Endometriosis impacts an estimated 1 in 10 women and girls of reproductive age worldwide. Moreover, recent research suggests that polycystic ovary syndrome (PCOS) is thought to affect somewhere between 4 to 20% of women of reproductive age globally. Though endometriosis and PCOS are common health conditions, people often mistake one for the other or vice versa.
“Endometriosis and PCOS are two reproductive health conditions that are not well understood among many in the medical community,” Dr. Stephanie Hack, board-certified OB-GYN and host of the ”Lady Parts Doctor” podcast, told HuffPost. “They both are associated with the menstrual cycle and fertility issues, making it easy to confuse them. However, they are very different.”
HuffPost spoke with experts about the differences between PCOS and endometriosis, and why it’s important to understand the unique symptoms and treatments for each health condition.
What are endometriosis and PCOS, and how do symptoms differ?
“Endometriosis is a condition in which cells that resemble the lining of the uterus are present anywhere in the body,” said Dr. Gaby Moawad, a clinical associate professor of obstetrics and gynecology at The George Washington University and founder of The Center for Endometriosis & Advanced Pelvic Surgery (CEAPS).
This means that endometrial-like tissue grows in areas such as the ovaries, fallopian tubes, and tissue lining the pelvis. However, this tissue cannot shed like healthy endometrial tissue inside the uterus does during your period. In turn, endometriosis can cause severe pelvic pain, pain during menstruation and intercourse, nausea, bloating, and even pain during urination and bowel movements. Endometriosis may increase the risk of developing ovarian cancer, and there is also a correlation between endometriosis and certain autoimmune diseases.
In some cases, people with endometriosis can form endometriomas, which are commonly referred to as “chocolate cysts” due to their dark brown appearance. Though people with endometriosis can form cysts, this is not the same as having PCOS.
According to Moawad, “PCOS by definition is irregular ovulation,” and is a health condition in which the ovaries produce “excess male hormones in the body,” aka androgens. Due to hormonal imbalances and elevated androgen levels, Hack explained that PCOS symptoms include “irregular and/or infrequent periods, weight gain, acne, ovaries with multiple cysts and excessive body hair.”
In addition, people with PCOS regularly develop other serious health conditions. June-Ann Joseph, an advocate and host of the “Black Broke and Anxious” Podcast, said that her PCOS has caused her to experience insulin resistance, difficulty losing weight, and the formation of acanthosis nigricans, which is a skin condition that causes dark, velvety patches to form on different areas of the body.
There are some commonalities between endometriosis and PCOS.
Though endometriosis and PCOS are completely different health conditions, Moawad said a “chronic inflammation pattern” is present in both. Some studies suggest that, though rare, people can have both endometriosis and PCOS.
As Hack noted, both conditions can cause subfertility, an unwanted delay in becoming pregnant, or infertility, which is a complete inability to get pregnant after one year or more of having regular, unprotected sex.
Though PCOS is a common cause of infertility, endometriosis typically creates more complicated fertility issues. This is because, as Moawad said, “endometriosis not only affects the quality of eggs and ovaries, but it also creates a lot of scar tissue which could close the fallopian tubes, as well as damage the uterus.” An estimated 30 to 50% of women with endometriosis experience infertility.
How do physicians treat endometriosis versus PCOS?
Neither PCOS nor endometriosis can be cured, but rather symptoms can be managed through different treatment methods.
OB-GYNs typically take a holistic approach when treating people with PCOS, utilizing medications that induce ovulation or address potential hormonal imbalances, vitamins to address any nutritional deficiencies that may worsen PCOS symptoms, and working alongside patients to modify lifestyle habits — such as diet — that may contribute to inflammation.
Moawad explained that, for people with endometriosis, the “gold standard” treatment is surgical excision. People who experience severe pain or fertility issues may opt to undergo a laparoscopy; this is a minimally invasive procedure in which a surgeon will use a laparoscope to find areas of endometriosis and remove any lesions or scar tissue. Hormonal therapies such as gonadotropin-releasing hormone (GnRH) agonists, birth control pills and hormonal IUDs are also often prescribed for endometriosis.
However, Moawad said that these “medications tend to quiet the symptoms for a period of time, but they don’t cure [endometriosis].” Similarly, surgical interventions for endometriosis are not permanent, and up to 80% of women experience pain again within two years of surgery.
Misconceptions surrounding PCOS and endometriosis must be addressed.
Misinformation is ultimately harmful, and may lead to a delay in diagnosis and treatment for many people with these health conditions. Rachel Ennis, a psychology project worker, was only diagnosed with endometriosis in 2022 after experiencing symptoms of the health condition for over 15 years.
“I wish people understood just how exhausting it is to have to fight with medical professionals to get taken seriously, and to get a diagnosis,” Ennis said. “Endometriosis is a whole body disease that can impact every area of your life.”
Further, Joseph stressed that more research about PCOS needs to be done so that doctors can better support patients — and so that people don’t turn to social media for medical advice.
“There are a lot of scam artists and influencers telling you that if you follow their diet plan, you can cure your PCOS,” she explained.
Find a medical professional who validates your concerns and takes your symptoms seriously.
It’s crucial to find an OB-GYN who specializes in specific health conditions like endometriosis and PCOS, and specific practice areas such as surgical excision. Though many people may think endometriosis and PCOS are minor conditions, Hack explained they are serious health issues that can be detrimental to a person’s day-to-day life in their own unique ways.
It’s well past time to ditch the misconceptions surrounding both PCOS and endometriosis, and to develop a greater understanding of these health conditions that impact millions of people across the world.
“The most important thing is that we have to empower our patients, validate their concerns and their symptoms, and give them the highest quality of care that they deserve,” Moawad said.