PCOS and Endometriosis: symptoms, causes, differences, treatment

Polycystic ovary syndrome (PCOS) and endometriosis are prevalent reproductive health disorders affecting people assigned female at birth. Both conditions can disrupt your reproductive health and have implications on fertility and overall physical and mental health. Though they share common symptoms such as menstrual irregularities and challenges with conception, they are distinct in their origins and management. The understanding of the nuances between the two is vital in recognising the impact they may have on your life and the importance of consulting with your doctor for accurate diagnosis and treatment.

Key Takeaways

  • PCOS and endometriosis are distinct but can co-exist, affecting reproductive health and fertility.
  • Accurate diagnosis by a specialised healthcare professional is crucial due to overlapping symptoms.
  • Understanding both conditions enables informed health decisions and appropriate treatment choices.

PCOS and Endometriosis: what’s the difference?

Although both of these chronic conditions are associated with reproductive health, they are two separate conditions.

What is PCOS?

Polycystic Ovary Syndrome (PCOS) is a hormonal disorder commonly identified by a combination of symptoms. To be diagnosed with PCOS, you typically need to have at least two of these three features:

  • Irregular menstrual cycles due to infrequent ovulation
  • Elevated levels of androgens (male hormones) which may cause physical signs such as excess facial or body hair
  • Polycystic ovaries

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

What is endometriosis?

Endometriosis occurs when tissue resembling the endometrium, the lining of the uterus grows outside of the uterine cavity. This tissue can appear on the ovariesfallopian tubes, or the peritoneum, and rarely, beyond the pelvic region. It’s a chronic condition with symptoms varying from person to person.

The primary symptoms often include severe pelvic pain, menstrual irregularities, and sometimes, infertility. The growth of this tissue acts as it normally would inside the uterus, causing localised inflammation and scarring. Endometriosis is recognised as a long-term condition with potential impacts on one’s quality of life, particularly due to the severe pain associated with the condition.

Symptoms of PCOS vs Endometriosis

Although there are some overlapping symptoms, PCOS and endometriosis can present quite differently.

Symptoms of PCOS

If you’re experiencing symptoms of Polycystic Ovary Syndrome (PCOS), they might include:

Note that pain specifically associated with PCOS is not common, though some people with PCOS report menstrual pain.

Symptoms of Endometriosis

Your experience of endometriosis could involve:

  • Chronic pelvic pain, especially pronounced during your period
  • Increased discomfort during or after sexual intercourse
  • Painful sensations while using the toilet during menstruation
  • Possible nausea, alongside constipation or diarrhoea
  • Heavy bleeding during menstrual cycles
  • Challenges with fertility

PCOS vs Endometriosis Symptoms

You may realise that some symptoms are common to both conditions:

  • Heavy bleeding can be a feature of both, yet contrasted by skipped or irregular periods in PCOS.
  • Pelvic pain is typically associated with endometriosis, while PCOS may present cysts on the ovaries.
  • Both conditions can result in fertility difficulties.


Diagnosing the two conditions may involve ultrasounds but to definitively diagnose endometriosis, surgery is required.

Diagnosing PCOS

To confirm you have PCOS, your doctor will look for two out of these three indicators:

  • Signs of high androgen levels, either physically observable or biochemically identified.
  • Disrupted or absent menstrual cycles.
  • Presence of ovarian cysts detectable by pelvic ultrasound.

Your medical history and a blood test to examine your hormone levels are typical first steps. An imaging test like a pelvic ultrasound can help spot cysts on your ovaries.

Diagnosing endometriosis

For endometriosis, laparoscopy is the definitive method for diagnosis. This procedure inserts a camera-equipped tube via a small incision to search for endometriosis tissue. Prior to recommending a laparoscopy, an ultrasound or MRI may be used to exclude other conditions.


Due to a lack of funding for reproductive health, we still aren’t 100% sure why PCOS and endometriosis occur. Emerging evidence suggests genetics, lifestyle factors, environmental factors, immune disorders and more may contribute to these conditions developing.

Causes of PCOS

The precise cause of PCOS remains uncertain, but several factors may contribute:

  • Genetics: A greater incidence of PCOS in individuals with a family history of the condition suggests a genetic element.
  • Environmental aspects: Exposure to environmental chemicals could contribute to PCOS development
  • Lifestyle factors: Diet, exercise, stress, sleep disturbance and circadian disruption may contribute to PCOS diagnosis but are unlikely to be the sole reason PCOS develops

Causes of endometriosis

Endometriosis is a condition where tissue similar to the lining of the uterus grows outside the uterine cavity. The causes are not fully understood, but hypotheses include:

  • Genetics: No specific gene has been identified but genetic predisposition to endometriosis has been documented in family and twin studies.
  • Retrograde menstruation: Where menstrual blood flows back into the pelvic cavity instead of leaving the body.
  • Immune system disorders: This may make the body unable to recognise and destroy endometrial-like tissue that grows outside the uterus.
  • Surgical scar implantation: Following procedures like a hysterectomy or C-section, endometrial cells might attach to the surgical incision.


Treating PCOS compared to endometriosis differs significantly.

Treating PCOS

For Polycystic Ovary Syndrome (PCOS), managing your symptoms may involve:

  • Lifestyle modifications: Lifestyle changes like incorporating regular exercise, eating a varied diet, improving sleep and reducing stress may help to improve hormone balance which may improve insulin resistance associated with PCOS.
  • Medication: Options include hormonal birth control to regulate menstrual cycles and potentially reduce acne and excess hair growth.

Treating endometriosis

Endometriosis management may include:

  • Pain relief: Over-the-counter pain medication can alleviate discomfort.
  • Hormonal treatments: Hormonal birth control helps decrease menstrual flow and prevent endometriosis from getting worse.
  • Surgical options: Procedures like laparoscopic surgery to remove endometrial tissue can reduce pain and improve fertility chances.

Key takeaways: PCOS and endometriosis

  • PCOS and endometriosis may cause similar reproductive health issues.
  • Experiencing symptoms like heavy bleeding and fertility difficulties warrants consultation with your GP.
  • These conditions can coexist, but having one does not necessarily increase the likelihood of having the other.
  • Always seek professional medical advice if you suspect you have either or both conditions.

Frequently Asked Questions

Can people with PCOS also have endometriosis?

Yes, it’s possible for a person to be diagnosed with both polycystic ovary syndrome (PCOS) and endometriosis. While they are distinct conditions, they can coexist, which may complicate diagnosis and treatment.

How might PCOS and endometriosis affect my chances of conception?

Both PCOS and endometriosis can impact fertility. PCOS is often associated with irregular ovulation, while endometriosis can lead to obstructions or inflammation in the reproductive tract. Together, they may affect your chances of conception, and seeking advice from a healthcare professional is advisable.

What are the distinguishing symptoms of PCOS and endometriosis?

PCOS symptoms may include:

  • Irregular menstrual cycles
  • Excess androgen levels leading to hirsutism
  • Multiple small cysts on the ovaries

Endometriosis symptoms are often:

  • Pelvic pain, especially during menstruation
  • Pain during intercourse
  • Heavy menstrual bleeding or bleeding between periods

How can I differentiate between PCOS and other conditions with similar symptoms?

Differentiating between PCOS and similar conditions usually involves, but is not limited to:

  • Hormonal blood tests
  • Ultrasounds
  • Detailed assessment of your symptoms and medical history

Consult a healthcare provider for an accurate diagnosis.

What impact does PCOS have on the endometrial lining?

PCOS can affect the endometrial lining due to irregular menstruation. This irregular shedding may increase the risk of developing endometrial abnormalities, including a heightened risk of endometrial cancer.

What lifestyle adjustments are recommended for managing both PCOS and endometriosis?

Treatment of PCOS and endometriosis vary considerably. But general lifestyle adjustments that may be helpful for managing both conditions include:

  • Regular physical activity
  • A varied diet rich in fruits, vegetables, and whole grains
  • Stress management techniques
  • High-quality sleep

In some cases, your healthcare provider might recommend specific medications or surgical options as part of your treatment plan.

Alex Okell ANutr Founder and Editor

Founder and Editor | Registered Associate Nutritionist


Founder of Be The Collective LTD [The PCOS Collective & The Endo Collective] Alex Okell ANutr is a London-based reproductive health nutritionist with experience in research, private practice and digital media. She holds a Master’s degree in Nutrition from King’s College London and has co-authored papers with the University of Cambridge, King’s College London, The Food Foundation and the Food Standards Agency. Alex offers 1:1 PCOS support in our virtual PCOS clinic.

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