The quickest way to tell them apart: endometriosis hurts, badly, and PCOS mostly does not.
What PCOS Is
PCOS is a hormone disorder built on two things: too much androgen (male hormone) and insulin resistance. The name comes from the small fluid-filled sacs that can form on the ovaries, though plenty of women with PCOS never have them.
PCOS Symptoms
- Irregular periods, or none
- Heavy bleeding when they do come
- Extra hair on the face and body (hirsutism)
- Acne and oily skin
- Thinning hair, in a male pattern
- Weight gain, mostly around the middle
- Trouble getting pregnant
- Dark patches of skin, often on the neck and in the groin
What Endometriosis Is
Endometriosis is tissue like the lining of your womb growing outside it. It turns up on the ovaries, the fallopian tubes, the lining of the pelvis, and sometimes further afield.
Endometriosis Symptoms
- Severe period pain, sometimes bad enough to stop your day
- Pain during sex
- Pain when you go to the loo, worse during your period
- Heavy bleeding, during periods or between them
- Exhaustion
- Bloating and nausea
- Trouble conceiving
The Key Differences
Both affect fertility and periods. Past that they part ways.
The Cause
PCOS is a hormone imbalance: too much androgen, too much insulin. Endometriosis is tissue in the wrong place, responding to your cycle as if it were still in the womb.
Pain
With endometriosis, pain is the main event: during periods, during sex, sometimes when you use the toilet. With PCOS, pain is not usually the problem, though heavy bleeding makes some periods hurt.
What You Can See
PCOS shows on the outside: acne, extra hair, hair loss, all from the androgens. Endometriosis does not. Its damage is internal.
Your Cycle
PCOS makes periods irregular, rare or absent, because ovulation is unreliable. With endometriosis your cycle is usually regular. It just hurts, and it may be heavy.
Can You Have Both?
Yes. You can have PCOS and endometriosis together, and some research suggests PCOS raises your risk of endometriosis.
If you have symptoms of both, find doctors who will treat both rather than picking one.
How Each Is Diagnosed
They are found in completely different ways.
PCOS
Doctors diagnose PCOS when at least two of these three are true:
- Irregular or absent periods, meaning ovulation is unreliable
- High androgens, shown by a blood test or by physical signs
- Polycystic ovaries on an ultrasound
Endometriosis
Harder to pin down:
- It starts with your symptoms and an examination
- An ultrasound or MRI can pick up larger patches
- Laparoscopy, keyhole surgery, is the gold standard. It lets a surgeon see the tissue and take a sample
How Each Is Treated
Different problems, different goals.
PCOS
- Lifestyle. Managing your weight through food and movement improves symptoms a lot for many women.
- Medication. The pill to regulate periods, anti-androgens for hair growth and acne, and insulin drugs like metformin.
- Food. A low-glycemic diet, to handle insulin resistance and lower inflammation.
- Supplements. Some women do well on inositol, omega-3s and specific vitamins.
Endometriosis
- Pain relief. Over the counter, or on prescription.
- Hormone therapy. The pill, progestins, or GnRH agonists, all to slow the tissue growing.
- Surgery. Keyhole surgery to remove the tissue while keeping your uterus and ovaries.
- Food. An anti-inflammatory diet, which eases symptoms for many women.
Frequently Asked Questions About PCOS vs Endometriosis
How does the pain differ?
Endometriosis pain is severe and sometimes disabling: during your period, during sex, sometimes when you use the toilet. It comes from the inflammation and irritation of tissue growing where it should not.
PCOS pain is usually not the main problem, though some women get discomfort from cysts, or painful periods from heavy bleeding. The difference is that endometriosis pain is worse, more constant, and tied tightly to your cycle.
Can diet help both?
Yes, but not the same diet. For PCOS you want low glycemic eating to handle insulin resistance: complex carbohydrate, lean protein, good fats and plenty of fibre.
For endometriosis you want anti-inflammatory eating: omega-3s, fruit, vegetables and whole grains, with less red meat, trans fat and processed food.
With both, a nutritionist who knows both can build a plan that covers both sets of symptoms.
How does fertility treatment differ?
For PCOS, it usually starts with drugs that trigger ovulation, like clomiphene or letrozole. Metformin helps some women by improving insulin sensitivity.
For endometriosis, surgery to remove the tissue often improves the odds. If first-line treatment does not work in either case, IUI or IVF come next.
The protocols for those differ depending on which condition you have.
Can one be mistaken for the other?
Yes, because both cause irregular periods and fertility trouble. But their patterns differ. PCOS brings irregular periods, extra hair, acne and metabolic problems.
Endometriosis brings severe period pain, pain during sex, and sometimes pain when you use the toilet. Telling them apart needs your history, an examination, hormone tests and imaging.
And for endometriosis, a firm diagnosis may need keyhole surgery.
How do the side effects compare?
Both use hormone medication, aimed at different things. Metformin can upset your stomach. Anti-androgens can cause fatigue and changes to your liver.
The pill, used for both, can bring headaches, mood changes and a small clot risk. GnRH agonists for endometriosis are harder: they can cost you bone density and bring on menopausal symptoms.
Everyone reacts differently, which is why the plan has to be built around you rather than the condition.
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