Endometriosis & PCOS: Can You Have Both and How to Deal with It
Endometriosis and polycystic ovarian syndrome (or PCOS) are conditions that affect women and can be hard to diagnose. Apart from making life painful, they can also make women feel isolated, confused, and upset.
Endometriosis and PCOS affect 1 out of 10 women. It is common for most women to be diagnosed with only one disorder, but some women can be diagnosed with both. Both conditions can affect fertility, and studies show that having both makes it harder to conceive.
Endometriosis and PCOS can overlap, and each disorder has distinct symptoms, as discussed below.
What is Endometriosis?
Endometriosis is a disease or condition that occurs when tissue that resembles the uterine lining known as the endometrium grows outside the uterus, causing pain. This tissue grows on the pelvic and reproductive organs such as the abdominal cavity, ovaries, and fallopian tubes. But, there is also a possibility of having extra-pelvic endometriosis. In reality, endometriosis has been discovered on every anatomical structure and organ in the body apart from the spleen.
Widespread inflammation in the body results from tissue buildup that bleeds the same way the endometrium does during a period. As a result, women go through debilitating pain during periods, throughout their menstrual cycle, or/and when having sexual intercourse. Other women experience no symptoms, yet they may have severe endometriosis.
Other than pain, there are other symptoms that you may experience with endometriosis, including:
- Nausea and vomiting, especially during a period
- Rectal bleeding, especially during a period
- Bloating (at times referred to as endo belly)
- Painful bowel movements
- Heavy menstrual periods
- Painful urination
- Constipation and/or diarrhea.
Laparoscopic surgery is the only known way used to diagnose endometriosis. However, your doctor may use imaging such as an MRI and ultrasound to help diagnose. Laparoscopic surgery is a procedure that is minimally invasive where a doctor makes small incisions around your abdomen and uses a camera known as a laparoscope to check your organs. If your doctor diagnoses you with endometriosis, they use special tools to get rid of the lesions (called excision) and treat the disease.
What is PCOS?
A polycystic ovarian syndrome is a hormonal condition or disorder that primarily affects women of reproductive age, but its effects can go beyond the reproductive years. Women with this condition usually experience hormonal imbalance specifically due to excess production of estrogen and the male sex hormone known as androgens. When produced in excess, these hormones cause hormonal imbalance leading to polycystic ovaries (many cysts growing on the ovaries), infertility, and missing or irregular periods.
PCOS has other signs, which include:
- Pelvic pain
- Weight gain
- Thinning hair
- Insulin resistance – Up to 80%
- Excessive body hair
Some women may experience the effects of PCOS like infertility but have no symptoms at all. Your doctor will determine if you have PCOS by doing a blood test to observe your hormone levels and may also recommend an ultrasound to check if your ovaries are polycystic.
Endometriosis vs. PCOS: Knowing the Difference
Most women only have PCOS or endometriosis, even though it is possible to have both conditions. If you’re experiencing non-specific symptoms such as fatigue, pelvic pain, or unexplained infertility, it is improbable to know which condition you may have.
The difference between the two is that endometriosis causes painful and heavy periods, while PCOS causes absent or irregular ones. Even though your doctor may order an MRI or ultrasound for both of these conditions, a hormone test will show significant differences if you have PCOS endometriosis. Endometriosis is a condition that affects the immune system and is not a hormonal condition.
Women who have both endometriosis PCOS can go for months without having a period, only to later have a period that almost results in hemorrhaging. In addition, a common symptom of endometriosis is pelvic pain which is less common in PCOS. However, it is also common in women who have both PCOS endometriosis.
Infertility is the most common overlapping symptom whether you have endometriosis, PCOS, or both. Many women who have the two conditions may struggle to conceive and may require to use assisted reproductive technologies to get pregnant.
How Do Endometriosis and PCOS Affect Fertility?
It is not impossible for women with PCOS and endometriosis to get pregnant. However, both conditions make it hard to conceive naturally. Also, having the two conditions together makes it difficult to get pregnant. Regardless, you need to consult with your OB/GYN if you suspect you may have either condition. Your OB/GYN will go over your symptoms and provide you with a proper diagnosis.
Endometriosis and PCOS have no cure, but each condition has different options for treatment. It may be easier to conceive if you treat the underlying condition(s) causing infertility. Combining various treatment options may be necessary if you have the two conditions.
Treat endometriosis and/or PCOS:
It is an ideal option for patients who want to get pregnant. Metformin is a medication commonly used for PCOS, and it helps you to ovulate more regularly to increase your chances of conceiving naturally. Hormonal birth control is also effective in symptom management of both PCOS and endometriosis. However, it is not an option for women who want to conceive.
Laparoscopy is the most common procedure used to diagnose and remove mild to moderate endometriosis. You need to identify a skilled surgeon who is an expert in excision (cutting out or eliminating endometriosis lesions) and not ablation (or burning endometriosis lesions). Burning the lessons may cause scarring, which eventually worsens infertility.
An excision specialist is the best because, during the surgery, they will not leave any endometriosis behind. If the endometriosis lesions don’t get entirely removed, they may regrow, causing more pain. Studies have shown that up to 70 per cent of all cases show no evidence of endometriosis lesions returning after surgery five years after surgery.
Keep in mind that laparoscopy is not a treatment for PCOS. Women with both conditions should treat PCOS with lifestyle changes, medications, or treatments that your doctor will suggest in addition to having laparoscopic surgery for endometriosis.
Some women prefer to manage endometriosis and PCOS using a natural approach. It is essential to have a healthy lifestyle, regular exercise, and a balanced PCOS diet to boost fertility. For PCOS, a gradual weight loss will help you start ovulating regularly and regain your period. As for endometriosis, you need to adopt an anti-inflammatory diet full of antioxidants. Also, most women with endo may experience some relief of symptoms by taking a gluten-free diet (more information on endometriosis diets).
In vitro fertilization (IVF)
IVF is the best option for women with PCOS and endometriosis or both who want to get pregnant. There are various types of IVF. Some IVF treatments use medication such as Clomid to stimulate the ovaries to produce/release more eggs. It is ideal for women with PCOS who do not ovulate regularly.
In rare cases, some women choose to have a hysterectomy. It is a procedure done to remove both the fallopian tubes and ovaries caused by endometriosis scarring. IVF using a surrogate mother is the alternative option in such a case. If you are interested in IVF, your doctor will tell you the right choice for you and your partner.
Dealing With Emotions if You Have Polycystic Ovarian Syndrome and Endometriosis
It can be overwhelming to handle the emotional toll of being diagnosed with both endometriosis PCOS. Many women report feeling hopeless, depressed, or angry about their diagnoses.
Both diseases can cause embarrassing, uncomfortable, and painful symptoms. It can also be saddening and frustrating to know that there is no cure for these symptoms. However, you can do certain things to manage the emotional toll of endometriosis and PCOS. They include:
- Identify a support group: Whether in-person or online, having meetings with women with similar disease(s) will help you not feel alone. These meetings will help you appreciate that you are not alone and learn to manage and live with the symptoms; in Australia, there are a large range of services such as
- Choose a supportive and skilled doctor: The right doctor will take you seriously, listen to your concerns, and stay updated on the latest research.
- Take things a day at a time: Some days, you may have more energy, while you may need to rest more on other days. Plan your day-to-day activities around how you’re feeling to avoid fatigue and burnout
- Be ready to manage the symptoms on the go: Keep supporting items such as over-the-counter pain relievers or heating patches in your work desk, car, or purse to avoid being overwhelmed by the symptoms when you’re far from home.
What If You Have Both PCOS and Endometriosis? What support groups are available in Australia