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PCOS and Endometriosis: can you have both?

PCOS and endometriosis are conditions that both affect people assigned female at birth. They both can have significant impacts on the health, fertility and quality of life of those affected.

Due to the similarities between conditions both causing menstrual problems and difficulty in getting pregnant, it is sometimes assumed the two conditions may be linked.

However, to date, PCOS and endometriosis are not considered to be definitively related to one another, although it is possible to have both conditions at the same time. Whilst some similarities, previously highlighted, do occur, the causes, symptoms and treatments do differ.

Keep reading to explore the similarities and differences between the two conditions.

PCOS and Endometriosis: what’s the difference?

Despite the fact both conditions are only present in those assigned female at birth and both affect reproductive health, endometriosis and PCOS are two distinct conditions.

What is PCOS?

PCOS is a common condition that affects hormone levels including LH, FSH, testosterone and insulin. The three main characteristics of PCOS, two of which are required for diagnosis, include irregular periods, excess androgens (e.g. testosterone), and polycystic ovarian morphology (cysts on the ovaries). PCOS is most likely to be present in people who are in the late teens to early years of their twenties.

>> Read more | PCOS 101: a beginners guide to PCOS

What is endometriosis?

Endometriosis is a condition where tissue that is similar to the lining of the womb, can begin to grow in other places including the ovaries and fallopian tubes. It is a long-term condition that can affect people of any age.

Symptoms

In both conditions, the symptoms will vary both in how they display in an individual as well as the severity of the symptom.

Symptoms of PCOS

Symptoms of PCOS can include irregular or no periods, difficulty getting pregnant, excessive hair growth on the body and face, thinning hair and loss from the head and oily skin and acne. Generally, PCOS doesn’t cause pain but people do note that PCOS period pain may exist.

Symptoms of Endometriosis

Symptoms of endometriosis can include pain in your lower tummy/back which can be heightened during your period, pain during or after sex, pain when going to the toilet during your period, feeling nauseous or suffering with constipation, diarrhoea and difficulty getting pregnant.

PCOS vs Endometriosis Symptoms

You will notice that there are some symptoms that can be symptoms of both PCOS and endometriosis. It is also important to note that not everyone with endometriosis or PCOS will present with all symptoms. Everyone’s conditions are likely to look different.

EndometriosisPolycystic Ovary Syndrome (PCOS)
Heavy bleedingHeavy bleeding
Painful periodsMissed periods or irregular periods
Lower back pain during periodCysts on ovaries
Painful bowel movementsHirsutism
Difficulty getting pregnantDifficulty getting pregnant
Painful sexAcne
Painful urinationOily skin
Pelvic painThinning hair
Digestive issuesDark, thicker skin patches

Diagnosis

Diagnosing PCOS is very different to diagnosing endometriosis.

Diagnosing PCOS

PCOS is diagnosed when someone presents with 2 out of 3 of the following:

  • Biochemical or physical symptoms of high androgen levels
  • Irregular or entirely missed periods or ovulation
  • Cysts on the ovaries

To diagnose PCOS, often you will have a blood test and an ultrasound.

Diagnosing endometriosis

Endometriosis is diagnosed following a laparoscopy. A laparoscopy is when a thin tube passes through a small hole in the stomach to look for patches of endometriosis tissue. This is the only way to be sure that endometriosis is present. Sometimes you may have an ultrasound or MRI to rule out other conditions before a laparoscopy is recommended.

Causes

Similarly in both conditions, the cause of PCOS and endometriosis is unknown. There are several hypothesised theories to why they occur, which we will discuss further.

Causes of PCOS

It is thought that PCOS is linked to genetics, and those with a first relative with PCOS are more likely to have PCOS themselves. There are also potential links to environmental and lifestyle factors contributing to the onset of PCOS, but more research is needed.

Causes of endometriosis

The cause of endometriosis is unknown, but researchers believe that there could be five possible causes:

  1. Retrograde menstruation: the theory that some of the tissue shed during a period flows through the fallopian tubes into other areas of the body
  2. Lymphatic or vascular system spread: endometrial tissue may spread to distant organs and implant via blood or lymphatic channels
  3. Stem cells: stem cells have been hypothesised to regenerate endometrial tissue in the menstrual cycle, and spread to other parts of the body
  4. Coelomic metaplasia: it is believed that cells in the body outside the uterus undergo changes to become endometrial-like tissue and begin to grow
  5. Surgery: it is hypothesised that certain surgeries may displace endometrial tissue

Treatment

There is no cure for PCOS and no cure for endometriosis. For both conditions, the aim is to manage symptoms and risks to improve health and quality of life as much as possible. Both conditions may use birth control to help manage the conditions.

Treating PCOS

PCOS cannot be cured so treating the condition involves lifestyle changes, medication and supplements.

Treating endometriosis

Endometriosis cannot be cured but treatment can be given to relieve pain, help improve fertility and reduce the chances of the condition flaring up again.

Treatment involves having surgery to remove or destroy areas of endometriosis tissue, taking birth control and managing pain with painkillers.

Can you have PCOS and endometriosis together?

Yes, you can have PCOS and endometriosis together, at the same time. One condition doesn’t impact the other condition and there may be multiple symptoms that overlap between the two conditions.

PCOS is easier to diagnose because it involves blood tests and ultrasounds, whereas to diagnose endometriosis, one has to undergo a laparoscopy which is an invasive surgery.

Does PCOS cause endometriosis?

To put it simply, no, PCOS does not cause endometriosis. The two are separate conditions which can occur at the same time and may have overlapping symptoms. Speak to your doctor or healthcare professional if you believe you have either of the conditions or both.

Key takeaways: PCOS and endometriosis

PCOS and endometriosis are both common conditions that affect people assigned female at birth. They both can impact reproductive health and may have overlapping symptoms like heavy bleeding and difficulty getting pregnant. They both can be present at the same time, but having one of PCOS and endometriosis does not impact the likelihood of having the other condition. If you think you have PCOS or endometriosis, or both, speak to your doctor.

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