Endometriosis & PCOS: Can You Have Both and How to Deal with It
Both polycystic ovarian syndrome (or PCOS) and endometriosis are conditions that can be difficult for women to be diagnosed with. Having both can not only make life painful but also make women feel upset, confused and isolated.
Roughly the same number of women have endometriosis as PCOS with 1 in 10 women having each condition respectively. While most women may be diagnosed with just one of the disorders, it’s possible to be diagnosed with both. Because both conditions affect fertility, studies suggest that having both can make it even more difficult to conceive.
While PCOS and endometriosis can overlap, each disorder has distinct symptoms that we will discuss below.
What is Endometriosis?
Endometriosis is a painful condition in which tissue similar to the lining of the uterus (a.k.a. the endometrium) grows outside the uterus. This tissue most frequently grows on the reproductive and pelvic organs, such as the fallopian tubes, ovaries, and abdominal cavity. However, it’s also possible to have extra-pelvic endometriosis — in fact, endometriosis has been found on every organ and anatomical structure in the body except the spleen.
Because the tissue builds up and bleeds in the same way that the endometrium does during your period, it can cause widespread inflammation in the body. Some women experience debilitating pain during their period, throughout their cycle, and/or while having sexual intercourse. Other women have no symptoms at all, yet can still have severe endometriosis. The severity of symptoms does not correlate with the extent of the disease.
Other symptoms you might experience with endometriosis, besides pain, are:
- Heavy menstrual periods
- Bloating (sometimes called “endo belly”)
- Painful urination
- Painful bowel movements
- Constipation and/or diarrhea
- Rectal bleeding, especially during your period
- Nausea and/or vomiting, especially during your period
Endometriosis can only be officially diagnosed via laparoscopic surgery, though your doctor may use imaging like ultrasound and MRI to aid in the diagnosis. Laparoscopic surgery is a minimally invasive procedure where a doctor creates small incisions in your abdomen and uses a camera called a laparoscope to view your organs. If they find endometriosis, they can also use special tools to remove the lesions (called excision) and treat the disease.
What is PCOS?
Polycystic ovarian syndrome (PCOS) is a hormonal disorder primarily affecting women of reproductive age, though its effects can last beyond the reproductive years. Women with PCOS experience hormone imbalance and specifically make excess male sex hormones called androgens, as well as excess estrogen. This hormone imbalance can lead to many cysts growing on the ovaries (polycystic ovaries), irregular or missing periods, and infertility.
Other signs of PCOS include:
- Weight gain
- Insulin resistance
- Excessive body hair
- Thinning hair
- Pelvic pain
Some women may have no symptoms, yet still suffer from the effects of PCOS, such as infertility. Your doctor can determine if you are suffering from PCOS by using a blood test to check your hormone levels and may also order an ultrasound to inspect your ovaries to see if they are polycystic.
Endometriosis vs. PCOS: Knowing the Difference
While it’s possible to have both endometriosis and PCOS, most women have only one of the two conditions. If you’re suffering from non-specific symptoms such as unexplained infertility, pelvic pain, or fatigue, you might be unsure which condition is the most likely.
The most important difference to remember is that endometriosis causes heavy, painful periods, while PCOS causes irregular or absent ones. Your doctor may order imaging like ultrasound or MRI for either of these conditions, but a hormone test will only show differences if you have PCOS. Endometriosis is not a hormonal condition, but a condition of the immune system.
Women with both endometriosis and PCOS say that they may go months without a period, only to finally have a period that almost causes hemorrhaging. Additionally, pelvic pain is common in endometriosis, but less common in PCOS; however, it may be more common in women with PCOS who also have endometriosis.
Ultimately, infertility is the most frequently overlapping symptom, whether you have PCOS, endometriosis, or both. With both PCOS and endometriosis, many women struggle to conceive and may need to use assisted reproductive technologies to successfully get pregnant.
How Do Endometriosis & PCOS Affect Fertility?
Pregnancy is not impossible for women with endometriosis or PCOS, but both conditions make it more difficult to conceive naturally. Having both conditions together may make it especially challenging to get pregnant. Regardless, if you suspect you have either condition, you should schedule an appointment with your OB/GYN to go over your symptoms and determine what you might have.
Though there is no cure for endometriosis or PCOS, different options for treatment are available for each condition. Treating the underlying condition(s) causing your infertility may make it easier for you to conceive. If you have both, a combination of these treatment options may be prescribed.
Some options for treating endometriosis and/or PCOS include:
Medication may be an option for some patients who are looking to get pregnant. Metformin is one medication used for PCOS. It may help you ovulate more regularly, allowing you to conceive naturally. Hormonal birth control is also used for symptom management in both PCOS and endometriosis, but it is not appropriate for women who are trying to conceive.
Laparoscopy is the gold standard of treatment for endometriosis. You should look for a skilled surgeon who specializes in excision (or cutting out endometriosis lesions), rather than ablation (or burning endometriosis lesions), as burning the lesions can cause scarring that may worsen infertility. An excision specialist will also make sure not to leave any endometriosis behind during surgery, since this can cause the endometriosis lesions to regrow and cause more pain.
It’s important to note that laparoscopy does not treat PCOS. If you have both conditions, you will need to treat your PCOS with medications, lifestyle changes, or other treatments suggested by your doctor in addition to having surgery for endometriosis.
Some women prefer a natural approach to managing endometriosis and/or PCOS. Maintaining a healthy lifestyle with a balanced diet and regular exercise routine can potentially boost your fertility. For PCOS in particular, gradual weight loss may help you regain your period and start ovulating regularly. When it comes to endometriosis, you should look into adopting an anti-inflammatory diet rich in antioxidants. Many women with endo also experience relief of symptoms from going on a gluten-free diet.
In-Vitro Fertilization (IVF)
IVF may be an option for some women with endometriosis, PCOS, or both who are looking to get pregnant. There are different types of IVF. Some IVF protocols use medication like Clomid to stimulate the ovaries to release more eggs; this may be especially helpful if you have PCOS and do not ovulate regularly.
Rarely, women may choose to have a hysterectomy or need to have one or both ovaries or fallopian tubes due to endometriosis scarring. In this case, IVF using a surrogate mother may be a good option for you. Talk to your doctor if you are interested in IVF to see if it is the right choice for you and your partner.
Dealing with Emotions if You Have Both Polycystic Ovarian Syndrome and Endometriosis
The emotional toll of being diagnosed with both PCOS and endometriosis can feel overwhelming. Many women talk about feeling angry, depressed, or hopeless about their diagnoses.
Both diseases can cause painful, uncomfortable, and embarrassing symptoms. Living with these symptoms, yet knowing there is no cure for them, can be frustrating and saddening. The following tips can help you manage the emotional toll of both PCOS and endometriosis:
- Find a support group. Whether online or in-person, meeting other women with your disease(s) may help you feel less alone.
- Choose a skilled and supportive doctor. The right medical professional will listen to your concerns, take you seriously, and be up-to-date on the latest research.
- Take things one day at a time. Some days you may need to rest more, while other days you may have more energy. Plan your daily activities around how you’re feeling as much as possible to avoid burnout and fatigue.
- Be prepared to manage symptoms on-the-go. Keeping supportive items, such as heating patches or over-the-counter pain relievers, in your purse, work desk, or car can help you feel less overwhelmed by symptoms when you’re away from home.
✔️ Medically Reviewed by Banafsheh Kashani, MD, FACOG
Banafsheh Kashani, M.D., FACOG is a board-certified OB/GYN and specialist in reproductive endocrinology and infertility at Eden Fertility Centers, and has been treating couples and individuals with infertility since 2014. Prior to joining Eden Centers for Advanced Fertility, she was practicing as a top fertility specialist at Kaiser Permanente in Orange County and Reproductive Fertility Center. Dr. Kashani has received numerous awards throughout her years of study and medical training.
Dr. Kashani has conducted extensive research in female reproduction, with a specific focus on the endometrium and implantation. Additionally, Dr. Kashani has authored papers in the areas of fertility preservation, and fertility in women with PCOS and Turners syndrome. She also was part of a large SART-CORS study evaluating the trend in frozen embryo transfers and success rates.
Dr. Kashani is a fellow of the American Congress of Obstetricians and Gynecologists. In addition, she is a diplomat of the American Board of Obstetrics and Gynecology and an active member of the American Society of Reproductive Medicine (ASRM) and Pacific Coast Reproductive Society (PCRS). She is also a member of the Society of Reproductive Endocrinology and Infertility (SREI).