinic for the pain and infertility. It turns out I have stage III/IV endo, had a lap 4/2018. After going through 5 rounds of ART post-lap, I was then diagnosed with lean PCOS. As of 3/2019 I now have been diagnosed with Hashimoto’s disease, but with a normal TSH?!? So three diseases in one year. I’m 34, naturally slender (i try to gain weight!), and have been on an elimination diet my a naturopath acupuncturist recommended. No sugar. Nothing processed except unsweetened almond milk. No fruit or diary, no alcohol, very selective vegetables, and as much meat as i’d like. (Its like an even more extreme version of Keto). I’ve been on ubquinol, vitamin d3, b complex, prenatal, melatonin (at night), omega 3 fish oil. I was thinking about adding moringa powder. My question is: are there any supplements and types of foods that would help with all three? Each disease has its own “recommended” diet and i’m left feeling confused and isolated. Thank you! Celeste

    Reply
    • I have all three too! And it is so hard to figure out what to do. I haven’t gotten to the point of dealing with infertility- I can only imagine how much harder it makes this.

      I have “normal” TSH too. From my understanding,
      Hashimotos is diagnosed by having a higher than normal level of antibodies, which attack our thyroid and that over time the antibodies will impact thyroid function – potentially moving TSH and other thyroid hormones out of the normal range and leading to a diagnosis of hypothyroidism. Basically the antibodies haven’t done enough damage yet to impair our thyroids to the point that we fall outside the average range of the normal population – but quite likely it has changed our levels to be outside what was normal for us prior to having Hashimoto’s (though apparently at first, it might actually change them in the opposite direction as our bodies try to overcompensate). I believe it is in our cases called “sub-clinical” – nothing to treat yet in conventional medicine.

      I’ve had endo since mid-teens (officially diagnosed at 26 by surgery) and the pain has been horrendous. It led to leg pain that was actually worse than any of the pelvic pain and went from being cyclical to almost daily, along with spotting. My doctor put me on an estrogen patch and I didn’t bleed for a year and a half – it was the most amazing year and a half since I was 14. But then PCOS came on and I guess my body was converting all that estrogen into testosterone. I lost so much hair, 4 inches of length – everyone asked me for months if I’d gotten a hair cut. It was devastating. At that time (about a year ago) as I was trying to figure out what was happening, I was also diagnosed with hashimotos- and now I’m here with all three too.

      I’ve since tried to just be on my mirena IUD but the pain is so high and the hair loss was still bad. The pill makes both a little better but the pcos symptoms are still not great. Everything in the literature about improving pcos says to not do the pill though but I’m afraid I’ll go back to the constant pelvic and leg pain if I stop taking it. Making the choice between hormonal health and being pain has been especially hard. I’d love to do things the natural way but the stabbing pain in my pelvis and burning pain on my thighs likes to try to persuade me otherwise.

      To add to all that, I have extreme reactive hypoglycemia (if I have sugar, my body releases too much insulin and my blood sugar quickly crashes, to a level where the lab had to double check that they didn’t make a mistake) – there is *some* literature around this and pcos but very little and it is very confusing. I’ve been told by two doctors though that metformin and inositol (the two things that it seems most recommended for pcos!) are not right for me as I shouldn’t have my cells taking up any more glucose than they already do. So I’m utterly confused now!

      Anyway, my original intention for this message was to tell you that you’re not alone with this wonderful trio of health issues but apparently I have used it to vent too! It is confusing and difficult when recommendations for one of the three doesn’t take into consideration the other two and there is nothing out there to answer the question of what to do in our case. It sounds like you’re doing one of the best things by following the diet you are – I am trying! Have been gluten free for years and try to avoid dairy and sugar but it feels like I’m addicted at times :/ I hope you get some answers. Good luck!

      Reply
  15. Hi Lara,

    Would you say that low LH and high FSH (almost a 1:3 ratio) would constitute as HA?

    I lost my period 4 years ago after a phase of overtraining/restrictive eating so I was put on the birth control pill. Since then, I have gained about 25 lbs., but I never stopped exercising, and I was probably still not supplementing my activity levels with enough calories/carbohydrates during some of that time. I stopped taking the pill in December and still haven’t gotten a period. The last blood tests I took still showed low estradiol, low progesterone, low LH, high FSH and normal testosterone.

    Thanks!

    Reply
  16. How does Vitex interact with Endometriosis? I’m now suspecting my 16 year old has endo. Painful periods, Urinary infections around period, fatigue, very heavy period, etc. She has been on vitex per her functional medicine doctor for 5 months in an effort to help her period. I’m worried that maybe she shouldn’t be on it. I know you don’t like children uner 18 on vitex normally but I ran this by my functional medicine doc and after researching she felt it was okay to put her on it.

    Reply
  17. I am reading Period Repair Manual and wish I had read it years ago. I’m now 42, on the Mirena IUD for over a year to treat very heavy and irregular periods, and on Spironolactone (Aldactone) for hormonal acne, hair loss, and hirsutism. I have PCOS. I feel that the IUD and Spironolactone have worked well for my symptoms but I don’t want to take Spiro forever. I also feel as though these hormonal treatments have somehow interfered with my estrogen and progesterone levels, as my hair loss seemed to worsen after the IUD. After Spiro I now have symptoms of low estrogen. She prescribed an estrogen cream, but I’m wondering if that’s my best option. My gynecologist insists that since the IUD hormones are absorbed locally, and neither the IUD or Spiro contain estrogen, that these are not the culprits and that it is just due to my age. I should note that when I was on the birth control pill I also experienced very low estrogen, but again, my doctor says that’s because the pill contains estrogen. It just seems odd to me that the symptoms related to low estrogen came on so suddenly, and soon after starting Spiro. Thinking of going off Spiro for now and taking myo inositol with d chiro inositol, magnesium, and zinc? Do you have general recommendations for weaning off this medication, and/or taking out the IUD and minimizing the risk of the symptoms coming back full force?

    Reply
  18. Hi Lara, I so appreciate the important work you’re doing to help women achieve good health using their periods as a barometer. I have a question for you about obstetric cholestasis. I have 4 children and discovered recently (starting with developing impaired glucose tolerance during my 4th pregnancy) that I have insulin resistant PCOS. This was a big shock to me as I am quite thin and don’t have severe acne or hirsutism. I have always had very irregular periods though, which FAM practitioners told me was probably due to being very thin (naturally, no dieting) or stress. No one ever suggested PCOS, which I think was because I don’t “look” like a stereotypical PCOS sufferer. After realizing what is going on, I am now taking magnesium, zinc, inositol, vitamin D, B complex per your book, and working on my diet for the last 6 months.

    Anyways, in my last pregnancy I developed obstetric cholestasis toward the end. Itching ceased upon delivery. I am now 17 months postpartum and in the luteal phase of my 3rd pp cycle, and have developed itching again. Apparently high progesterone levels in the luteal phase can cause cyclical itching in some women who’ve had obstetric cholestasis. I am somewhat horrified that my body isn’t handling this most essential hormone. Do you have any thoughts on how to address this? Do you have any thoughts on how to address the risk of obstetric cholestasis in another pregnancy? Many thanks.

    Reply
  19. I am reading your book right now! I went to the doctor today and contacted my doctor back home in the States and they both believe that I have endometriosis. The symptoms were covered up by birth control for 12 years until I finally got off it.
    My question is: my insurance won’t cover the surgery to medically confirm it’s endometriosis in Australia and I won’t be returning to the US until possibly Christmas where I would be fully insured. Do you recommend trying to get the surgery to check it here sooner rather than later or can I possibly focus on diet changes like eliminating gluten, dairy, eggs, and meat right now and hope they at least brings down the inflammation I’ve always had until I return home?

    Reply
    • Yes, many of my patients use natural treatments (dairy-free plus zinc plus N-acetyl cysteine) to tide them over until their surgery.

      It may also reduce the lesions and inflammation which is a better way to go into the surgery.

      Reply
  20. Hi Lara!
    I’ve been listening to your new book and am loving it! Very helpful information. This post peaked my interest bc I’m kind of all over the place with symptoms. I stopped the pill April 2018 hoping to feel better and I feel like it has unleashed some underlying issues. I have “regular” periods, meaning they come every 28/29 days but they are heavy with lots of clots and last 7 days. Bleeding stops for 2-3 days and then I spot up until I see CM but it is also always bloody. I do see the CM every month tho. Cramping is there but not severe however I’ve had really bad lower back pain & sharp pains with sex (not all the time) but both worsen around my period and ovulation. Pain/cramping during ovulation also seems worse than my period. I also get constipated and have major bloating around both events…I will look 4/5 months pregnant! I’m in the process of trying to track ovulation closer (taking temp. and testing LH) to see if I’m actually ovulating…tbd. This all makes me think it’s endo (my mom had a full hystorectomy at my age – 36). I’ve had bloodwork and ultrasound – everything seems normal. Doctor suggested taking out my uterus or doing uterine ablation and laparoscopy for endo…I’m not a fan of any of those ideas bc I still don’t know if it’s endo for sure. Is the laparoscopy surgery the only way to find out? On the other hand, I also have hirsutism, hair loss, acne, bad headaches around my period, muscle aches, weight gain (gained about 15 lbs in 6 months after coming off the pill…I struggle to lose it and my weight can fluctuate 4/5 lbs overnight! This makes me think maybe it’s PCOS. I’m at a loss and don’t know where to start but I definitely don’t want to remove my uterus unless absolutely necessary! I have started a clean Keto diet (no dairy for a month) and a higher carb allowance and trying to adhere to the 16/8 eating window. I’m hoping this will help but I’m unsure of whether to have the laparoscopy surgery done or what to do?? I’ve been to several doctors and they all just want to put me back on the pill, not trying to find the root cause or saying it’s just what happens when we get older. I refuse to believe I should be feeling this bad 2-3 weeks out of the month at 36!!! I do have 2 beautiful children and am done having kids so I’m not as concerned about I fertility as I am just feeling better!!

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  21. Dear Lara,

    I wonder if you could help me. I’m 37 years old, dealing with endometriosis (have had it undiagnosed for years) and am trying to get pregnant. I’ve been to several fertility specialists. I did two rounds of IUI and one round of IVF all failed. the IVF failed to yield any embryos. I had one huge follicle that they ended up finding out was empty. but i did have 7 follicles when they did the ultrasound. I think i was overstimulated by the fertility drugs because i ended up with a 10 mm endometrioma.

    My doctor prescribed depot lupron injection 11.25 mg in one shot. i took it and it shrank the endometrioma to 1 mm. it was supposed to last 3 months, after a month i got my period and it stopped working. the doctor prescribed me another dose of lupron and i didn’t take it. I’ve had enough. i came across vitex and started to take 400 mg of it. I should mention i have celiac disease and hashimotos disease (on .75 of synthroid and my Tsh is stable)

    My question is, can the vitex work for me? I really am tired of the IVF drugs. I also don’t want the dr. treatments anymore. a year ago as part of the process i had a laparoscopy and they removed a fallopian tube. i now have one tube. the dr says that i could get pregnant naturally. i believe i will. I pray a lot. I believe that the solution for me should be a natural one and i have spent too much time on modern medicine.

    Can the vitex help with the endometriosis?

    thank you for your assistance,

    Essie

    Reply
    • Short answer: No, Vitex is not particularly helpful for endometriosis. Mainly because endometriosis is not a hormonal condition.
      You’ll want to take a look at the treatments I discuss in Period Repair Manual.

      Reply
  22. Hello Lara. I am just wondering if there is anything that can help decrease belly fat? I have lost ten lbs so far being more active and changing my diet, but none of it was belly fat and I don’t really need to lose fat anywhere else. I have adrenal PCOS and a quality multi vitamin by pure encapsulations did not improve symptoms or weight loss. The last time I lose 20 lbs before I gained it all back, my body composition didn’t charge and I still had excess fat around my abdomen. A lot actually. Any advice on how to combat this? Thank you so much.

    Reply
    • are you 100% sure it’s belly fat? And not digestive bloating or distension? Just checking because I’ve had many patients think it’s fat and actually it’s bloating…

      Reply
      • Yes, I’m sure it’s fat. Hormonally, I have high androgens and cortisol. When I try to low carb I end up wanting sugar and feel like I’m missing something. But when I eat balanced ie a meal of eggs, beans, spinach, avocado I’m not really losing weight either. Weight loss is so slow for me and nothing wants to come off of the belly area when I lose weight. I have a lot of love handles and back fat too. Wondering if anything can help. I am 5’6” and 153 lbs and most of the fat is in my mid section. I appreciate your help tremendously.

        Reply
        • Have you tried intermittent fasting? I have had life long issues with losing weight but have had the most success with cutting out sugar, and also intermittent fasting (pick an 8 hour window to eat during the day, and only black tea, coffee, and water outside that window basically). Good luck.

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  23. I had both but was only diagnosed with pcos initially. I was asking the dr why I was experiencing pain with pcos, but she just brushed it off saying that I was thin and therefore there was nothing much wrong with me.

    I eventually got diagnosed with Endo when I moved abroad and then went through years of infertility after the Endo was removed by surgery. Ivf didn’t work at all, in that the drugs didn’t work and I wasn’t producing eggs. The higher the dose or drugs, the worse the result.

    It was only a desperate attempt to defy the drs who refused to do more Ivf and told me I had a 1% chance of conceiving naturally that allowed me to conceive my children naturally. It was natural remedies such as diet, supplements and Chinese medicine (a real all out approach), along the lines of what you recommend, and it worked, twice. My fertility dr was amazed. I have read that people have both pcos and Endo tend to be very thin, and therefore can be misdiagnosed by drs who expect the patient to be carrying some weight with the conditions. It was the case for me. I actually gained weight after Endo surgery and management, possibly because the pcos is not so under control. More gps need to be educated about the possibility of having both.

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  24. Hi Lara, great article. I’m still trying to wrap my head around it all because I feel doctors just rush through everything. I have had Endo since I was 17 (at least diagnosed) I am now 32. 1 year ago was diagnosed with PCOS and lost one ovary during surgery to clear endo and cysts. I am married with no children yet but honestly haven’t been trying so don’t know if it’s possible. I’m overweight for my height I should be 35
    Kg lighter at least and have Insulin resistance and am
    on metformin. I have every side effect known to these conditions and am quite down about it and struggling to lose weight. Any suggestions? I don’t know where to start. Thank you 🙂 Kat

    Reply
        • The complicated thing is that pill masks PCOS and also worsens PCOS because PCOS is a hormonal condition and the pill shuts down hormones. The pill can also worsen the insulin resistance that underlies most PCOS.

          I should have put that in the post. For anyone who has had to resort to the pill for endometriosis, the whole PCOS side of things becomes masked and steadily worsening and difficult to treat naturally. (Although you can still work on reversing insulin resistance. Read Reverse Insulin Resistance in 4 Easy Steps.)

          Many of my patients opt for natural (non-pill) treatment for endometriosis and therefore have the opportunity to also correct the hormonal imbalance that is PCOS.

          I hope that helps. I may try to word it a bit more concisely and add it to the post.

          Reply
  25. Thank you for the great article! I wonder if supplementing with bioidentical estrogen after menopause may cause endo to return? Thank you!

    Reply
    • unfortunately, yes. But that can be prevented by using a very low dose AND by 1) treating endometriosis with the treatments discussed in the treatment post, 2) reducing histamine intolerance and 2) taking natural micronized progesterone together with estrogen. All of those treatments have an anti-endometriosis effect.

      My basic philosophy is that by treating the inflammatory aspect of endometriosis and therefore making it less likely to flare, women can then enjoy the benefits of estrogen (their own estrogen, or possibly low-dose postmenopausal estrogen supplementation).

      Reply
  26. Can you have endo without pain, but irregular spotting? I’m 31 and had severe period pain when I was young, then I went on the pill for ten years and went off 18 months ago. Since then i’ve had no pain but spotting every month one week before my period. They thought it was polyps and two were removed a few months ago but the spotting continues! I also have a cyst. Could it be endo?? Please help!

    Reply
    • Yes, possibly…
      But there are other causes of spotting including anovulatory cycles, underactive thyroid, low progesterone, and more. Are you sure you’re ovulating?

      Reply
      • Thank you, yes I believe I am as I read your book and requested a progesterone test on day 21 and it was in the optimal range. My cycle is 27 days every month. My thyroid was also checked and was normal. I do have celiac disease so I feel like cytokines are an isssue. The spotting is so frustrating as I feel like I have to deal with blood half of the month!

        Reply
        • I have the exact same issue. I consulted with Lara but was not keen on her suggestions to alter my high carb vegan diet. It’s now years later and I have changed my diet but am still experiencing spotting (brown colour) for a week before my period. I am considering consulting with Lara again to try and resolve this.

          Reply
  27. Lara, thank you for this article. I’ve been successfully reversing PCOS, but on other hand I’ve been noticing more endometriosis pain. I declined the surgery due to my determination to let the body heal itself with my loving care and understanding. What I believe helped me with the PCOS remission is age (I am 34 now), being on Vitex for 3 months, chemical free household & cosmetics, not eating much animal products and quitting my highly stressed job. I am sooooooo excited that the hirtuism has been improving.
    As stated in this article, the endo pain came around the same time when I noticed all the PCOS improvements. However, it seems the endo pain went away after a few months. And last thing, I just started using natural progesterone to help with the transition. I’ll see how it goes in the future.

    I just received your book Period Repair Manual, so much good information in it!!!!!!!

    Reply
    • thanks for sharing your story. Yes, you are the reason I wrote this post! (you and other women experiencing the same pattern of endometriosis emerging as healthy cycles kick back in.)

      If the pain has gone away again, you hopefully should be ok…

      Reply
      • It got to the point where my pelvic area started hurting right after ovulation and stopped after menstruation. Only a few good days in my cycle 🙂 I couldn’t function in my daily live. Never felt this way.

        The pain has been gone for a few months. Now I am left with larger blood clots. I am hoping it’s a part of the process. Thank you Lara for everything you do.

        Reply
  28. I have two lap sx for endo. Was on trial elagolix years ago and most recently Lupron for 6 months. I don’t want to have surgery! My next step is Trying NAC. How much do you recommend? I read a study that used 600mg 3x day for 3 days on a row, then off 4 days. I was going to try that. Apparently there are not a lot of side effects of NAC.

    Reply
  29. I’m curious as to how endometriosis is diagnosed. I’ve been wondering if I have both for a while as pain (I pass out) is my main symptom.

    Reply
    • If you have an endometrioma or DIE (deep infiltrating endo), than a skilled eye can pick up the endometrioma and/or deep infiltrating nodule(s) on imaging.

      However, it is more common to have superficial endo throughout the peritoneum, cul-de-sac, and bowel, and that typically does not show up on ultrasound. Unfortunately, the only way to definitively diagnose endo is by taking a specimen during lapascopic surgery, and having it test positive in pathology.

      I was just laparoscopically diagnosed with endo and adeno a few months ago. I saw two surgeons who specialize in endo, and they both strongly suspected it based on my symptoms and exam. Pathology confirmed their strong suspicions

      Reply

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