Living with chronic conditions like endometriosis and polycystic ovary syndrome (PCOS) can be challenging, especially when the symptoms can overlap and are often misunderstood. These two women’s health issues, though distinct, share common ground in how they impact a woman’s life and reproductive health. From symptoms to treatment, learn about the differences between endometriosis and PCOS, and how some lifestyle choices can help you manage these conditions.
What is endometriosis?
Endometriosis is a disorder where cells from the lining of the uterus implant themselves in other parts of the abdomen and body. These cells respond to hormonal changes during the menstrual cycle and grow. When ovulation doesn’t result in pregnancy, these cells die leading to pain, inflammation and tissue injury. When your immune system repairs these injuries, it results in the formation of scar tissue and, in some cases, infertility.
According to Mini Somasundaram, MD, OB-GYN, “Endometriosis is the number one cause of chronic pelvic pain in women. About 60% of women with chronic pelvic pain, which is defined as pelvic pain for six months or longer, have endometriosis as a source of the pain.” Endometriosis can contribute to infertility, pain with intercourse and has a lot of long-term effects as well.
Endometriosis doesn’t always manifest as pelvic pain, that is just the primary symptom. Some women will have what has been labeled “silent endometriosis,” where the primary symptom is infertility rather than pain. “That’s where, a lot of times, endometriosis and PCOS get lumped together. Because with PCOS, infertility can be one of the major signs,” says Dr. Somasundaram.
What is PCOS?
PCOS is a hormonal disorder where the ovaries produce higher-than-normal levels of androgens (male-associated hormones) and testosterone. This hormonal imbalance can lead to irregular menstrual cycles, ovarian cysts, and symptoms like acne, hirsutism or excess body hair, and weight gain. PCOS was originally diagnosed in women with increased levels of androgens like testosterone, but now it’s more often seen in women who have gained weight or have insulin resistance.
“There is definitely a big interaction between insulin resistance and PCOS,” says Dr. Somasundaram. “So as women gain weight, they become more insulin-resistant, and their risk for PCOS tends to go up. Because of this, some fertility doctors will say that if women lose weight, their fertility will improve. But it’s not always so direct, because the weight gain could be hormonal — their body pushing them to gain weight.”
Early warning signs and symptoms
The symptoms of endometriosis and PCOS can sometimes overlap, making diagnosis tricky. However, there are distinct signs for each.
For endometriosis, the hallmark symptoms include:
- Severe pelvic pain, particularly during menstruation
- Pain during intercourse or after
- Chronic lower back and abdominal pain
- Pain with bowel movements or urination, especially during periods
- Infertility
According to Dr. Somasundaram, “Endometriosis can be especially complicated to diagnose in teenagers. About 80% of young women starting their cycles will have pelvic pain, but only about 16% of women will have endometriosis.”
There can also be a familial or genetic link, meaning women who have a mother, sister, daughter or close relative who has endometriosis are 7 to 10 times more likely to have endometriosis than individuals who do not have a familial history with the condition.
Meanwhile, PCOS symptoms often revolve around hormonal imbalances:
- Irregular or absent periods
- Heavy bleeding during periods
- Weight gain, particularly around the abdomen
- Acne and oily skin
- Excess facial and body hair growth (hirsutism)
When identifying if your period cycle is irregular, it won’t be a difference between a 28-day cycle one month and 32-day cycle the next. “Women with PCOS may have irregular periods like a 24-day cycle one month and a 45-day cycle the next” explains Dr. Somasundaram.
Treating endometriosis
Treatment for endometriosis and PCOS often focuses on symptom management, as neither condition has a definitive cure.
For endometriosis, the first line of treatment typically involves pain relief first. Prophylactic NSAIDs are often recommended to alleviate pain. “Meaning, we’ll give you pain medicine when we know your cycle’s going to start in 24 to 48 hours to suppress some of the hormones and the prostaglandins that cause the pelvic pain,” explains Dr. Somasundaram.
Oftentimes, women will start taking pain medicine after they are in pain. If they wait until after the pain has already set in, it takes a lot more medicine to get the pain under control.
Birth control pills and hormonal therapy are the second line of treatment. Birth control pills, patches, or hormonal IUDs help regulate the hormonal swings that exacerbate the condition.
Dr. Somasundaram adds, “The two natural states in which women with endometriosis feel better are pregnancy and menopause, so hormonal treatments are often aimed at mimicking these states.”
For people who experience uncomfortable side effects from birth control pills, there are some non-hormonal treatments they can talk to their doctors about as well.
Surgery is required to definitively diagnose someone with endometriosis. Because of this, doctors often choose to treat suspected endometriosis with hormonal therapy and pain relief first. In some cases, laparoscopic surgery is required to remove endometrial tissue, especially when fertility is a concern. Laparoscopies usually have shorter recovery times and smaller scars as compared to traditional open surgery (laparotomy).
Treating PCOS
Similarly to endometriosis, treatment for PCOS often includes hormonal therapy. Birth control pills can help to regulate periods and reduce androgen levels.
Another prescribed treatment is using a medication like metformin that improves insulin resistance, helping to manage weight and restore regular menstrual cycles.
Lifestyle changes like weight management through diet and exercise can be essential in managing PCOS, especially when insulin resistance is involved. “When you have insulin resistance, your body produces more insulin than it needs, your food goes to storage very quickly, and it’s hard for it to come out of storage. So that results in weight gain,” explains Dr. Somasundaram. “So the idea is if you exercise, you increase your insulin receptors, and by increasing your insulin receptors, you can reduce your insulin resistance.”
How diet and exercise help
Both endometriosis and PCOS can benefit from lifestyle changes, particularly diet and exercise.
Exercise helps by reducing insulin resistance, particularly in PCOS patients. For women with endometriosis, regular physical activity stimulates the immune system and increases endorphins, which can provide some relief from chronic pain.
Diet also plays a significant role. For women with PCOS, a low-glycemic diet, limiting refined carbs like those found in white flour, white rice, sugar and processed foods, can help manage blood sugar levels. In endometriosis, an anti-inflammatory diet may reduce flare-ups. Dr. Somasundaram recommends, “minimizing additives and preservatives in food and eating clean can help reduce your body’s load of inflammatory agents.”
How endometriosis and PCOS affect fertility
Both conditions can affect fertility, but in different ways. In endometriosis, the growth of endometrial-like tissue can block the fallopian tubes, preventing the egg and sperm from meeting. However, as Dr. Somasundaram points out, “Not everyone with endometriosis will have trouble conceiving, but some women may require more effort or fertility treatments like IVF.”
For PCOS, the main issue lies in irregular ovulation. Women with PCOS may ovulate less frequently, reducing the chances of conception. However, treatments like hormonal therapy or some medications can help stimulate ovulation, making conception more likely. “PCOS is very treatable, and we have really good medications to normalize ovulation and improve fertility,” assures Dr. Somasundaram.
Supporting someone with endometriosis or PCOS
When a person is dealing with chronic pain all the time, it can lead to anxiety and depression. It’s important to understand not only what about the disorder is causing anxiety and depression, but also how to best support someone through these symptoms.
“If you’re hurting all the time and you’re maxed out managing that pain, your body is scanning the horizon to make sure that nothing else you come across is going to hurt you because you’re already maxed out,” explains Dr. Somasundaram. “So anxiety is almost like a coping mechanism for your body to be like, I’m going to protect myself from more injury.”
Dr. Somasundaram reminds us that physical issues and mental issues are very intertwined. So, patients dealing with these conditions are more prone to sadness, depression and anxiety, especially because living with chronic pain and fluctuations in your body’s weight can often affect patients’ lifestyles in a bigger way.
“A lot of times I will counsel my patients to see a therapist to talk about what their life experience is, to process it, to manage it,” says Dr. Somasundaram. “It doesn’t mean the pain goes away when you talk to a therapist. It’s just a way to process what your life experience is to try to come out stronger after having done that.”
Supporting a loved one with endometriosis or PCOS requires empathy and understanding, as these conditions are often invisible.
“Endometriosis affects many women who look healthy on the outside but are struggling with pain. It’s crucial for family and friends to believe them and be supportive,” says Dr. Somasundaram.
Additionally, if someone with PCOS is dealing with weight gain or dietary changes, it’s important to offer non-judgmental support. Dr. Somasundaram explains, “It’s not about shaming weight gain but about understanding the metabolic challenges they’re facing.”
Endometriosis and PCOS are complex conditions that require ongoing management. Early diagnosis, effective treatment, and lifestyle changes can make a significant difference in improving quality of life. Whether you are experiencing these conditions or supporting someone who is, understanding the challenges involved can foster greater empathy and lead to better care.
