PCOS vs. Endometriosis: What’s the Difference and Why It Matters
Healthy’s Summary
Polycystic ovary syndrome (PCOS) and endometriosis are two of the most common reproductive health conditions affecting women—especially between the ages of 30 and 60. Both can cause painful periods, hormonal imbalances, fertility issues, and frustration. But they’re not the same condition, and confusing the two can lead to delayed diagnosis and ineffective treatment.
While PCOS primarily involves hormone-related disruptions in ovulation and metabolism, endometriosis is a chronic inflammatory condition where tissue similar to the uterine lining grows outside the uterus. Understanding the differences is essential to getting the right care and feeling better faster.
What’s The Difference Between PCOS vs Endometriosis?
Polycystic ovary syndrome (PCOS) is a hormonal disorder that affects ovulation. It’s characterized by:
- Irregular or absent periods
- Excess androgen (male hormone) levels
- Ovarian cysts (not always present)
It’s also linked to insulin resistance, weight gain, acne, and thinning hair. PCOS can make it harder to conceive and increases your risk of type 2 diabetes and cardiovascular disease.
According to the Centers for Disease Control and Prevention (CDC), PCOS affects up to 5–10% of women of reproductive age.
What Is Endometriosis?
Endometriosis happens when endometrial-like tissue grows outside the uterus—on the ovaries, fallopian tubes, bladder, and even the bowel. During your cycle, this tissue reacts like the uterine lining: it thickens, breaks down, and bleeds—but with nowhere to go.
This can cause:
- Severe menstrual cramps
- Pain during or after sex
- Painful bowel movements
- Chronic pelvic or back pain
- Fatigue and digestive symptoms
The Office on Women’s Health reports that it can take an average of 7–10 years to be diagnosed.
Shared Symptoms
PCOS and endometriosis can both lead to:
- Irregular periods
- Infertility or difficulty conceiving
- Fatigue
- Mood changes
This overlap often causes confusion—but the underlying causes and treatment paths are different.
Key Differences between PCOS vs. Endometriosis
| Feature | PCOS | Endometriosis |
| Primary Issue | Hormone imbalance | Tissue overgrowth and inflammation |
| Period Patterns | Irregular or absent | Often regular but very painful |
| Pain | Less common, more metabolic symptoms | Intense pelvic pain, especially with periods |
| Fertility Impact | Problems with ovulation | Problems due to anatomical damage or inflammation |
| Hormone Levels | Elevated androgens (testosterone) | Normal or low estrogen with high inflammation |
| Weight Gain | Common | Less common unless inflammation is severe |
How They’re Diagnosed
PCOS:
- Hormone blood tests
- Pelvic ultrasound to check ovaries
- Rule out other causes of irregular periods
Endometriosis:
- Pelvic exam
- Ultrasound or MRI (for cysts)
- Laparoscopy (minimally invasive surgery) for confirmation
More information on diagnosis is available from the National Institute of Child Health and Human Development.
Treatment Options
For PCOS:
- Birth control to regulate cycles
- Metformin or inositol to improve insulin sensitivity
- Anti-androgens for acne or hair growth
- Lifestyle changes (diet, exercise)
For Endometriosis:
- Hormonal therapies to reduce or stop periods
- Pain relief (NSAIDs, physical therapy)
- Laparoscopic surgery to remove endometrial tissue
- Anti-inflammatory diets and supportive care
Can You Have Both?
Yes. Some women are diagnosed with both PCOS and endometriosis—which can complicate symptoms and fertility. That’s why working with a specialist who understands both conditions is so important.
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The Takeaway
PCOS and endometriosis are different conditions with different root causes, but both can affect your quality of life. If you’re dealing with pain, irregular cycles, or fertility issues, don’t wait—getting the right diagnosis is the first step to feeling better.
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