PCOS & Endometriosis: What You Need to Know

One in 10 women have endometriosis; which, in the U.K alone, equates to around 1.5 million women and people assigned female at birth. PCOS, too, impacts around one in 10 women and those assigned female at birth in the U.K.

These are staggering statistics; and yet, despite the widespread prevalence of these conditions, there are still sagging gaps in knowledge, awareness and education around women’s health.

This isn’t the fault of women, FYI. Rather, it’s the result of the all-too-present gender health gap, which – as ELLE pointed out earlier this year – has led to the increasing possibility of women resigning themselves to the gaping holes in information and guidance pertaining to women’s health conditions, not even bothering to Google them; not because they don’t care, but because few (if any) answers are likely to come up.

But we want you to keep looking for answers – because we’re committed to closing the gender health gap by providing answers that are often lacking elsewhere. And today, concerning PCOS and endometriosis specifically – which, as we’ve established, impact vast numbers of women and people assigned female at birth – we’re taking a deep dive into the differences between the two conditions that can often get confused and exploring how they could impact fertility.

What exactly is PCOS?

“PCOS (or polycystic ovary syndrome) is a condition where females have a hormonal imbalance leading to increased androgens, or ‘male sex hormones’,” says Dr. Cielo Gnecco, MD, FACOG- OB-GYN with Orlando Health. “We do not know what exactly causes PCOS, but we know that it can potentially occur due to a patient’s genetics.” It’s linked to abnormal hormone levels, including substantial insulin levels.

Symptoms include:

  • Irregular periods (“skipping a period for two/three or more months at a time,” Gnecco explains)
  • Abnormal amount of hair growth on (e.g.) the chin, abdomen or breasts  in
  • Polycystic ovaries (enlarged ovaries that contain lots of follicles, fluid-filled sacs that cluster around the eggs)

What exactly is endometriosis?

“Endometriosis is an inflammatory condition where tissue similar to the inner lining of a woman’s uterus (called the endometrium) grows outside of the uterus, causing pain and inflammation during, and outside of, a female’s menstrual period,” Gnecco explains.

“To this date, there is no known cause of endometriosis,” says Gnecco. “A few theories have been developed, which state that endometriosis may be caused by one’s genetics, by transport of endometrial cells via blood or lymphatics, or by retrograde menstruation, when blood that collects in the uterine cavity is spilled into the abdomen via the fallopian tubes.”

Gnecco lists endometriosis symptoms as including:

  • Painful menstrual cramps
  • Pain during sex
  • Discomfort during a bowel movement
  • Irregular bleeding
  • Abdominal bloating 

Can you have PCOS and endometriosis at the same time?

“Absolutely,” says Carrie Levine, Certified Nurse Midwife and Functional Medicine Certified Practitioner. “An abnormal period is the most likely overlapping symptom, although the abnormalities can differ. Women with PCOS often have irregular periods and women with endometriosis have painful periods.”

How can you test for each condition?

“You can evaluate for PCOS through a physical exam and bloodwork,” says Levine; and Gnecco expands further on what the latter means.

“When ruling out PCOS, we must do lab work in order to rule out other conditions that may resemble this syndrome,” Gnecco explains. “Once we rule out other etiologies, we can diagnose PCOS using the Rotterdam criteria. Patients with two of these three factors can be diagnosed with PCOS:

  • Irregular menstruation (not having a period for two/three months at a time)
  • Having hirsutism (abnormal hair growth)
  • Polycystic ovaries

“Endometriosis can be diagnosed clinically given a patient’s history and response to treatment,” Gnecco goes on. “It can be confirmed via surgery such as a laparoscopy by visualising endometriotic implants in one’s pelvic or abdominal cavity and potentially taking a biopsy for confirmation.”

How does each condition impact fertility (if at all)?

“PCOS can impact fertility as patients with it can have issues with anovulation,” says Gnecco. “When patients do not ovulate, they are not able to get pregnant” – an issue known as anovulatory infertility, which may impact 70-80% of women with PCOS.

Endometriosis, meanwhile, can lead to “inflammation and creation of pelvic scar tissue,” according to Gnecco. “When severe, inflammation can cause blockage of a female’s fallopian tubes, which are essential for patients to get pregnant,” she continues.

Even with severe endometriosis, though, it’s absolutely possible to get pregnant – in fact, it’s estimated that around 60-70% of people with the condition can conceive spontaneously – and whether you have – or suspect you have – PCOS or endometriosis, it’s important not to panic. “I’ve seen many, many, many women have families when they get to the root cause of their issue,” says Levine – which is why it’s so important to keep searching – and, where necessary, pushing – for answers. “Endometriosis is often misdiagnosed and not treated appropriately,” says Gnecco. “It is important for women to be aware of some of the warning signs and to have a discussion with their medical doctor.”

How can each condition be managed?

Straight off the bat, a common recommendation for PCOS or endometriosis is oral contraception. But you’re reading OVUM; and so we’d hazard a guess that you’re currently trying to conceive or thinking about doing so in the near future. In which case, an oral contraception is – to state the obvious – of no use to you, especially not as a long-term solution. 

Luckily, though, there are lifestyle modifications you can try and implement to help manage your PCOS and/or endometriosis.

“One of the first recommended therapies for both conditions are lifestyle modifications,” says Gnecco. “Patients are encouraged to keep a healthy diet low on sugar and to exercise regularly.”

Levine agrees, adding that, for both conditions: “Stabilising blood sugar and eating and living an anti-inflammatory lifestyle are foundational.”

With PCOS specifically, the NHS explains that, if you are overweight, losing excess weight of even just 5% could improve both your symptoms and the risk of developing long-term health problems. It’s recommended to calculate your BMI and, if necessary, implement regular exercise and a healthy, balanced diet.

Levine has some tips in this regard, which can help manage both conditions in and of themselves. “Women PCOS and/or endometriosis could benefit from decreasing dietary carbohydrate intake because high-carb diets may increase insulin levels, which may subsequently increase androgen production, aerobic exercise and eating lots of cruciferous vegetables,” she explains.

And when it comes to endometriosis, it really is all about incorporating that anti-inflammatory diet if you’re looking to manage your symptoms. We’re talking plenty of omega-3 fats, reducing the red meat, caffeine, alcohol and processed foods and incorporating lots of fruits and vegetables (shock!) as a starting point.

Regarding fertility specifically, there are also medications you can try if you want to boost your chances of conception.

A medicine called clomifene may be a good starting point. It aims to stimulate ovulation through encouraging the ovaries to release an egg each month.

It’s worth speaking with your healthcare provider to know whether clomifene or a different medication might be right for you, though. One such example is tamoxifen, which is an alternative to clomifen; or, if you have PCOS, your doctor may float the idea of metformin. While not currently licensed for treating PCOS in the UK, metformin is often used to treat type 2 diabetes and, since many people with PCOS have insulin resistance, it can be used ‘off label’ to lower insulin and blood sugar levels, encourage fertility via stimulating ovulation, encouraging regular periods and reducing miscarriage risk, and manage the symptoms.

Equally, though, it might be that medication in general just isn’t right for your unique circumstances – which is why it’s always better to speak with a doctor, first and foremost.

Key takeaways:

  • PCOS is a condition where females have a hormonal imbalance leading to increased androgens. Symptoms include irregular periods, abnormal hair growth and ovarian cysts.
  • Endometriosis is an inflammatory condition where the inner lining of the uterus grows outside of it. Symptoms include painful menstrual cramps and pain during sex. discomfort during a bowel movement, irregular bleeding and abdominal bloating.
  • You can have PCOS and endometriosis at the same time, with an abnormal period being the most common overlapping symptom.
  • PCOS can be tested via a physical exam and bloodwork; endometriosis can be tested for by evaluating an individual’s personal history, a pelvic exam and exploratory surgery.
  • PCOS and endometriosis may impact fertility, but that doesn’t mean patients with one or both of these conditions won’t get pregnant.
  • Both conditions can be managed via lifestyle modifications such as stabilising blood sugar, incorporating an anti-inflammatory, balanced diet and regular exercise – and fertility may be stimulated via medications such as clomifene.

Written by Izzie Price. Izzie Price is a freelance journalist and health writer, often specialising in women's health (though she also writes about love and relationships). She's written for Refinery29, Glamour, Cosmopolitan, Stylist, the Independent, the Telegraph, the i, HuffPost, Metro, Dazed, Vice and Reader's Digest, among others.

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