Endometriosis Vs PCOS: Experts Explain The Key Differences

Endometriosis and Polycystic Ovary Syndrome (PCOS) are two common but different conditions. While both conditions affect women’s reproductive health and impact the menstrual cycle and fertility, their causes, symptoms, and treatments vary significantly. This article will explain the differences between endometriosis and PCOS. Keep reading. 

To get a better understanding of this, the editorial team of OnlyMyHealth reached out to Dr Chetna Jain, Director, Department of Obstetrics and Gynaecology, Cloudnine Group of Hospitals, Sector 14, Gurgaon and Dr Ritambhara Bhalla, Associate Director - Department of Obstetrics and Gynaecology at Cloudnine Group of Hospitals, Chandigarh.

Endometriosis vs PCOS: Causes And Symptoms

To understand whether what you are struggling with is endometriosis or PCOS, Dr Bhalla compares their causes and symptoms. Let’s take a look.

Causes

Endometriosis: It iscaused by the growth of endometrial-like tissue outside the uterus (on the ovaries, fallopian tubes, and pelvis). It is oestrogen-dependent and linked to inflammation and immune factors.

PCOS: A hormonal disorder characterised by excess androgens (male hormones), insulin resistance, and irregular ovulation.

Symptoms

Endometriosis:

• Severe pelvic pain (especially during periods).
• Pain during intercourse.
• Painful bowel movements or urination.
• Heavy or painful periods.
• Infertility.

PCOS:

• Irregular or missed periods.
• Weight gain.
• Acne and oily skin.
• Excess facial/body hair (hirsutism).
• Hair thinning on the scalp.
• Difficulty conceiving due to irregular ovulation.

ALSO READ - Laparoscopic Ovarian Drilling For PCOS: All You Need To Know

Endometriosis Vs PCOS: How They Impact Period And Fertility

Now that we know how each of their symptoms and causes differ, let us take a deeper look into how they impact period and fertility, as shared by Dr Bhalla:

Period Patterns

Endometriosis: Periods are usually regular but very painful and sometimes heavy.

PCOS: Periods are irregular, infrequent, or absent.

Fertility Impact

Endometriosis: Affects fertility due to adhesions, inflammation, and damage to pelvic organs.

PCOS: Affects fertility due to a lack of ovulation.

A 2021 study, published in the ‘International Journal of Environmental Research and Public Health’, highlighted some differences between the two conditions. The study noted that women seeking care for PCOS are usually much younger, averaging 25 years old, and often visit doctors during the spring. Women diagnosed with endometriosis are generally older, averaging 38 years old, and they seek treatment during the winter. The researchers added that women with PCOS require more frequent doctor visits as they age, while endometriosis patients need fewer doctor visits with time. 

Endometriosis Vs PCOS: Know Their Diagnosis And Treatment

On this note, Dr Bhalla sheds light on the diagnosis and treatment options for endometriosis and PCOS:

Diagnosis 

Endometriosis: Ultrasound/MRI; laparoscopy (keyhole surgery) is the gold standard for confirmation.

PCOS: Diagnosed based on clinical symptoms + blood tests + ultrasound; Rotterdam criteria (irregular cycles, high androgens, and polycystic ovaries).

Treatment

Endometriosis:

• Pain management (NSAIDs).
• Hormonal therapy.
• Surgical removal (laparoscopy) in severe cases.

PCOS:

• Lifestyle changes (diet, exercise, and weight management).
• Hormonal pills to regulate cycles.
• Medications for ovulation, if trying to conceive.

Endometriosis Vs PCOS: Key Differences (as shared by Dr Jain)

Endometriosis Vs PCOS: Expert Shares Long-term Risks

What about the long-term risks associated with endometriosis and PCOS? Dr Bhalla lists them for us:

• Endometriosis: Chronic pain, adhesions, and rare risk of malignancy.
• PCOS: Diabetes, metabolic syndrome, heart disease, and endometrial issues.

As per a 2022 study, published in the ‘Journal of Reproduction and Infertility’ (JRI), endometriosis and PCOS are complete opposites on the reproductive health spectrum. Both of these conditions are linked to the women’s reproductive system; however, since their biological causes are exact opposites, researchers stated that they believe understanding this contrast can pave the way for better treatments for both.

Can Endometriosis Occur After Menopause?

“Endometriosis after menopause is uncommon but clinically important. Any new symptoms like pelvic pain or bleeding should be evaluated promptly. Early diagnosis and appropriate management can prevent complications and improve quality of life,” shares Dr Jain.

According to the Cleveland Clinic, the occurrence of endometriosis after menopause is not typical. If you get it after menopause, it may be because it was present before; it may have reactivated if you have been taking Hormone Replacement Therapy (HRT).

Can Endometriosis And PCOS Coexist?

If you are wondering if both these conditions can co-exist or not, let us explain.

It is possible to have both PCOS and endometriosis together; however, they are distinct conditions with different causes. 

As per a 2021 study, published in the ‘AJOG Global Reports’ journal, nearly one in 20 women who were seeking surgical gynaecologic care had both PCOS and endometriosis at the same time. For women who were not specifically seeking reproductive care, this overlap was roughly one in 50. The study further noted that women diagnosed with both these conditions face a significantly higher risk of experiencing severe chronic pelvic pain and may struggle with infertility. Ultimately, understanding the connection between the two is crucial because treating only one condition may leave the other's symptoms untreated.

When To Visit A Doctor

If you are wondering when to visit a doctor, be it for endometriosis or PCOS, our expert explains this as well. “Recognising the difference is crucial, as management strategies and long-term care vary significantly. Early diagnosis and a tailored treatment plan can help improve quality of life and fertility outcomes,” says Dr Bhalla. Visit a gynaecologist if you experience the following symptoms:

• Pain in the pelvic area.
• Pain/ bleeding between periods.
• Increased period bleeding.
• Irregular or missed period.
• Pain during or after sex.
• Difficulty conceiving.

ALSO READ - Is Birth Control The Best Treatment For PCOS? Doctors Explain

Conclusion

Pain is the dominant symptom in endometriosis, while hormonal symptoms (irregular cycles, acne, and hair changes) dominate in PCOS. While both conditions affect reproductive health, they are fundamentally different: Endometriosis is synonymous with pain-driven tissue growth outside the uterus, while PCOS is synonymous with hormone-driven ovulation and metabolic disorder.